Tics are unique from most movement disorders, in that they are partially suppressible. As part of the inhibitory motor network, the pre-supplementary motor area is engaged in motor control and may be involved in tic physiology. We used dual-site transcranial magnetic stimulation to assess inhibitory connectivity between right pre-supplementary motor area and left primary motor cortex, which has previously been demonstrated in healthy adults. We also used diffusion tensor imaging to investigate white matter connectivity in children with chronic tics. Twelve children with chronic tic disorder and fourteen typically developing controls underwent MRI with diffusion tensor imaging indices analysis followed by single and paired-pulse transcranial magnetic stimulation with conditioning pulse over the right pre-supplementary motor area followed by left motor cortex test pulse. Neurophysiologic and imaging data relationships to measures of tic severity and suppressibility were also evaluated in tic patients. Pre-supplementary motor area-mediated inhibition of left motor cortex was present in healthy control children but not in chronic tic disorder participants. Less inhibition correlated with worse tic suppressibility (ρ = − 0.73, p = 0.047). Imaging analysis showed increased fractional anisotropy in the right superior longitudinal fasciculus, corpus callosum, corona radiata and posterior limb of the internal capsule (p < 0.05) in tic participants, which correlated with lower self-reported tic suppressibility (ρ = − 0.70, p = 0.05). Physiologic data revealed impaired frontal-mediated motor cortex inhibition in chronic tic participants, and imaging analysis showed abnormalities in motor pathways. Collectively, the neurophysiologic and neuroanatomic data correlate with tic suppressibility, supporting the relevancy to tic pathophysiology.
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We appreciate participants and families who took time to participate in this study.
This research was supported in part by The Sage Foundation (Brighton, MI), Cincinnati Children’s Research Foundation, Tourette Association of America and National Institutes of Health.
Conflict of interest
DG has received honoraria and travel support from the Tourette Association of America and has received research support from the National Institutes of Health. PH has received research support through the National Institutes of Health. SW received funding support from Cincinnati Children’s Research Foundation, has received salary support from Tourette Association of America and the National Institute of Health, and received funding for equipment used in this study from The Sage Foundation (Brighton, MI). The rest of the authors have no disclosures relevant to this study. On behalf of all authors, the corresponding author states that there is no conflict of interest.
This study was approved by the CCHMC Institutional Review Board.
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Bruce, A.B., Yuan, W., Gilbert, D.L. et al. Altered frontal-mediated inhibition and white matter connectivity in pediatric chronic tic disorders. Exp Brain Res (2021). https://doi.org/10.1007/s00221-020-06017-0
- Transcranial magnetic stimulation
- Diffusion tensor imaging
- Pre-supplementary motor area