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A Functional Neuroanatomy of Tics in Tourette Syndrome
Emily Stern, MD;
David A. Silbersweig, MD;
Kit-Yun Chee, MD;
Andrew Holmes, PhD;
Mary M. Robertson, MD;
Michael Trimble, MD;
Christopher D. Frith, PhD;
Richard S. J. Frackowiak, MD;
Raymond J. Dolan, MD
Arch Gen Psychiatry. 2000;57:741-748.
Background Tics are involuntary, brief, stereotyped motor and vocal behaviors often associated with irresistible urges. They are a defining symptom of the classic neuropsychiatric disorder, Tourette syndrome (TS), and constitute an example of disordered human volition. The neural correlates of tics are not well understood and have not been imaged selectively.
Methods Event-related [15O]H2O positron emission tomography techniques combined with time-synchronized audio and videotaping were used to determine the duration of, frequency of, and radiotracer input during tics in each of 72 scans from 6 patients with TS. This permitted a voxel-by-voxel correlational analysis within Statistical Parametric Mapping of patterns of neural activity associated with the tics.
Results Brain regions in which activity was significantly correlated with tic occurrence in the group included medial and lateral premotor cortices, anterior cingulate cortex, dorsolateral-rostral prefrontal cortex, inferior parietal cortex, putamen, and caudate, as well as primary motor cortex, the Broca's area, superior temporal gyrus, insula, and claustrum. In an individual patient with prominent coprolalia, such vocal tics were associated with activity in prerolandic and postrolandic language regions, insula, caudate, thalamus, and cerebellum, while activity in sensorimotor cortex was noted with motor tics.
Conclusions Aberrant activity in the interrelated sensorimotor, language, executive, and paralimbic circuits identified in this study may account for the initiation and execution of diverse motor and vocal behaviors that characterize tics in TS, as well as for the urges that often accompany them.
From the Department of Psychiatry, Weill Medical College of Cornell University, New York, NY (Drs Stern and Silbersweig); the Wellcome Department of Cognitive Neurology, Institute of Neurology (Drs Stern, Silbersweig, Holmes, Frith, Frackowiak, and Dolan) and the National Hospital for Neurologic Diseases (Drs Robertson and Trimble), London, England; and the Neuropsychiatric Institute, Prince Henry Hospital, Sydney, Australia (Dr Chee).
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