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Berg L, Martino D, L'Erario ZP, Pringsheim T. Symptom Severity and Health Impacts of Functional Tic-Like Behaviors in Youth. Pediatr Neurol 2024; 155:68-75. [PMID: 38603984 DOI: 10.1016/j.pediatrneurol.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/23/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND We performed this study to improve understanding of the relationship between functional tic-like behaviors (FTLBs) and quality of life, loneliness, family functioning, anxiety, depression, and suicidality. METHOD This cross-sectional study assessed self-reported quality of life, disability, loneliness, depression, anxiety, family functioning, tic severity, and suicide risk in age- and birth-sex matched youth with FTLBs, Tourette syndrome (TS), and neurotypical controls. We performed specific subanalyses comparing individuals with FTLBs who identified as transgender/gender diverse (TGD) with cisgender individuals. RESULTS Eighty-two youth participated (age range 11 to 25, 90% female at birth), including 35 with FTLBs, 22 with TS, and 25 neurotypical controls. A significantly higher proportion of participants with FTLB identified as TGD (15 of 35) than TS (two of 22) and neurotypical control (three of 25) participants. Compared with neurotypical controls, individuals with FTLBs had significantly lower quality of life, greater disability, loneliness, social phobia, anxiety symptoms, depressive symptoms, and suicidality. Compared with individuals with TS, individuals with FTLBs had more school/work absences due to tics, had more depressive symptoms, were more likely to be at high risk for suicidality, and had disability in self-care and life activity domains. There were no significant differences between cisgender and TGD participants with FTLB in any of the domains assessed. CONCLUSIONS Youth with FTLB have unique health care needs and associations with anxiety, depression, sex, and gender.
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Affiliation(s)
- Lindsay Berg
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Tamara Pringsheim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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Branca C, Bortolato M. The role of neuroactive steroids in tic disorders. Neurosci Biobehav Rev 2024; 160:105637. [PMID: 38519023 PMCID: PMC11121756 DOI: 10.1016/j.neubiorev.2024.105637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/03/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
Tics are sudden, repetitive movements or vocalizations. Tic disorders, such as Tourette syndrome (TS), are contributed by the interplay of genetic risk factors and environmental variables, leading to abnormalities in the functioning of the cortico-striatal-thalamo-cortical (CSTC) circuitry. Various neurotransmitter systems, such as gamma-aminobutyric acid (GABA) and dopamine, are implicated in the pathophysiology of these disorders. Building on the evidence that tic disorders are predominant in males and exacerbated by stress, emerging research is focusing on the involvement of neuroactive steroids, including dehydroepiandrosterone sulfate (DHEAS) and allopregnanolone, in the ontogeny of tics and other phenotypes associated with TS. Emerging evidence indicates that DHEAS levels are significantly elevated in the plasma of TS-affected boys, and the clinical onset of this disorder coincides with the period of adrenarche, the developmental stage characterized by a surge in DHEAS synthesis. On the other hand, allopregnanolone has garnered particular attention for its potential to mediate the adverse effects of acute stress on the exacerbation of tic severity and frequency. Notably, both neurosteroids act as key modulators of GABA-A receptors, suggesting a pivotal role of these targets in the pathophysiology of various clinical manifestations of tic disorders. This review explores the potential mechanisms by which these and other neuroactive steroids may influence tic disorders and discusses the emerging therapeutic strategies that target neuroactive steroids for the management of tic disorders.
