Tourette Syndrome Brain Changes Found

[myrose]

HANOVER, Germany, May 11 (UPI) -- German medical scientists say they used a new imaging technology to discover changes in Tourette's syndrome patients' brain structure.

 

The researchers, led by Dr. Kirsten Muller-Vahl of the Hanover Medical School, said Magnetization Transfer Imaging had never been used to study Tourette's patients. The scientists said they also found a correlation between the extent of some of the structural changes they identified and symptom severity.

 

The researchers said they identified alterations in the frontal lobe of the Tourette's patients that might be responsible for the pathology of the syndrome.

 

"Our in vivo findings, using two sensitive and unbiased techniques, support the hypothesis that alterations in frontostriatal circuitries underlie Tourette's pathology," said Muller-Vahl.

 

MTI, the scientists said, is a refinement of the nuclear magnetic resonance technique, allowing detection of changes invisible to conventional MRI scanners.

 

The imaging technology discovered alterations, in comparison to controls, in brain areas involved in the selection, programming, initiation and control of movement.

 

"We suggest that Tourette's is primarily caused by a dysfunction in prefrontal cortex areas, rather than the basal ganglia, as has been previously thought," the scientists said.

The study appears in the journal BMC Neuroscience.

 

 

 

Background

Pathophysiological evidence suggests an involvement of fronto-striatal circuits in Tourette syndrome (TS). To identify TS related abnormalities in gray and white matter we used optimized voxel-based morphometry (VBM) and magnetization transfer imaging (MTI) which are more sensitive to tissue alterations than conventional MRI and provide a quantitative measure of macrostructural integrity.

 

Methods

Volumetric high-resolution anatomical T1-weighted MRI and MTI were acquired in 19 adult, unmedicated male TS patients without co-morbidities and 20 age- and sex-matched controls on a 1.5 Tesla neuro-optimized GE scanner. Images were pre-processed and analyzed using an optimized version of VBM in SPM2.

 

Results

Using VBM, TS patients showed significant decreases in gray matter volumes in prefrontal areas, the anterior cingulate gyrus, sensorimotor areas, left caudate nucleus and left postcentral gyrus. Decreases in white matter volumes were detected in the right inferior frontal gyrus, the left superior frontal gyrus and the anterior corpus callosum. Increases were found in the left middle frontal gyrus and left sensorimotor areas. In MTI, white matter reductions were seen in the right medial frontal gyrus, the inferior frontal gyrus bilaterally and the right cingulate gyrus. Tic severity was negatively correlated with orbitofrontal structures, the right cingulate gyrus and parts of the parietal-temporal-occipital association cortex bilaterally.

 

Conclusions

Our MRI in vivo neuropathological findings using two sensitive and unbiased techniques support the hypothesis that alterations in frontostriatal circuitries underlie TS pathology. We suggest that anomalous frontal lobe association and projection fiber bundles cause disinhibition of the cingulate gyrus and abnormal basal ganglia function.

 

 

 

 

 

http://www.upi.com/Science_News/2009/05/11...19461242082800/

[kim]

Did these adults have any co-morbidities when they were younger? Were they on medications at any point in time?

 

MRI and MTI were acquired in 19 adult, unmedicated male TS patients without co-morbidities

 

 

These results may apply to only a small subset of "TS" individuals. Also, are these changes a cause or a result?

 

I really think they need to focus on identifying subsets. I fear people see these studies and think "TS" is the result of some structural brain abonormality. Again, that may be the case for some and every study that yields info is important, but statements like this may be a bit misleading? Just my thoughts!

 

support the hypothesis that alterations in frontostriatal circuitries underlie TS pathology.

[lynnie1264]

Hi Kim,

 

You mentioned "subsets" of TS. Can you explain what you mean? I've heard of this too, but I brought it up on here a while ago and a couple said they'd never heard of subsets.

 

I can't even remember where I first read about them but it made sense.

