title: White-matter abnormalities in Tourette syndrome extend beyond motor pathways.
abstract: Tourette syndrome is a neuropsychiatric disorder with the cardinal symptoms of motor and vocal tics. Often tics are accompanied by comorbidities such as obsessive-compulsive disorder, attention-deficit-hyperactivity disorder or depression. Research has mainly focused on the cortico-striato-thalamo circuit, but clinical symptoms and recent neuroimaging studies reporting altered resting network connectivity have suggested abnormalities in Tourette syndrome beyond the major motor circuits. We acquired diffusion-weighted data at 1.5T in nineteen adult patients fulfilling the DSM-IV-TR criteria for Tourette syndrome and in a healthy control group. Diffusion tensor imaging (DTI) analysis in our adult TS sample shows a decrease of FA and increase in radial diffusivity in the corticospinal tract. There are widespread changes (reduced FA and increased radial diffusivity) in the anterior and posterior limb of the internal capsule. Furthermore, it confirms prior findings of altered interhemispheric connectivity as indicated by a FA-decrease in the corpus callosum. In addition, our results indicate that TS is not restricted to motor pathways alone but affects association fibres such as the inferior fronto-occipitalis fascicle, the superior longitudinal fascicle and fascicle uncinatus as well. Tics are the hallmark of Tourette syndrome, so the involvement of the corticospinal tract fits in well with clinical symptoms. Cortical regions as well as limbic structures take part in the modulation of tics. Our findings of alterations in long association fibre tracts and the corpus callosum are a potential source for hindered interhemispheric and transhemispheric interaction. The change in radial diffusivity points toward a deficit in myelination as one pathophysiological factor in Tourette syndrome.
authors.affiliation: Department of Psychiatry and Psychotherapy, RWTH Aachen University, 52074 Aachen, Germany. i.neuner@fz-juelich.de
authors.forename: Irene
authors.initials: I
authors.lastname: Neuner
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Kupriyanova
authors.forename: Tony
authors.initials: T
authors.lastname: Stöcker
authors.forename: Ruiwang
authors.initials: R
authors.lastname: Huang
authors.forename: Oleg
authors.initials: O
authors.lastname: Posnansky
authors.forename: Frank
authors.initials: F
authors.lastname: Schneider
authors.forename: Marc
authors.initials: M
authors.lastname: Tittgemeyer
authors.forename: N Jon
authors.initials: NJ
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000473:pathology*; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D011712:Pyramidal Tracts / Q000473:pathology*; D005879:Tourette Syndrome / Q000473:pathology*; D055815:Young Adult