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Affiliation(s)
- Caterina Branca
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Marco Bortolato
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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Wang CX, Wang B, Sun JJ, Xiao CY, Ma H, Jia FY, Li HH. Circulating retinol and 25(OH)D contents and their association with symptoms in children with chronic tic disorders. Eur Child Adolesc Psychiatry 2024; 33:1017-1028. [PMID: 37166521 PMCID: PMC11032271 DOI: 10.1007/s00787-023-02226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023]
Abstract
The present study measured serum levels of vitamin A (VA) and vitamin D (VD) in children with chronic tic disorders (CTD) and investigated their potential association with CTD and comorbidity of attention deficit hyperactivity disorder (ADHD) and the association of their co-insufficiencies or deficiencies with CTD symptoms. A total of 176 children (131 boys and 45 girls, median age of 9 years) with CTD were recruited as the CTD group. During the same period, 154 healthy children were selected as the healthy control (HC) cohort. Circulating retinol and 25-hydroxyvitamin D (25[OH]D) levels were measured for all participants using high-performance liquid chromatography (HPLC) and tandem mass spectrometry. The Yale Global Tic Severity Scale (YGTSS) was employed for the assessment of tic status and CTD impairment. The Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) and the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) were used to evaluate comorbidity symptoms. CTD pediatric participants exhibited markedly diminished circulating retinol and 25(OH)D levels compared to HCs. Moreover, VA and VD deficiencies and their co-insufficiencies/deficiencies were more prevalent in CTD participants than HCs. Circulating 25(OH)D levels were inversely proportional to the YGTSS motor tic scores. YGTSS scores in CTD children with only VA or VD insufficiency or deficiency or with VA and VD co-insufficiency/deficiency did not differ from those in CTD children with normal VA and VD. CTD children with comorbid ADHD displayed reduced circulating retinol and 25(OH)D concentrations and elevated prevalence of VD deficiency compared to CTD participants without comorbid ADHD. Lower serum retinol content was intricately linked to the presence of elevated CTD and comorbid ADHD. VA and VD deficiencies and their co-insufficiencies/deficiencies were markedly enhanced in CTD pediatric participants compared to HCs. Lower VA concentration was linked to the presence of enhanced CTD and comorbid ADHD. Therefore, children with CTD, especially with comorbid ADHD, may be at a higher risk of VA or VD deficiency, which may prompt the clinicians to consider whether blood tests for VA and VD in CTD children would be helpful for clinical care.
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Affiliation(s)
- Cheng-Xin Wang
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, 130021, China
| | - Bing Wang
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Jian-Jian Sun
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Chun-Ying Xiao
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Huan Ma
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Fei-Yong Jia
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Hong-Hua Li
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
- School of Public Health, Jilin University, Changchun, Jilin, China.
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Li HH, Wang XF, Wang B, Jia FY. Vitamin D3 improves iminodipropionitrile-induced tic-like behavior in rats through regulation of GDNF/c-Ret signaling activity. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02376-z. [PMID: 38396228 DOI: 10.1007/s00787-024-02376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/08/2024] [Indexed: 02/25/2024]
Abstract
Children with chronic tic disorders (CTD), including Tourette syndrome (TS), have significantly reduced serum 25-hydroxyvitamin D [25(OH)D]. While vitamin D3 supplementation (VDS) may reduce tic symptoms in these children, its mechanism is unclear. The study aim was to investigate the effects and mechanisms of vitamin D deficiency (VDD) and VDS on TS model behavior. Forty 5-week-old male Sprague-Dawley rats were randomly divided into (n = 10 each): control, TS model, TS model with VDD (TS + VDD), or TS model with VDS (TS + VDS; two intramuscular injections of 20,000 IU/200 g) groups. The VDD model was diet-induced (0 IU vitamin D/kg); the TS model was iminodipropionitrile (IDPN)-induced. All groups were tested for behavior, serum and striatal 25(OH)D and dopamine (DA), mRNA expressions of vitamin D receptor (VDR), glial cell line-derived neurotrophic factor (GDNF), protooncogene tyrosine-protein kinase receptor Ret (c-Ret), and DA D1 (DRD1) and D2 (DRD2) receptor genes in the striatum. TS + VDD had higher behavior activity scores throughout, and higher total behavior score at day 21 compared with TS model. In contrast, day 21 TS + VDS stereotyped behavior scores and total scores were lower than TS model. The serum 25(OH)D in TS + VDD was < 20 ng/mL, and lower than control. Striatal DA of TS was lower than control. Compared with TS model, striatal DA of TS + VDD was lower, while in TS + VDS it was higher than TS model. Furthermore, mRNA expression of VDR, GDNF, and c-Ret genes decreased in TS model, and GDNF expression decreased more in TS + VDD, while TS + VDS had higher GDNF and c-Ret expressions. VDD aggravates, and VDS ameliorates tic-like behavior in an IDPN-induced model. VDS may upregulate GDNF/c-Ret signaling activity through VDR, reversing the striatal DA decrease and alleviating tic-like behavior.
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Affiliation(s)
- Hong-Hua Li
- Department of Developmental and Behavioral Pediatrics, Children's Hospital, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
- School of Public Health, Jilin University, Changchun, Jilin Province, China
- The Child Health Clinical Research Center of Jilin Province, Changchun, China
| | - Xi-Fei Wang
- Department of Developmental and Behavioral Pediatrics, Children's Hospital, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
- The Child Health Clinical Research Center of Jilin Province, Changchun, China
| | - Bing Wang
- Department of Developmental and Behavioral Pediatrics, Children's Hospital, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
- The Child Health Clinical Research Center of Jilin Province, Changchun, China
| | - Fei-Yong Jia
- Department of Developmental and Behavioral Pediatrics, Children's Hospital, The First Hospital of Jilin University, Changchun, Jilin, 130021, China.
