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Brain Advance Access originally published online on March 6, 2006
Brain 2006 129(8):2029-2037; doi:10.1093/brain/awl050
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© The Author (2006). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Neural correlates of tic generation in Tourette syndrome: an event-related functional MRI study

S. Bohlhalter, A. Goldfine*, S. Matteson*, G. Garraux, T. Hanakawa, K. Kansaku, R. Wurzman and M. Hallett

Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health Bethesda, MD, USA

Correspondence to: Mark Hallett, Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Building 10, Room 5N226, 10 Center Drive, MSC-1430, Bethesda, MD 20892-1428, USA E-mail: hallettm{at}ninds.nih.gov

Little is known about the neural correlates of tics and associated urges. In the present study, we aimed to explore the neural basis of tics in patients with Tourette syndrome by using event-related functional MRI (fMRI). Ten patients (6 women, 4 men; age: mean ± SD = 31 ± 11.2) were studied while spontaneously exhibiting a variety of motor and vocal tics. On the basis of synchronized video/audio recordings, fMRI activities were analysed 2 s before and at tic onset irrespective of the clinical phenomenology. We identified a brain network of paralimbic areas such as anterior cingulate and insular cortex, supplementary motor area (SMA) and parietal operculum (PO) predominantly activated before tic onset (P < 0.05, corrected for multiple comparisons). In contrast, at the beginning of tic action, significant fMRI activities were found in sensorimotor areas including superior parietal lobule bilaterally and cerebellum. The results of this study indicate that paralimbic and sensory association areas are critically implicated in tic generation, similar to movements triggered internally by unpleasant sensations, as has been shown for pain or itching.

Key Words: tic; Tourette syndrome; functional MRI; paralimbic areas

Abbreviations: ACC, anterior cingulate cortex; ADHD, attentional deficit hyperactivity disorder; BA, Brodmann area; BOLD, blood-oxygen level-dependent; fMRI, functional magnetic resonance imaging; DLPFC, dorsolateral prefrontal cortex; OCD, obsessive compulsive disorder; PO, parietal operculum; SMA, supplementary motor area; SPL, superior parietal lobules; SPM, statistical parametric map; TS, Tourette syndrome

.

Received November 6, 2005. Revised December 27, 2005. Accepted February 3, 2006.

*These authors contributed equally to this work.


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