 

Thanks,

Lyn.

[kim]

Lyn,

 

Look at these studies.

 

Dr. Sharp has an affected daughter. Now, i guess he didn't feel like taking the advice that the majority of parents get from Peds/most neuro's. which is, why don't we just wait and see. Most kids just outgrow it. The practical application of some of these studies is just unknown or lost on many of our medical professionals. If only family histories were even asked about it would make me feel better. If you read the PANDAS forum at all, you will see the articles (and wonderful interpret. by buster) of Leckman and Swedo's, etc. studies too.

 

http://www.ncbi.nlm.nih.gov/pubmed/1848536...Pubmed_RVDocSum

 

No global differences were found between TS and controls. However, expression of many genes and multiple pathways differed between TS and controls within each age group (5-9, 10-12, and 13-16), including genes involved in the immune-synapse, and proteasome- and ubiquitin-mediated proteolysis pathways. Notably, across age strata, expression of interferon response, viral processing, natural killer and cytotoxic T-lymphocyte cell genes differed. Our findings suggest age-related interferon, immune and protein degradation gene expression differences between TS and controls.

 

http://www.ncbi.nlm.nih.gov/pubmed/1750347...Pubmed_RVDocSum

 

Fourteen genes, primarily Natural Killer Cell (NK) genes, discriminated between TS and all controls. Granzyme B and NKG7 were confirmed using RT-PCR. Five probesets (four genes) reside in chromosomal regions previously linked to familial TS or obsessive-compulsive disorder. Using the 14 genes, a Principal Components Analysis as well as a cluster analysis identified a TS subgroup (n = 10/16) that overexpressed the NK genes. 7/10 subjects within this subgroup were diagnosed with attention-deficit hyperactivity disorder (ADHD), suggesting that this expression profile might be associated with TS and co-morbid ADHD. Principal Components Analysis of gene expression in blood may be useful for identifying subgroups of other complex neurodevelopmental diseases, and the gene expression profile identified in this study may provide a biomarker for at least one subgroup of heritable TS.

 

 

 

http://en.wikipedia.org/wiki/Granzyme_B

 

Granzyme B (granzyme 2, cytotoxic T-lymphocyte-associated serine esterase 1), also known as GZMB, is a human gene.

 

Cytolytic T lymphocytes (CTL) and natural killer (NK) cells share the remarkable ability to recognize, bind, and lyse specific target cells. They are thought to protect their host by lysing cells bearing on their surface 'nonself' antigens, usually peptides or proteins resulting from infection by intracellular pathogens. The protein encoded by this gene is crucial for the rapid induction of target cell apoptosis by CTL in cell-mediated immune response.[1]

[guy123]

this is fascinating. in to read this later!

[dmc2267]

HANOVER, Germany, May 11 (UPI) -- German medical scientists say they used a new imaging technology to discover changes in Tourette's syndrome patients' brain structure.

 

The researchers, led by Dr. Kirsten Muller-Vahl of the Hanover Medical School, said Magnetization Transfer Imaging had never been used to study Tourette's patients. The scientists said they also found a correlation between the extent of some of the structural changes they identified and symptom severity.

 

The researchers said they identified alterations in the frontal lobe of the Tourette's patients that might be responsible for the pathology of the syndrome.

 

"Our in vivo findings, using two sensitive and unbiased techniques, support the hypothesis that alterations in frontostriatal circuitries underlie Tourette's pathology," said Muller-Vahl.

 

MTI, the scientists said, is a refinement of the nuclear magnetic resonance technique, allowing detection of changes invisible to conventional MRI scanners.

 

The imaging technology discovered alterations, in comparison to controls, in brain areas involved in the selection, programming, initiation and control of movement.

 

"We suggest that Tourette's is primarily caused by a dysfunction in prefrontal cortex areas, rather than the basal ganglia, as has been previously thought," the scientists said.