- The Child Health Clinical Research Center of Jilin Province, Changchun, China.
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Saluja S, Qiu L, Wang AR, Campos G, Seilheimer R, McNab JA, Haber SN, Barbosa DAN, Halpern CH. Diffusion Magnetic Resonance Imaging Tractography Guides Investigation of the Zona Incerta: A Novel Target for Deep Brain Stimulation. Biol Psychiatry 2024:S0006-3223(24)01105-3. [PMID: 38401802 DOI: 10.1016/j.biopsych.2024.02.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND The zona incerta (ZI) is a subcortical structure primarily investigated in rodents that is implicated in various behaviors, ranging from motor control to survival-associated activities, partly due to its integration in multiple neural circuits. In the current study, we used diffusion magnetic resonance imaging tractography to segment the ZI and gain insight into its connectivity in various circuits in humans. METHODS We performed probabilistic tractography in 7T diffusion MRI on 178 participants from the Human Connectome Project to validate the ZI's anatomical subdivisions and their respective tracts. K-means clustering segmented the ZI based on each voxel's connectivity profile. We further characterized the connections of each ZI subregion using probabilistic tractography with each subregion as a seed. RESULTS We identified 2 dominant clusters that delineated the whole ZI into rostral and caudal subregions. The caudal ZI primarily connected with motor regions, while the rostral ZI received a topographic distribution of projections from prefrontal areas, notably the anterior cingulate and medial prefrontal cortices. We generated a probabilistic ZI atlas that was registered to a patient-participant's magnetic resonance imaging scan for placement of stereoencephalographic leads for electrophysiology-guided deep brain stimulation to treat their obsessive-compulsive disorder. Rostral ZI stimulation improved the patient's core symptoms (mean improvement 21%). CONCLUSIONS We present a tractography-based atlas of the rostral and caudal ZI subregions constructed using high-resolution diffusion magnetic resonance imaging from 178 healthy participants. Our work provides an anatomical foundation to explore the rostral ZI as a novel target for deep brain stimulation to treat refractory obsessive-compulsive disorder and other disorders associated with dysfunctional reward circuitry.
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Affiliation(s)
- Sabir Saluja
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Liming Qiu
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allan R Wang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gustavo Campos
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Seilheimer
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer A McNab
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Suzanne N Haber
- Department of Pharmacology & Physiology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts
| | - Daniel A N Barbosa
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Casey H Halpern
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
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Sapozhnikov Y, Vermilion J. Co-Occurring Anxiety in Youth with Tic Disorders: A Review. J Child Adolesc Psychopharmacol 2023; 33:402-408. [PMID: 37870770 DOI: 10.1089/cap.2022.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Objective: To review the current state of the literature regarding anxiety symptoms and anxiety disorders in chronic tic disorder (CTD). Results: We conducted a literature search on anxiety and tic disorders. Anxiety symptoms and anxiety disorders are common in youth with CTD, with ∼30%-50% of youth with CTD having at least one co-occurring anxiety disorder. Tics often improve by young adulthood but anxiety symptoms tend to persist, or worsen, over time. Anxiety and tics are closely related, but the exact nature of their relationship is poorly understood. We discuss some potential ways in which anxiety and tics are linked with an emphasis on the underlying brain circuitry involved. The relationship between anxiety and tics may be related to the premonitory urge. In addition, stress hormones may link anxiety and tics. Individuals with CTD have greater activation of their hypothalamic-pituitary-adrenal system in response to acute stress. We also review the impact of anxiety on youth with CTD and approaches to management of anxiety in youth. Conclusions: Anxiety is common in youth with CTD, is associated with more severe CTD, and can adversely affect a child's function. Thus, it is important to identify anxiety disorders in CTD and manage them appropriately.
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Affiliation(s)
- Yelizaveta Sapozhnikov
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer Vermilion
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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7
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Lamanna J, Ferro M, Spadini S, Racchetti G, Malgaroli A. The Dysfunctional Mechanisms Throwing Tics: Structural and Functional Changes in Tourette Syndrome. Behav Sci (Basel) 2023; 13:668. [PMID: 37622808 PMCID: PMC10451670 DOI: 10.3390/bs13080668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
Tourette Syndrome (TS) is a high-incidence multifactorial neuropsychiatric disorder characterized by motor and vocal tics co-occurring with several diverse comorbidities, including obsessive-compulsive disorder and attention-deficit hyperactivity disorder. The origin of TS is multifactorial, with strong genetic, perinatal, and immunological influences. Although almost all neurotransmettitorial systems have been implicated in TS pathophysiology, a comprehensive neurophysiological model explaining the dynamics of expression and inhibition of tics is still lacking. The genesis and maintenance of motor and non-motor aspects of TS are thought to arise from functional and/or structural modifications of the basal ganglia and related circuitry. This complex wiring involves several cortical and subcortical structures whose concerted activity controls the selection of the most appropriate reflexive and habitual motor, cognitive and emotional actions. Importantly, striatal circuits exhibit bidirectional forms of synaptic plasticity that differ in many respects from hippocampal and neocortical plasticity, including sensitivity to metaplastic molecules such as dopamine. Here, we review the available evidence about structural and functional anomalies in neural circuits which have been found in TS patients. Finally, considering what is known in the field of striatal plasticity, we discuss the role of exuberant plasticity in TS, including the prospect of future pharmacological and neuromodulation avenues.
