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Tourette Syndrome: Functional Imaging of Motor Activation Pathways in Verbal and Motor Tics
Tourette Syndrome (TS) is a disorder characterized by frequent motor and verbal tics. The exact mechanism of tic generation and the pathophysiology of TS is widely debated but believed to be related to abnormalities within frontal lobe-subcortical circuitry. The goal of this project is to further clarify the role of this motor-related circuitry in the pathophysiology of TS by examining patterns of brain activation involved in tic generation, motor response preparation and response inhibition. We propose to use fMRI to identify brain regions involved in the production of tics, to determine if patients with TS demonstrate different patterns of motor activation (including anomalous cerebral dominance) associated with response preparation, and to determine if patients with TS demonstrate different patterns of activation when performing a task that requires response inhibition. Aim 1: To test the hypothesis that the cerebral pathways underlying tic generation involve the proposed frontal subcortical circuit. Aim 2: To replicate, in pediatric patients with TS, the fMRI finding in adults with TS of an increased area of cerebral activation in both sensorimotor and supplementary motor cortices during a standard motor task (sequential finger tapping). Furthermore, to test the hypothesis that children with TS will exhibit more bilaterally symmetrical activation compared to that of controls. Aim 3: To test the hypothesis that on fMRI, during performance of a Go/No-go task, children with TS will show anomalous activity corresponding to No-go stimuli in subcortical (caudate) regions; those with comorbid ADHD will also show anomalous activation in cortical (inferolateral frontal, orbital frontal) regions.
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