title: Role of the right dorsal anterior insula in the urge to tic in Tourette syndrome.
abstract: BACKGROUND
  The mid-posterior part of the insula is involved in processing bodily sensations and urges and is activated during tic generation in Tourette syndrome. The dorsal anterior part of the insula, however, integrates sensory and emotional information with cognitive valuation and is implicated in interoception. The right dorsal anterior insula also participates in urge suppression in healthy subjects. This study examined the role of the right dorsal anterior insula in the urge to tic in Tourette syndrome.
  
  
  METHODS
  Resting-state functional magnetic resonance imaging was performed in 13 adult Tourette patients and 13 matched controls. The role of the right dorsal anterior insula within the urge-tic network was investigated using graph theory-based neural network analysis. The functional connectivity of the right dorsal anterior insula was also correlated with urge and tic severity.
  
  
  RESULTS
  Even though the patients did not exhibit any overt tics, the right dorsal anterior insula demonstrated higher connectivity, especially with the frontostriatal nodes of the urge-tic network in patients compared with controls. The functional connectivity between the right dorsal anterior insula and bilateral supplementary motor area also correlated positively with urge severity in patients.
  
  
  CONCLUSIONS
  These results suggest that the right dorsal anterior insula is part of the urge-tic network and could influence the urge- and tic-related cortico-striato-thalamic regions even during rest in Tourette syndrome. It might be responsible for heightened awareness of bodily sensations generating premonitory urges in Tourette syndrome.
authors: Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
authors: Sule
authors: S
authors: Tinaz
authors: Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
authors: Patrick
authors: P
authors: Malone
authors: Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
authors: Mark
authors: M
authors: Hallett
authors: Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
authors: Silvina G
authors: SG
authors: Horovitz
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000098:blood supply / Q000503:physiopathology*; D004292:Dominance, Cerebral; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012146:Rest; D020323:Tics / Q000473:pathology*; D005879:Tourette Syndrome / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: functional MRI; graph theory; interoception; network; resting-state