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Affiliation(s)
- Jacopo Lamanna
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Faculty of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Mattia Ferro
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Psychology, Sigmund Freud University, 20143 Milan, Italy
| | - Sara Spadini
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Division of Neuroscience, Scientific Institute Ospedale San Raffaele, 20132 Milan, Italy
| | - Gabriella Racchetti
- Division of Neuroscience, Scientific Institute Ospedale San Raffaele, 20132 Milan, Italy
| | - Antonio Malgaroli
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Faculty of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
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Mewara A, Sreenivasan P, Khurana S. Primate malaria of human importance. Trop Parasitol 2023; 13:73-83. [PMID: 37860614 PMCID: PMC10583777 DOI: 10.4103/tp.tp_79_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/10/2023] [Indexed: 10/21/2023] Open
Abstract
Nonhuman primate (NHP) malaria poses a major threat to the malaria control programs. The last two decades have witnessed a paradigm shift in our understanding of the malaria caused by species other than the traditionally known human Plasmodium species - Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale. The emergence of the malaria parasite of long-tailed macaque monkeys, Plasmodium knowlesi, as the fifth malaria species of humans has made the scientific community consider the risk of other zoonotic malaria, such as Plasmodium cynomolgi, Plasmodium simium, Plasmodium inui, and others, to humans. The development of knowledge about P. knowlesi as a pathogen which was earlier only known to experimentally cause malaria in humans and rarely cause natural infection, toward its acknowledgment as a significant cause of human malaria and a threat of malaria control programs has been made possible by the use of advanced molecular techniques such as polymerase chain reaction and gene sequencing. This review explores the various aspects of NHP malaria, and the association of various factors with their emergence and potential to cause human malaria which are important to understand to be able to control these emerging infections.
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Affiliation(s)
- Abhishek Mewara
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Priya Sreenivasan
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumeeta Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Estrada-Sánchez AM, Rangel-Barajas C, Howe AG, Barton SJ, Mach RH, Luedtke RR, Rebec GV. Selective Activation of D3 Dopamine Receptors Ameliorates DOI-Induced Head Twitching Accompanied by Changes in Corticostriatal Processing. Int J Mol Sci 2023; 24:ijms24119300. [PMID: 37298250 DOI: 10.3390/ijms24119300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
D3 receptors, a key component of the dopamine system, have emerged as a potential target of therapies to improve motor symptoms across neurodegenerative and neuropsychiatric conditions. In the present work, we evaluated the effect of D3 receptor activation on the involuntary head twitches induced by 2,5-dimethoxy-4-iodoamphetamine (DOI) at behavioral and electrophysiological levels. Mice received an intraperitoneal injection of either a full D3 agonist, WC 44 [4-(2-fluoroethyl)-N-[4-[4-(2-methoxyphenyl)piperazin 1-yl]butyl]benzamide] or a partial D3 agonist, WW-III-55 [N-(4-(4-(4-methoxyphenyl)piperazin-1-yl)butyl)-4-(thiophen-3-yl)benzamide] five minutes before the intraperitoneal administration of DOI. Compared to the control group, both D3 agonists delayed the onset of the DOI-induced head-twitch response and reduced the total number and frequency of the head twitches. Moreover, the simultaneous recording of neuronal activity in the motor cortex (M1) and dorsal striatum (DS) indicated that D3 activation led to slight changes in a single unit activity, mainly in DS, and increased its correlated firing in DS or between presumed cortical pyramidal neurons (CPNs) and striatal medium spiny neurons (MSNs). Our results confirm the role of D3 receptor activation in controlling DOI-induced involuntary movements and suggest that this effect involves, at least in part, an increase in correlated corticostriatal activity. A further understanding of the underlying mechanisms may provide a suitable target for treating neuropathologies in which involuntary movements occur.
