title: Cognitive-behavioral therapy induces sensorimotor and specific electrocortical changes in chronic tic and Tourette's disorder.
abstract: BACKGROUND
  Tic disorders, such as the Gilles de la Tourette syndrome and persistent tic disorder, are neurodevelopmental movement disorders involving impaired motor control. Hence, patients show repetitive unwanted muscular contractions in one or more parts of the body. A cognitive-behavioral therapy, with a particular emphasis on the psychophysiology of tic expression and sensorimotor activation, can reduce the frequency and intensity of tics. However, its impact on motor activation and inhibition is not fully understood.
  
  
  METHODS
  To study the effects of a cognitive-behavioral therapy on electrocortical activation, we recorded the event-related potentials (ERP) and lateralized readiness potentials (LRP), before and after treatment, of 20 patients with tic disorders and 20 healthy control participants (matched on age, sex and intelligence), during a stimulus-response compatibility inhibition task. The cognitive-behavioral therapy included informational, awareness training, relaxation, muscle discrimination, cognitive restructuration and relapse prevention strategies.
  
  
  RESULTS
  Our results revealed that prior to treatment; tic patients had delayed stimulus-locked LRP onset latency, larger response-locked LRP peak amplitude, and a frontal overactivation during stimulus inhibition processing. Both stimulus-locked LRP onset latency and response-locked LRP peak amplitude normalized after the cognitive behavioral therapy completion. However, the frontal overactivation related to inhibition remained unchanged following therapy.
  
  
  CONCLUSIONS
  Our results showed that P300 and reaction times are sensitive to stimulus-response compatibility, but are not related to tic symptoms. Secondly, overactivity of the frontal LPC and impulsivity in TD patients were not affected by treatment. Finally, CBT had normalizing effects on the activation of the pre-motor and motor cortex in TD patients. These results imply specific modifications of motor processes following therapy, while inhibition processes remained unchanged. Given that LRPs are partially generated within the sensorimotor and supplementary motor area, the reported reduction in tic frequency and improvements of LRPs components suggest that CBT induced a physiological change in patients' motor area.
authors.affiliation: Laboratoire de Psychophysiologie Cognitive et Sociale, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, Canada H1N 3V2; Department of Psychiatry, Faculty of Medicine, University of Montreal, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Morand-Beaulieu
authors.affiliation: Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, Canada H1N 3V2; Department of Psychiatry, Faculty of Medicine, University of Montreal, Canada.
authors.forename: Kieron P
authors.initials: KP
authors.lastname: O'Connor
authors.affiliation: Laboratoire de Psychophysiologie Cognitive et Sociale, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, Canada H1N 3V2; Department of Psychiatry, Faculty of Medicine, University of Montreal, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Sauvé
authors.affiliation: Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, Canada H1N 3V2; Department of Stomatology, Faculty of Dental Medicine, University of Montreal, Canada.
authors.forename: Pierre J
authors.initials: PJ
authors.lastname: Blanchet
authors.affiliation: Laboratoire de Psychophysiologie Cognitive et Sociale, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, Canada H1N 3V2; Department of Psychiatry, Faculty of Medicine, University of Montreal, Canada. Electronic address: marc.lavoie@umontreal.ca.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Lavoie
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004569:Electroencephalography; D005071:Evoked Potentials / Q000502:physiology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007266:Inhibition, Psychological; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011930:Reaction Time / Q000502:physiology; D057566:Self Report; D066191:Sensorimotor Cortex / Q000503:physiopathology*; D012720:Severity of Illness Index; D013981:Tic Disorders / Q000473:pathology / Q000534:rehabilitation*; D005879:Tourette Syndrome / Q000473:pathology / Q000534:rehabilitation*
keywords: Cognitive-behavioral therapy; Event-related potentials; Gilles de la Tourette syndrome; Lateralized readiness potentials; Sensorimotor remediation; Tics