Fractality as a quantitative assessment tool for tic disorders and functional tic-like behaviors

分形作为抽动障碍和功能性抽动样行为的定量评估工具

• 批准号: 10728174
• 负责人: KEVIN J BLACK
• 金额: $ 42.76万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10728174
• 关键词: 6 year old; Affect; Age; Assessment tool; Behavior; Black Populations; Characteristics; Child; Childhood; Chronic; Clinical; Clinical Research; Clinical Treatment; Complex; Data Set; Deep Brain Stimulation; Development; Diagnosis; Dimensions; Disease; Epidemiology; Etiology; Face; Fractals; Frequencies; Functional disorder; Future; Gilles de la Tourette syndrome; Goals; Head; High Prevalence; Individual; International; Lead; Measures; Methods; Modeling; Motor Tics; Movement; Movement Disorders; Natural History; Neck; Neurologic Symptoms; Patient Care; Patients; Pattern; Periodicity; Persons; Pharyngeal structure; Physics; Procedures; Publications; Research; Resistance; Resolution; Risk Factors; Sampling; Schools; Series; Severities; Students; Symptoms; Teenagers; Testing; Therapeutic; Tic disorder; Time; Training; Video Recording; Visit; Vocal Tics; Waxes; blind; boys; clinical diagnosis; clinical encounter; clinical practice; comorbidity; demographics; emerging adult; experience; follow-up; improved; patient subsets; phenomenological models; risk sharing; tic suppression; tic-like movements; vocalization; young adult

Project summary The natural history of tics is characterized by a high prevalence in boys, with onset around around 4‒6 years of age. The initial tic symptoms are usually simple motor tics affecting the face, head, and neck. The first vocal tic occurs on average a few years later, and is usually a simple vocal tic such as throat clearing or sniffing. If the tics persist more than a year, the severity usually peaks around the age of 8 to 12 years. Most individuals with tics undergo significant improvement or complete resolution before early adulthood. Recently, while tics in patients with Tourette syndrome (TS) have been increasing rapidly, a different pattern has also been observed. Some teenagers and young adults have experienced sudden onset of complex tic-like movements and vocalizations. These patients differ significantly on several other features as well, and such distinct tic-like behavior is now referred to as functional neurological symptom disorder with tics, or functional tic-like behavior (FTLB). However, differentiating FTLB from typical tics is still challenging, and diagnosis and treatment are important issues under active study in numerous centers worldwide. Tic disorders are distinguished from other movement disorders not only by the phenomenology of individual tics, but also by the timing of tics: they are neither rhythmic nor completely unpredictable. Rather, tics tend to occur in clusters (several tic attacks within a few seconds, followed by an extended period of tic-free time). On longer time scales, several bouts of tics may be followed by a relatively tic-free period with repeated episodes grouped over minutes, and patients often describe a similar pattern over days or weeks. Based on this self- similarity over different time scales, fractal timing of tics in TS was demonstrated over 20 years ago, and we recently extended those results to both Provisional Tic Disorder and TS, applying a model from physics to measure fractal dimension (Df) in relatively brief data sets (5 minutes). The Df of the tic time series correlates with the tic severity, suggesting that Df may be useful as an objective indicator of tic severity. We hypothesized that the fractal dimension Df of tics may distinguish FTLB from typical tics. Specifically, FTLB may not show a fractal pattern, or the quantitatively measured fractal dimension may differ from that of typical tics. The objective of this proposal is to investigate Df with the following specific aim: Df will be computed from video samples of tics or FTLB, blind to diagnosis, contributed locally and from collaborators worldwide, and compared to test this hypothesis. The long-term goal is to find an objective measure that distinguishes FLTB from tic disorders, and if Df can be successfully demonstrated to differ between the two, future studies could look at comorbidities, treatment, and how they change when healthy individuals mimic tics.

项目摘要 抽动的自然历史的特征是男孩的流行率很高，大约4至6年的发作 年龄。最初的抽动符号通常是影响面部，头部和颈部的简单运动抽动。第一个声音抽动 几年后平均发生，通常是一种简单的声音抽动，例如清除或嗅探。如果是 抽动持续一年多，严重程度通常在8至12岁的年龄左右达到顶峰。大多数人 在成年早期之前，抽动经历了显着改善或完全解决。最近，抽动 Tourette综合征（TS）的患者正在迅速增加，也观察到了另一种模式。 一些青少年和年轻人突然经历了复杂的类似TIC的动作和 发声。这些患者在其他几个功能上也有显着不同的不同，这种不同的TIC样 现在的行为被称为具有抽动的功能性神经系统症状障碍或功能性抽动行为 （FTLB）。但是，将FTLB与典型抽动区分开仍然具有挑战性，诊断和治疗是 在全球众多中心积极研究下的重要问题。 抽动疾病与其他运动障碍区分开来，不仅通过个体的现象学 抽动，也是通过抽动的时间：它们是有节奏的，也不是完全不可预测的。相反，抽动倾向于 （在几秒钟内进行几次抽动攻击，然后是无抽动时间的长时间）。 更长的时间尺度，几次抽搐之后可能是一个相对无抽动的时期，重复发作 分钟超过几分钟，患者经常在几天或几周内描述类似的模式。基于这个自我 在不同时间尺度上的相似性，TS中的TIC的分形时间在20年前被证明，我们 最近将这些结果扩展到临时抽动障碍和TS，将物理学的模型应用于 在相对简短的数据集（5分钟）中测量分形维度（DF）。 TIC时间序列的DF相关 由于TIC的严重程度，表明DF可能可作为抽动严重程度的客观指标。 我们假设TIC的分形维度DF可能会将FTLB与典型的抽搐区分开。具体来说，FTLB 可能不会显示分形模式，或者定量测量的分形尺寸可能与典型的分形尺寸不同 抽动。该提案的目的是以以下具体目的调查DF：DF将从 抽动或FTLB的视频样本，对诊断盲人，在当地和全球合作者贡献，以及 与检验该假设相比。长期目标是找到一个区分FLTB的客观测量 从抽动疾病中，如果可以成功证明DF两者之间的不同，未来的研究就可以 查看合并症，治疗及其在健康个体模仿抽动时的变化。