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Affiliation(s)
- Ana María Estrada-Sánchez
- Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA
- División de Biología Molecular, Instituto Potosino de Investigación Científica y Tecnológica (IPICYT), Camino a la Presa San José No. 2055, Colonia Lomas 4a Sección, San Luis Potosi C.P. 78216, Mexico
| | - Claudia Rangel-Barajas
- Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA
| | - Andrew G Howe
- Psychology Department, University of California Los Angeles, Los Angeles, CA 90095, USA
- Intelligent Systems Laboratory, HRL Laboratories, LLC., Malibu, CA 90265, USA
| | - Scott J Barton
- Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA
| | - Robert H Mach
- Department of Radiology, University of Pennsylvania School of Medicine, Chemistry Building, 231 S. 34th St., Philadelphia, PA 19104, USA
| | - Robert R Luedtke
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107, USA
| | - George V Rebec
- Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA
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10
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Hao J, Zhang X, Liu Y, Zhang Z, Jiang K, Zhang XY, Wu M. Cross-sectional Exploration of the Relationship Between Glutamate Abnormalities and Tic Disorder Severity Using Proton Magnetic Resonance Spectroscopy. PHENOMICS (CHAM, SWITZERLAND) 2023; 3:138-147. [PMID: 37197641 PMCID: PMC10110806 DOI: 10.1007/s43657-022-00064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 05/19/2023]
Abstract
Glutamate (Glu) has been reported to be closely related to the pathophysiology of Tic Disorders (TD). By using proton magnetic resonance spectroscopy (1H-MRS), we aimed to investigate the relationship between in vivo Glu levels and the severity of TD. We performed a cross-sectional study in medication-free patients with TD and healthy controls aged between 5 and 13 years using 1H-MRS at 3 T. First, we measured the Glu levels in both patients and controls and observed the difference in subgroups, including mild TD patients and moderate TD patients. We then examined the correlations between the Glu levels and clinical features of the patients. Finally, we assessed the diagnostic value of 1H-MRS and the influencing factors. Our results show that the Glu levels in the striatum of all patients with TD were not significantly different from those of the healthy controls. Subgroup analysis revealed that the Glu levels in the moderate TD group were higher than those in the mild TD group and healthy controls. The correlation analysis showed that Glu levels are strongly positive correlated with TD severity. The optimal cutoff value of Glu levels to differentiate mild tics from moderate tics was 1.244, with a sensitivity of 88.2% and a specificity of 94.7%. Multiple linear regression models revealed that the severity of TD is one of the important factors that affect Glu levels. We conclude that Glu levels are mainly associated with the severity of tics, thus it could serve as a key biomarker for TD classification.
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Affiliation(s)
- Juanjuan Hao
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092 People’s Republic of China
- School of Medicine, Shaoxing University, 900 Chengnan Road, Shaoxing, 312000 People’s Republic of China
| | - Xin Zhang
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092 People’s Republic of China
| | - Ying Liu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433 People’s Republic of China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, 200433 People’s Republic of China
| | - Zhongyang Zhang
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092 People’s Republic of China
| | - Keyu Jiang
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092 People’s Republic of China
| | - Xiao-Yong Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433 People’s Republic of China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, 200433 People’s Republic of China
| | - Min Wu
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092 People’s Republic of China
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Kimura K, Murase N, Nagao Y, Nozaki M, Fukumizu M, Kita Y, Hayashi M, Hoshino K. Pre-movement gating of somatosensory evoked potentials in tourette syndrome. Brain Dev 2023; 45:324-331. [PMID: 36878743 DOI: 10.1016/j.braindev.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/29/2023] [Accepted: 02/12/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Tourette syndrome (TS) is a neurobehavioral disorder characterized by motor and vocal tics. Simple tics are purposeless involuntary movements that spontaneously resolve during middle adolescence. Complex tics appear to be semi-voluntary movements that may become intractable when associated with obsessive-compulsive disorder (OCD). Sensory tics or urges preceded by tics suggest sensorimotor processing impairment in TS. We aimed to clarify its pathophysiology by exploring the pre-movement gating (attenuation) of somatosensory evoked potentials (SEPs). METHODS We examined 42 patients (aged 9-48 years), 4 of whom underwent follow-up assessment, along with 19 healthy controls. We defined patients with only simple tics as TS-S and patients with complex tics as TS-C. Pre-movement gating of SEPs was assessed using a previously described method. Frontal N30 (FrN30) amplitudes were compared between pre-movement and resting states. The gating ratio of pre-movement/resting amplitude of the FrN30 component was assessed: the larger the ratio, the less the gating. RESULTS The gating ratio for TS-C patients was larger than that of TS-S patients and healthy controls, but a statistical difference between TS-S and TS-C appeared after 15 years and over (p < 0.001). There were no significant differences in the gating ratio between TS-S patients and healthy controls. The gating ratio was related to the severity of OCD (p < 0.05). CONCLUSION Sensorimotor processing was preserved for simple tics but impaired in complex tics, specifically after middle adolescence. Our study supports an age-dependent dysfunction of both motor and non-motor cortico-striato-thalamo-cortical circuits in complex tics. SEP gating seems promising as a tool for assessing age-dependent sensorimotor disintegration in TS.
