Modulation of clinical phenomena and event file coding by repetitive transcranial magnetic stimulation

辅助运动区(SMA)和辅助运动区前区(Pre-SMA)在动作选择和准备期间活跃，主要是内部产生的动作，在不同动作之间切换和克服习惯性反应。刺激和反应特征的结合和解除结合以及反应切换是事件编码过程中的关键要素，因此SMA和SMA前激活预计与这些过程特别相关。Gilles de la Tourette综合征(GTS)患者的SMA中记录了与抽搐和冲动相关的异常神经激活(即当前状态)。此外，许多研究表明，由SMA和Pre-SMA组成的运动网络存在结构和功能上的异常连接。此外，GTS患者的反应切换，尤其是参与SMA前状态的反应切换，与抽动的严重程度无关，因此已成为GTS的一个可能的特征标记。在这个项目中，我们将检验这样的假设，即抽搐和冲动代表了事件文件范式(S-R)和动作文件范式(R-R)中与异常特征绑定相关的SMA超激活状态标记。潜在的神经生理过程将在行为任务中使用脑电进行研究，在抑制性1赫兹SMA rTMS之前和之后进行，以调节大脑的激活。在控制条件下，我们将使用1赫兹Pre-SMA rTMS来特别解决反应切换缺陷，作为GTS的一个可能的性状标记。

The supplementary motor area (SMA) and pre-SMA are active during action selection and preparation predominantly of internally generated movements, switching between different actions and overcoming habitual responses. Binding and unbinding of stimulus and response features and response switching are key elements during event coding, so that SMA and pre-SMA activations are expected to be particularly relevant for these processes. Abnormal neural activation related to tics and urges (i.e. the current state) has been documented in the SMA in patients with Gilles de la Tourette syndrome (GTS). Also, a number of studies have shown abnormal structural and functional connectivity in motor networks comprising the SMA and pre-SMA. In addition, response switching, particularly engaging the pre-SMA, is impaired in GTS independently of tic severity and has thus emerged as a possible GTS trait marker. In this project, we will test the hypothesis that tics and urges represent state markers of SMA hyper-activation correlating with abnormal feature binding in the event file paradigm (S-R) and the action file paradigm (R-R). The underlying neurophysiological processes will be investigated using EEG during the behavioral tasks, performed before and after inhibitory 1Hz SMA rTMS to modulate brain activation. In a control condition, we will use 1 Hz pre-SMA rTMS to particularly address response-switching deficits as a possible trait marker in GTS.