Pubblicazioni

Randomized, sham-controlled trial of real-time fMRI neurofeedback for tics in adolescents with Tourette Syndrome

DG, Sukhodolsky; C, Walsh; WN, Koller; J, Eilbott; M, Rance; RK, Fulbright; Z, Zhao; MH, Bloch; R, King; JF, Leckman; D, Scheinost; B, Pittman; M, Hampson

Abstract:

Abstract Background Activity in the supplementary motor area (SMA) has been associated with tics in Tourette Syndrome (TS). The aim of this study was to test a novel intervention – real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback from SMA – for reduction of tics in adolescents with TS. Methods Twenty-one adolescents with TS were enrolled in a double-blind, randomized, sham-controlled, crossover study involving two sessions of neurofeedback from their SMA. The primary outcome measure of tic severity was the Yale Global Tic Symptom Severity Scale (YGTSS) administered by an independent evaluator before and after each arm. The secondary outcome was control over the SMA assessed in neuroimaging scans where subjects were cued to increase/decrease activity in SMA without receiving feedback. Results All 21 subjects completed both arms of the study and all assessments. Participants had significantly greater reduction of tics on the YGTSS scale after neurofeedback as compared to sham (p<0.05). Mean Total YGTSS score decreased from 25.2+4.6 at baseline to 19.9+5.7 at endpoint in neurofeedback and from 24.8+8.1 to 23.3+8.5 in sham. The 3.8-point difference is clinically meaningful and corresponds to an effect size of 0.59. However, there were no differences in changes on the secondary measure of control over the SMA. Conclusions This first randomized controlled trial of rt-fMRI neurofeedback in adolescents with TS suggests that this neurofeedback intervention may be helpful for improving tic symptoms. However, no effects were found in terms of change in control over the SMA, the hypothesized mechanism of action.

Patologie/Applicazioni:

• Bio – Neurofeedback (NFB)

Anno:

2019

Tipo di pubblicazione:

Articolo

Parola chiave:

Neurofeedback; SMA; Tourette; adolescenti

Testata scientifica:

Biological Psychiatry

Nota:

Ventuno adolescenti con sindrome di Tourette sono stati arruolati in uno studio crossover in doppio cieco, randomizzato, sham-controllato, che li ha coinvolti in due sessioni di neurofeedback in corrispondenza dell'area SMA (area motoria supplementare). Durante il compito, il controllo esercitato sulla SMA è stato monitorato e valutato in scansioni di neuroimaging dove i soggetti venivano spinti ad aumentare / diminuire l'attività nella SMA senza ricevere feedback. I partecipanti hanno avuto una riduzione significativamente maggiore dei tic sulla scala YGTSS dopo il training di neurofeedback rispetto allo sham (p <0,05). Il punteggio medio totale YGTSS è diminuito da 25,2 + 4,6 al basale a 19,9 + 5,7 all'endpoint nel neurofeedback e da 24,8 + 8,1 a 23,3 + 8,5 nello sham. Questo è il primo studio randomizzato e controllato sul neurofeedback con rt-fMRI e suggerisce che il neurofeedback può essere utile per migliorare i sintomi dei tic in adolescenti che soffrono di sindrome di Tourette. Tuttavia, non sono stati riscontrati effetti in termini di cambiamento nel controllo della SMA, il meccanismo d'azione ipotizzato all'inizio.

DOI:

doi.org/10.1016/j.biopsych.2019.07.035