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Affiliation(s)
- Kazue Kimura
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan.
| | - Nagako Murase
- Department of Neurology, National Hospital Organization, Nara Medical Center, Nara, Japan
| | - Yuri Nagao
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | - Maki Nozaki
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | - Michio Fukumizu
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | - Yosuke Kita
- Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan; Cognitive Brain Research Unit (CBRU), Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Kyoko Hoshino
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
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Jindachomthong K, Yang C, Huang Y, Coman D, Rapanelli M, Hyder F, Dougherty J, Frick L, Pittenger C. White matter abnormalities in the Hdc knockout mouse, a model of tic and OCD pathophysiology. Front Mol Neurosci 2022; 15:1037481. [PMID: 36504678 PMCID: PMC9731796 DOI: 10.3389/fnmol.2022.1037481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction An inactivating mutation in the histidine decarboxylase gene (Hdc) has been identified as a rare but high-penetrance genetic cause of Tourette syndrome (TS). TS is a neurodevelopmental syndrome characterized by recurrent motor and vocal tics; it is accompanied by structural and functional abnormalities in the cortico-basal ganglia circuitry. Hdc, which is expressed both in the posterior hypothalamus and peripherally, encodes an enzyme required for the biosynthesis of histamine. Hdc knockout mice (Hdc-KO) functionally recapitulate this mutation and exhibit behavioral and neurochemical abnormalities that parallel those seen in patients with TS. Materials and methods We performed exploratory RNA-seq to identify pathological alterations in several brain regions in Hdc-KO mice. Findings were corroborated with RNA and protein quantification, immunohistochemistry, and ex vivo brain imaging using MRI. Results Exploratory RNA-Seq analysis revealed, unexpectedly, that genes associated with oligodendrocytes and with myelin production are upregulated in the dorsal striatum of these mice. This was confirmed by qPCR, immunostaining, and immunoblotting. These results suggest an abnormality in myelination in the striatum. To test this in an intact mouse brain, we performed whole-brain ex vivo diffusion tensor imaging (DTI), which revealed reduced fractional anisotropy (FA) in the dorsal striatum. Discussion While the DTI literature in individuals with TS is sparse, these results are consistent with findings of disrupted descending cortical projections in patients with tics. The Hdc-KO model may represent a powerful system in which to examine the developmental mechanisms underlying this abnormality.
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Affiliation(s)
- Kantiya Jindachomthong
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Chengran Yang
- Department of Genetics, Washington University in St. Louis, St. Louis, MO, United States
| | - Yuegao Huang
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Daniel Coman
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Maximiliano Rapanelli
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Fahmeed Hyder
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States,Department of Biomedical Engineering, Yale University School of Medicine, New Haven, CT, United States
| | - Joseph Dougherty
- Department of Genetics, Washington University in St. Louis, St. Louis, MO, United States
| | - Luciana Frick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States,*Correspondence: Luciana Frick,
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States,Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, United States,Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, United States,Christopher Pittenger,
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13
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Hussain H, Djurin T, Rodriguez J, Daneelian L, Sundi S, Fadel A, Saadoon Z. Transactivation Response DNA-Binding Protein of 43 (TDP-43) and Glial Cell Roles in Neurological Disorders. Cureus 2022; 14:e30639. [DOI: 10.7759/cureus.30639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/07/2022] Open
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14
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Evaluation of EEG biomarkers of comprehensive behavioral intervention for tics in children with Tourette syndrome. Clin Neurophysiol 2022; 142:75-85. [DOI: 10.1016/j.clinph.2022.07.500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/01/2022] [Accepted: 07/17/2022] [Indexed: 11/22/2022]
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15
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Pharmacologic Treatment of Comorbid Attention-Deficit/Hyperactivity Disorder and Tourette and Tic Disorders. Child Adolesc Psychiatr Clin N Am 2022; 31:469-477. [PMID: 35697396 DOI: 10.1016/j.chc.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A complete and comprehensive medical and psychiatric evaluation is necessary to delineate tic symptoms from attention-deficit/hyperactivity disorder, and to prioritize the most problematic symptoms for intervention. Stimulants are the recommended first-line pharmacotherapy to treat attention-deficit/hyperactivity disorder symptoms in patients with tic disorders. Comprehensive behavioral intervention for tics is an effective behavioral therapy that is generally considered the first-line treatment of persistent tic disorders. α-Agonists can be added to stimulants if tics increase or be used as monotherapy to target attention-deficit/hyperactivity disorder and tics. Atomoxetine is also an excellent option to treat attention-deficit/hyperactivity disorder and tics.
