Kevin J. Black edited Pathophysiology.md  almost 8 years ago

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A review examined TS task-based fMRI studies in TS including studies of tic suppression, voluntary motor execution, voluntary motor inhibition, and tic severity \citep{26402403}. Free ticcing conditions (four studies) most commonly activated the left cerebellum, right cingulum, left middle frontal gyrus, the Rolandic operculum, right pallidum, right SMA and thalamus. In motor response inhibition studies, on No-Go trials TS subjects exhibited greater activation in the bilateral prefrontal cortex, thalamus and caudate. In contrast, on voluntary motor execution tasks greater activation in TS subjects was seen in the left prefrontal cortex, right cingulum, and the anterior SMA. Tic severity ratings were correlated with greater activation of the right dorsal premotor cortex and the SMA. Anterior cingulate cortex and SMA were involved across task types. The thalamus was involved in all types of studies except for self-produced movements. The authors also briefly summarize the the many issues related to neuroimaging studies such as the associated comorbidities, medication effects, the need for longitudinal studies, and the confounding effect of tics during scanning.   Additional studies are noted in Table 1.  ### Electrophysiology   Local field potentials associated with spontaneous tics were studied in 3 patients during DBS surgery \citep{25435514}. In all 3 patients repetitive thalamo-cortical coherent activity was present from 800 to 1500 msec prior to tic-associated muscle contractions. The frequency range affected varied among the patients and there were also ongoing intermittent intra-thalamic coherences that were not synchronized to the tics. The authors speculated that specific DBS targets may not matter as much as whether the target is part of the striato-pallido-thalamo-cortical network. However, since these patients were older and had very severe and complex tics, the authors acknowledge that it is not yet clear to what extent these results generalize to the TS population as a whole. Additional studies are noted in Table 1.