fMRI-based neurofeedback of motor-related cortical regions as a new therapeutic strategy in Tourette syndrome

• Applicants: Professorin Dr. Kirsten Müller-Vahl; Professorin Dr. Irene Neuner
• Subject Area: Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry
• Term: since 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 498047458

Tourette syndrome (TS) is characterized by motor and vocal tics, often accompanied by behavioral, cognitive and affective dysfunctions. Disturbances of the cortico-striato–thalamo-cortical pathways responsible for motor control and impulse inhibition have been previously reported. The aim of this study is to train patients with TS to control the activity in the supplementary motor area (SMA), a brain region that has been associated with the urge to tic. This study is based on using real-time functional magnetic resonance imaging (fMRI) neurofeedback in patients with TS. This technique allows visualization of activity from selected brain regions while they are being generated (i.e. in “real-time”). This activity can be shown to the patients during scanning so that they can learn to control it. Using this method, we aim to alter the involvement of the SMA in motor generation and control, and consequently to improve TS symptoms including tics.The experimental patient group will undergo two days of neurofeedback training during fMRI scanning. The control patient group will undergo the same procedure, but they will be given feedback from an alternate control region. Before and after training, patients will engage in clinical and neuropsychological evaluations. These tests will be used to assess whether neurofeedback has a positive effect on tic severity and other symptoms of TS. In addition, network organization of the cortico-striato–thalamo-cortical pathways will be assessed in the resting state before and after neurofeedback. We will employ machine learning to identify resting state network predictors of SMA down-regulation. This will provide insights on the network-level strategies of responders and help in planning conscious strategies for the non-responders to improve therapeutic outcome.Here we suggest a novel interventional approach by using real-time fMRI-based neurofeedback to increase control over motor outputs and consequently over unintended tics. Our aim is to assess whether patients with TS are able to alter local brain activity to improve their symptoms. The main hypotheses are the following: first, neurofeedback training can reduce tic severity in the experimental group compared to the controls; second, neurofeedback-based modulation of the SMA activation can induce changes in the activity level and connectivity of motor-related brain circuits; and third, the outcome of neurofeedback training can be predicted by network topological organization of the brain at rest.

• DFG Programme: Research Grants