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16
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Colvin MK, Erwin S, Alluri PR, Laffer A, Pasquariello K, Williams KA. Cognitive, Graphomotor, and Psychosocial Challenges in Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS). J Neuropsychiatry Clin Neurosci 2022; 33:90-97. [PMID: 33261524 DOI: 10.1176/appi.neuropsych.20030065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) is characterized by the sudden onset of obsessive-compulsive disorder (OCD) and other neurobehavioral symptoms following group A streptococcal infection. The cardinal neuropsychiatric symptoms are believed to reflect an aberrant autoimmune or inflammatory response that may selectively disrupt basal ganglia function. The investigators examined whether neuropsychological skills associated with frontostriatal networks (executive functions and motor skills) are affected in patients with PANDAS following resolution of acute symptoms and the degree to which there are persistent social, emotional, and academic difficulties. METHODS Twenty-seven patients ages 6-14 years (mean age=9.63 years [SD=1.78]; male, N=22) completed neuropsychological testing as part of routine clinical care. Performances on measures of intellectual ability, executive function, motor skills, and academic skills are reported, as well as parent-reported emotional, behavioral, and social skills. RESULTS On neuropsychological measures, patients exhibited average intellectual functioning with relative and mild difficulties in skills supporting cognitive efficiency, including attentional regulation, inhibitory control, and processing speed. Dexterity was normal but graphomotor skills were reduced. Core reading, math, and writing skills were within expectations, but reading and math fluency were reduced, and the majority of patients received special education services or accommodations. Parents reported high levels of concern about anxiety, depression, inattention, hyperactivity, and social skills. CONCLUSIONS These findings indicated relative difficulties with aspects of executive and motor functions. Although evaluations were performed following the resolution of acute symptoms, ongoing and significant academic difficulties and emotional, behavioral, and social concerns were targets for clinical intervention and support.
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Affiliation(s)
- Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Boston (Colvin, Erwin, Alluri, Laffer, Pasquariello, Williams); and Connecticut College, New London, Conn. (Pasquariello)
| | - Savannah Erwin
- Department of Psychiatry, Massachusetts General Hospital, Boston (Colvin, Erwin, Alluri, Laffer, Pasquariello, Williams); and Connecticut College, New London, Conn. (Pasquariello)
| | - Priyanka R Alluri
- Department of Psychiatry, Massachusetts General Hospital, Boston (Colvin, Erwin, Alluri, Laffer, Pasquariello, Williams); and Connecticut College, New London, Conn. (Pasquariello)
| | - Alexandra Laffer
- Department of Psychiatry, Massachusetts General Hospital, Boston (Colvin, Erwin, Alluri, Laffer, Pasquariello, Williams); and Connecticut College, New London, Conn. (Pasquariello)
| | - Kathryn Pasquariello
- Department of Psychiatry, Massachusetts General Hospital, Boston (Colvin, Erwin, Alluri, Laffer, Pasquariello, Williams); and Connecticut College, New London, Conn. (Pasquariello)
| | - Kyle A Williams
- Department of Psychiatry, Massachusetts General Hospital, Boston (Colvin, Erwin, Alluri, Laffer, Pasquariello, Williams); and Connecticut College, New London, Conn. (Pasquariello)
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17
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Chohan MO, Kopelman JM, Yueh H, Fazlali Z, Greene N, Harris AZ, Balsam PD, Leonardo ED, Kramer ER, Veenstra-VanderWeele J, Ahmari SE. Developmental impact of glutamate transporter overexpression on dopaminergic neuron activity and stereotypic behavior. Mol Psychiatry 2022; 27:1515-1526. [PMID: 35058566 PMCID: PMC9106836 DOI: 10.1038/s41380-021-01424-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/30/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a disabling condition that often begins in childhood. Genetic studies in OCD have pointed to SLC1A1, which encodes the neuronal glutamate transporter EAAT3, with evidence suggesting that increased expression contributes to risk. In mice, midbrain Slc1a1 expression supports repetitive behavior in response to dopaminergic agonists, aligning with neuroimaging and pharmacologic challenge studies that have implicated the dopaminergic system in OCD. These findings suggest that Slc1a1 may contribute to compulsive behavior through altered dopaminergic transmission; however, this theory has not been mechanistically tested. To examine the developmental impact of Slc1a1 overexpression on compulsive-like behaviors, we, therefore, generated a novel mouse model to perform targeted, reversible overexpression of Slc1a1 in dopaminergic neurons. Mice with life-long overexpression of Slc1a1 showed a significant increase in amphetamine (AMPH)-induced stereotypy