Abstract
Tourette Syndrome (TS) is a chronic and impairing neurological illness characterized by motor and phonic tics. Pharmacological treatments are the mainstay for TS, but there is emerging evidence that behavioral therapy may be effective even for the presumed involuntary tics. Thus, TS is a chronic disorder in which behavioral self management strategies warrant investigation.
In keeping with the goals of the Center for Self and Family Management of Vulnerable Populations we propose a pilot study aimed at the understanding of the neurobiological mechanisms of a behavioral intervention for tics, known as Habit Reversal Training (HRT), in children with TS. HRT teaches skills for coping with chronic tics, and it consists of increasing awareness of tics and practicing behaviors that are physically incompatible with the tics.
Currently, our research group is conducting two NIH-funded, multisite randomized controlled studies of HRT, one in children (MH070802, Scahill, Site-PI) and the other in adults (MH069874; Scahill, PI) with TS. These studies will provide rigorous test of HRT efficacy.
The study proposed in this application will examine the neurophysiological mechanisms of HRT, which will, in turn, strengthen the scientific foundation for the dissemination of this intervention for management of chronic tics. Specifically, we propose to examine the oscillatory synchronization among cortical areas involved in movement control and motor inhibition as measured by the EEG coherence before and after HRT. There is evidence that the elevated fronto-mesial EEG coherence in the alpha frequency band represents the neurobiological mechanism of tic suppression that can be strengthened by training 1, 2. We reason that because a) EEG alpha coherence is associated with motor inhibition and tic suppression and b) HRT trains motor inhibition and tic suppression, the improvement in tics after HRT could be associated with increased EEG alpha coherence.
We propose an open pilot study designed to evaluate effects of HRT on mesial-frontal EEG coherence in 12 children, aged 8-12, with TS. The specific aims of this pilot study are to evaluate whether there is a significant increase in EEG alpha coherence after 8 sessions of HRT and to explore the strength of association between the reduction in tic severity and increase in EEG coherence.
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Principal Investigator
Denis Sukhodolsky
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