Neurofeedback from the supplementary motor area for Tourette Syndrome

抽动秽语综合症辅助运动区的神经反馈

• 批准号: 10431318
• 负责人: Michelle Hampson
• 金额: $ 77.05万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-09 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10431318
• 关键词: Adolescent; Adopted; Affect; Affective; Age; Area; Attention; Basic Science; Behavior Therapy; Behavioral; Biological Psychiatry; Brain; Child; Chronic; Clinical; Clinical Trials; Cognitive; Complex; Control Groups; Corpus striatum structure; Crossover Design; Cues; Data; Disease; Double-Blind Method; Down-Regulation; Electric Stimulation; Ensure; Evidence based treatment; Feedback; Forms Controls; Functional Magnetic Resonance Imaging; Functional disorder; Generations; Gilles de la Tourette syndrome; Intervention; Involuntary Movements; Learning; Manuals; Measures; Monitor; Morphologic artifacts; Motivation; Motor; Motor Activity; Movement; Neurodevelopmental Disorder; Participant; Patients; Pattern; Performance; Pharmaceutical Preparations; Psyche structure; Publishing; Randomized; Reporting; Research Design; Rest; Running; Sensory; Severities; Signal Transduction; Stress; Structure; Symptoms; Techniques; Testing; Time; Training; Treatment Efficacy; Up-Regulation; Visual; association cortex; base; clinical application; clinical effect; clinical efficacy; cognitive task; design; experimental group; follow-up; frontier; improved; interest; intervention effect; mental imagery; neural circuit; neurofeedback; phenomenological models; relating to nervous system; symptomatic improvement; trial comparing

Abstract The proposed project is a clinical trial to confirm the efficacy of a real-time fMRI neurofeedback intervention that involves training adolescents with Tourette Syndrome to control a region of their supplementary motor area (SMA) believed to be involved in tic generation. The intervention involves providing feedback on SMA activity to participants while they practice regulating the region. They are cued to up-regulate and to down-regulate the area at different times and encouraged to try mental strategies for both up-regulating and down-regulating that have the potential to improve their symptoms. For up-regulation, this includes engaging in mental imagery of complex motor activities, or doing mentally demanding cognitive tasks, in order to co-opt the relevant neural circuitry for tasks other than tic generation. For down-regulation, this includes imagining relaxing scenarios that tend to be associated with reduced stress levels and an associated reduction in tic severity. This intervention was previously compared with a yoked sham control intervention in a small crossover design study that yielded very promising results: large clinical effects were observed and the groups showed differences in their ability to regulate the SMA during neurofeedback. Here we attempt to confirm that preliminary finding of efficacy in a larger, purely randomized design that includes follow-up of participants, and critically, employs a different form of control condition. In the proposed study, the control group will be trained via neurofeedback to control a region of their visual association cortex that is believed to be unrelated to their symptoms. This control region will be defined for each control subject in a manner that ensures it is not functionally connected to their SMA. By using this new form of control condition, this study ensures that the intervention has been tested against two of the most rigorous forms of control conditions used in clinical applications of real-time fMRI neurofeedback (yoked sham and training on a control region). Given that the different types of control conditions rule out different kinds of confounds, this is the most rigorous approach to testing this intervention: if results are promising, they cannot be dismissed as an artifact of the kind of control condition used. In short, with the proposed clinical trial, we aim to confirm the clinical efficacy of this new intervention, and to verify that it is acting via the hypothesized mechanism of action (enhancement of control over the SMA via neurofeedback). In addition, effects of the intervention on resting state functional connectivity patterns will be examined to better inform our understanding of the network changes induced by the training.

摘要 建议的项目是一项临床试验，以确认实时功能磁共振神经反馈干预的有效性。 这包括训练患有多发性抽动症的青少年控制他们辅助运动区的一个区域 (SMA)据信参与了TIC的产生。干预包括提供关于SMA活动的反馈 在参与者练习管理该地区的同时，向他们提供信息。他们被暗示要上调和下调 区域在不同的时间，并鼓励尝试心理策略，以上调和下调 有可能改善他们的症状。对于向上调节，这包括进行心理想象 复杂的运动活动，或做精神上要求很高的认知任务，以便吸收相关的神经 用于除TIC生成之外的其他任务的电路。对于下调监管，这包括想象放松的场景， 往往与压力水平的降低和抽搐严重程度的降低有关。这一干预 之前在一项小型交叉设计研究中与带轭的假对照干预进行了比较 产生了非常有希望的结果：观察到了巨大的临床效果，并且两组在 在神经反馈过程中调节SMA的能力。在此，我们试图确认以下初步调查结果 在一项更大的、纯随机设计中的有效性，包括对参与者的随访，而且关键的是，采用 不同形式的控制条件。在拟议的研究中，控制组将通过神经反馈进行培训，以 控制他们视觉联想皮层的一个区域，据信这与他们的症状无关。这 将为每个控制主体定义控制区域，以确保其在功能上不相互连接 给他们的SMA。通过使用这种新形式的控制条件，本研究确保了干预已经被 针对临床应用中使用的两种最严格的控制条件进行了测试 FMRI神经反馈(颈状假体和对照区域训练)。鉴于不同类型的控制 条件排除了不同类型的混淆，这是测试这种干预的最严格的方法：如果 结果是有希望的，但不能将其视为所使用的控制条件的产物。总之, 通过拟议的临床试验，我们的目标是确认这种新干预措施的临床疗效，并验证 它正在通过假设的行动机制(通过以下方式加强对SMA的控制)来采取行动 神经反馈)。此外，干预对静息状态功能连接模式的影响将是 为了更好地了解培训引起的网络变化，我们进行了审查。