The study appears in the journal BMC Neuroscience.

 

 

 

Background

Pathophysiological evidence suggests an involvement of fronto-striatal circuits in Tourette syndrome (TS). To identify TS related abnormalities in gray and white matter we used optimized voxel-based morphometry (VBM) and magnetization transfer imaging (MTI) which are more sensitive to tissue alterations than conventional MRI and provide a quantitative measure of macrostructural integrity.

 

Methods

Volumetric high-resolution anatomical T1-weighted MRI and MTI were acquired in 19 adult, unmedicated male TS patients without co-morbidities and 20 age- and sex-matched controls on a 1.5 Tesla neuro-optimized GE scanner. Images were pre-processed and analyzed using an optimized version of VBM in SPM2.

 

Results

Using VBM, TS patients showed significant decreases in gray matter volumes in prefrontal areas, the anterior cingulate gyrus, sensorimotor areas, left caudate nucleus and left postcentral gyrus. Decreases in white matter volumes were detected in the right inferior frontal gyrus, the left superior frontal gyrus and the anterior corpus callosum. Increases were found in the left middle frontal gyrus and left sensorimotor areas. In MTI, white matter reductions were seen in the right medial frontal gyrus, the inferior frontal gyrus bilaterally and the right cingulate gyrus. Tic severity was negatively correlated with orbitofrontal structures, the right cingulate gyrus and parts of the parietal-temporal-occipital association cortex bilaterally.

 

Conclusions

Our MRI in vivo neuropathological findings using two sensitive and unbiased techniques support the hypothesis that alterations in frontostriatal circuitries underlie TS pathology. We suggest that anomalous frontal lobe association and projection fiber bundles cause disinhibition of the cingulate gyrus and abnormal basal ganglia function.

 

 

 

 

 

http://www.upi.com/Science_News/2009/05/11...19461242082800/

 

 

I just read this, I am looking for information to help my Asperger's 12 year old son.

 

In September 08, he did QEEG based Neurofeedback to work on attention, the protcol used worked with brain waves F6,C6, not T4 which has shown success in calming anxiety, helping TS patients with tics. His attention is his biggest obstacle as he continues to work on age appropriate social skills and higher level abstract thinking. He was happy, well liked and successful.

 

My son developed both extreme vocal and motor tics in late October 2008 and doesn't show any signs of stopping. After each session, they changed there form but still existed. I've been to the experts who work with tics. He has been put on Resperidone twice which made the tics increase more. Life is ###### for him now, he is not the happy child everyone wanted to be around anymore and he has very little self-confidence left. Socially this has been a disaster for him. I just want to see him happy again.

 

My question is, every doctor I've been to is treating the tics as if he has Tourettes, I am not convinced since I was present at each Neurofeedback session saw/heard the onset/changes of these tics with each session but since there is not any proof to Neurofeedback causing tics my words fall on deaf ears. Would it make a difference of the origin of the tics in how they are treated? My relating to your post is, I could be wrong, this was "an alteration in the frontal lobe".

 

I'd appreciate any information,

[faith]

dmc,

could you clarify your question a little more? Are you saying that you feel the Neurofeedback triggered tic symptoms in your son? What part of the brain does Neurofeedback target? Do you feel it helped at all?

 

thanks

Faith

[Chemar]

If I recall correctly, Claire reported some years back that neurofeedback triggered stuff for her son.I have seen anecdotal reports both for and against it

 

when I asked our Integrative physician about it some years back I was cautioned about it as a treatment for tics/TS

 

we have used resonance biofeedback, but that is very different

[dmc2267]

dmc,

could you clarify your question a little more? Are you saying that you feel the Neurofeedback triggered tic symptoms in your son? What part of the brain does Neurofeedback target? Do you feel it helped at all?

