Linking Brain and Behavior in Chronic Tic Disorders

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Abstract The neural circuitry underlying premonitory urge and tic suppression is particularly important given the role of voluntary tic control in improved quality of life and enhanced effectiveness of empirically supported behavioral treatments such as Habit Reversal Training (HRT) for individuals with Chronic Tic Disorders (CTDs), including those with Tourette's Syndrome. Despite a building research base, the etiology and pathophysiology of CTDs remain poorly understood, with existing findings confounded by small sample sizes, developmental effects due to wide age range, medication usage, and uncontrolled psychiatric comorbidity. In the current project, we propose to apply an innovative approach (mobile brain/body imaging [MoBI] to characterizing the neural substrates underlying premonitory urge and tic suppression in CTDs. The MoBI approach involves the simultaneous recording and integration of high-definition motion capture video, cortical activity (electroencephalography; EEG) and muscle movements (electromyography; EMG). Use of this leading edge technology will advance our understanding of the neural substrates underlying urge suppression and may allow identification of putative biomarkers for premonitory urge and tic suppression. The current study proposes to use the MoBI approach on a sample of 175 children aged 8-12 years old, 125 with CTDs and 50 age-matched healthy control (HC) peers. We will use several paradigms to model the neural substrates underlying voluntary and involuntary movements and test whether CTDs involve quantitative or qualitative deviation in motor network circuitry relative to HC peers. Successful application of the MoBI approach to the problem of discovering and testing brain-based biomarkers for CTD is highly innovative in the context of current research, and also has clear potential for advancing clinical CTD research and practice.