A method to treat some Tourette syndrome symptoms using a new MRI based tool

Researchers at Yale University have developed a method to treat some Tourette syndrome symptoms using a new MRI based tool.

Their study appeared in the journal Biological Psychiatry in August 2019 and was titled, a Randomized, Sham-Controlled Trial of Real-Time Functional Magnetic Resonance Imaging Neurofeedback for Tics in Adolescents with Tourette Syndrome. We will in this blog review and explain the study and also discuss CBIT therapy which is already available for Tourette patients.

What is the basis for this new potential MRI based therapy?

Activity in a region of the brain called the supplementary motor area (SMA) has been associated with tics.

The investigators put tic patients into the MRI scanner and had a real-time functional magnetic resonance imaging neurofeedback session. The patients could see the SMA light up and they could try to control that area by focusing their thoughts on it (a neurofeedback session supervised by the study authors).

How many people were in this pilot study?

There were 21 people enrolled in the study. They were all in the adolescent age range. They received 2 sessions of “biofeedback.” There was a sham group in this study to make sure the results were not driven by a placebo effect.

What happened in the study? Did the neurofeedback provided by the MRI help the tics?
The subjects who received the real neurofeedback had a greater reduction of tics on the Yale Global Tic Severity Scale as compared with the sham control.

The authors cited that a 3.8-point difference on the major tic scale was clinically meaningful.

Are the results “generalizable” for everyone with Tourette and tics.

The neurofeedback intervention itself was useful however it will not be practical for most people to train tic and Tourette patients in a MRI environment.

The possible use of other modalities to help to train the SMA may offer a more practical treatment in the future.

Another aspect of the study is that it was very small and it is not clear that all Tourette patients and all tic subtypes will respond to this type of intervention.

Since this treatment is not available to everyone (research based theraoy), is there something else you could suggest?

This treatment has many similarities to cognitive behavioral treatment intervention (CBIT). CBIT can be taught by an occupational therapist, a psychologist or a CBIT trained therapists. The technique has been shown in JAMA to reduce tics and has been recently recommended by the new American Academy of Neurology guidelines. There is information on how to access CBIT on the Tourette Association of America website.

Tell me more about this paper in the Journal of the American Medical Association Association (JAMA) on CBIT therapy for Tourette syndrome (tics)?

In this study of 126 children the CBIT intervention decreased the Yale Global Tic Severity Scale about 4 points. More children receiving CBIT were rated as being very much improved or much improved.

One important point of the JAMA study was that 87% had continued benefit 6 months following treatment.

To read more books and articles by Michael S. Okun MD see Twitter @MichaelOkun https://www.tourettetreatment.com/ and http://parkinsonsecrets.com/ #EndingPD