 

thanks

Faith

 

 

I believe the Neuro triggered the tics, from the very first session, things were not right, sparatic facial grimsing and his already load voice becoming even louder (speaking as if he was wearing headphones) , subsequent session were adjustments to "rewards" frequency to adjust the voice, with each adjustment the tics became worse starting with eye blinking, each adjustment produced another vocal, mouth or hand tic or all three together).It was strange first day after the session it would seem the adjustment worked, the next day back to tics. Finally I stop the adjustments during the last session the voice tics were increasing in volumn and frequence during the session as rewards adjusmtnets were being made. To me, it was clear the tics were being controlled by the adjustments, I hear it.

 

I've read, and I am by no means an expert, I wasn't concerned with TS when I started out, the "calming" brainwave is T4, This particular protocol that was used on my son was C6, F6, this was recommended based on the brain mapping (qeeg). No I don't feel this helped for my son it has made his life very difficult and confusing. I have read where people beielve this helped them but that was not this protciol. I do know it effects everyone differently and there are no guarantee but I need to get some help for my son.

 

Thanks for responding.

Diana

[dmc2267]

If I recall correctly, Claire reported some years back that neurofeedback triggered stuff for her son.I have seen anecdotal reports both for and against it

 

when I asked our Integrative physician about it some years back I was cautioned about it as a treatment for tics/TS

 

we have used resonance biofeedback, but that is very different

 

 

I'm new here, would I be able to pull her post up?, would like to know if she was able to resolve it.

 

Thank you for your resply.

Diana

[Chemar]

Hi Diana

you could try a search for neurofeedback with user name Claire to narrow it down

 

she never went back as far as I recall. She felt it was detrimental.

 

her son's tics eventually did resolve after she found they were primarily photosensitivity induced

[melanie]

Im confused We do biofeedback and I think it realy helps (although we didnt go today) sometimes he has 1 or 2 days of relief.We do it for the anti anxiety component .Does the nww research mean its harmful I feel stupid again

Melanie

[faith]

Diana,

I think I understand, but could I ask what about this article above has interested you? Is it because you feel that a part of the brain was being targeted by the neurofeedback, and now that this article suggests it may not be that part afterall, that it may have actually worked adversely on your son? you are saying he didn't really have tics before this? and the neurofeedback was for anxiety and calming?

Forgive me for being inquisitive about this, but your experience may actually put some part of the puzzle in place. Are you agreeing with the article or disagreeing? Anything you could say about what you think is going on would be good to help some of us figure some things out, i.e. why or why not some are helped by certain things and why some are not. I may not be making much sense, but I am interested in what you were told about neurofeedback and how exactly this would work and help your child.

 

thanks

Faith

[dmc2267]

Hi Diana

you could try a search for neurofeedback with user name Claire to narrow it down

 

she never went back as far as I recall. She felt it was detrimental.

 

her son's tics eventually did resolve after she found they were primarily photosensitivity induced

 

Thank you, I did that, interesting..my son is addicted to his iphone and nintendo ds..but was a DS users for years never had any reaction. He has also been taking a pharmaceutical grade Salomin oil for that last 8 years-I've been reading some have had tics reactions, but they were able to immediately able to determine it was the Salomin oil causing the tics. I wonder if the cause of the tics is a combination of things triggered by the Neurofeedback.

 

Thaank you for your reply.

[dmc2267]

Im confused We do biofeedback and I think it realy helps (although we didnt go today) sometimes he has 1 or 2 days of relief.We do it for the anti anxiety component .Does the nww research mean its harmful I feel stupid again

Melanie

 

 

ok from what I understand, the protocol used to calm anxiety involves working only one wave T4, I believe it's on the left above the ear but more towards the forehead I've read people having success wth this. The protocol used for my son involved two waves C6, F6 located at the top left/right sides. A knowledgeable source has told me she feels this protocol put too much electricity in my son's brain. She spend alot of time and effort trying to fix it.

 

I hope my posting didn't cause any alarms, every child is different and will react differently. This is just my son's reaction.