title: Neural correlates of behavior therapy for Tourette's disorder.
abstract: Tourette's disorder, also called Tourette syndrome (TS), is characterized by motor and vocal tics that can cause significant impairment in daily functioning. Tics are believed to be due to failed inhibition of both associative and motor cortico-striato-thalamo-cortical pathways. Comprehensive Behavioral Intervention for Tics (CBIT), which is an extension of Habit Reversal Therapy (HRT), teaches patients to become more aware of sensations that reliably precede tics (premonitory urges) and to initiate competing movements that inhibit the occurrence of tics. In this study, we used functional magnetic resonance imaging (fMRI) to investigate the neural changes associated with CBIT treatment in subjects with TS. Eight subjects with TS were matched with eight healthy controls in gender, education, age, and handedness. Subjects completed the Visuospatial Priming (VSP) task, a measure of response inhibition, during fMRI scanning before and after CBIT treatment (or waiting period for controls). For TS subjects, we found a significant decrease in striatal (putamen) activation from pre- to post-treatment. Change in VSP task-related activation from pre- to post-treatment in Brodmann's area 47 (the inferior frontal gyrus) was negatively correlated with changes in tic severity. CBIT may promote normalization of aberrant cortico-striato-thalamo-cortical associative and motor pathways in individuals with TS.
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: tdeckersbach@partners.org.
authors.forename: Thilo
authors.initials: T
authors.lastname: Deckersbach
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Harvard University, Cambridge, MA, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Chou
authors.affiliation: University of Miami, Coral Gables, FL, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Britton
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Lindsay E
authors.initials: LE
authors.lastname: Carlson
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Hannah E
authors.initials: HE
authors.lastname: Reese
authors.affiliation: Nova Southeastern University, Fort-Lauderdale-Davie, FL, USA.
authors.forename: Jedidiah
authors.initials: J
authors.lastname: Siev
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Scahill
authors.affiliation: UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Piacentini
authors.affiliation: Texas A&M University, College Station, TX, USA.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Woods
authors.affiliation: Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
authors.affiliation: University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Peterson
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Darin D
authors.initials: DD
authors.lastname: Dougherty
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Sabine
authors.initials: S
authors.lastname: Wilhelm
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D054022:Cerebrum / Q000503:physiopathology*; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D007266:Inhibition, Psychological; D008279:Magnetic Resonance Imaging; D008297:Male; D009434:Neural Pathways / Q000503:physiopathology*; D011699:Putamen / Q000503:physiopathology; D005879:Tourette Syndrome / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Behavior therapy; Habit reversal; Neuroimaging; Tourette׳s disorder