and hyperlocomotion. Single-unit recordings demonstrated that Slc1a1 overexpression was associated with increased firing of dopaminergic neurons. Furthermore, dLight1.1 fiber photometry showed that these behavioral abnormalities were associated with increased dorsal striatum dopamine release. In contrast, no impact of overexpression was observed on anxiety-like behaviors or SKF-38393-induced grooming. Importantly, overexpression solely in adulthood failed to recapitulate these behavioral phenotypes, suggesting that overexpression during development is necessary to generate AMPH-induced phenotypes. However, doxycycline-induced reversal of Slc1a1/EAAT3 overexpression in adulthood normalized both the increased dopaminergic firing and AMPH-induced responses. These data indicate that the pathologic effects of Slc1a1/EAAT3 overexpression on dopaminergic neurotransmission and AMPH-induced stereotyped behavior are developmentally mediated, and support normalization of EAAT3 activity as a potential treatment target for basal ganglia-mediated repetitive behaviors.
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Affiliation(s)
- Muhammad O. Chohan
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Jared M. Kopelman
- Department of Psychiatry, Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA, USA,Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Hannah Yueh
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Zeinab Fazlali
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Natasha Greene
- New York State Psychiatric Institute, New York, NY, USA,Department of Psychology, Barnard College of Columbia University, New York, NY, USA
| | - Alexander Z. Harris
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Peter D. Balsam
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Psychology, Barnard College of Columbia University, New York, NY, USA
| | - E. David Leonardo
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Edgar R. Kramer
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, Devon, UK
| | - Jeremy Veenstra-VanderWeele
- Department of Psychiatry, Columbia University, New York, NY, USA. .,New York State Psychiatric Institute, New York, NY, USA.
| | - Susanne E. Ahmari
- Department of Psychiatry, Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA, USA,Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA
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18
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Bond M, Moll N, Rosello A, Bond R, Schnell J, Burger B, Hoekstra PJ, Dietrich A, Schrag A, Kocovska E, Martino D, Mueller N, Schwarz M, Meier UC. Vitamin D levels in children and adolescents with chronic tic disorders: a multicentre study. Eur Child Adolesc Psychiatry 2022; 31:1-12. [PMID: 33851280 PMCID: PMC9343310 DOI: 10.1007/s00787-021-01757-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022]
Abstract
This study investigated whether vitamin D is associated with the presence or severity of chronic tic disorders and their psychiatric comorbidities. This cross-sectional study compared serum 25-hydroxyvitamin D [25(OH)D] (ng/ml) levels among three groups: children and adolescents (3-16 years) with CTD (n = 327); first-degree relatives (3-10 years) of individuals with CTD who were assessed for a period of up to 7 years for possible onset of tics and developed tics within this period (n = 31); and first-degree relatives who did not develop tics and were ≥ 10 years old at their last assessment (n = 93). The relationship between 25(OH)D and the presence and severity of tics, as well as comorbid obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD), were analysed controlling for age, sex, season, centre, latitude, family relatedness, and comorbidities. When comparing the CTD cohort to the unaffected cohort, the observed result was contrary to the one expected: a 10 ng/ml increase in 25(OH)D was associated with higher odds of having CTD (OR 2.08, 95% CI 1.27-3.42, p < 0.01). There was no association between 25(OH)D and tic severity. However, a 10 ng/ml increase in 25(OH)D was associated with lower odds of having comorbid ADHD within the CTD cohort (OR 0.55, 95% CI 0.36-0.84, p = 0.01) and was inversely associated with ADHD symptom severity (β = - 2.52, 95% CI - 4.16-0.88, p < 0.01). In conclusion, lower vitamin D levels were not associated with a higher presence or severity of tics but were associated with the presence and severity of comorbid ADHD in children and adolescents with CTD.
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Affiliation(s)
- Molly Bond
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Natalie Moll
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Alicia Rosello
- Statistics, Modelling and Economic Department, National Infection Service, PHE, London, UK ,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rod Bond
- University of Sussex, Brighton, UK
| | - Jaana Schnell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Bianka Burger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Pieter J. Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anette Schrag
- Department of Clinical Neuroscience, UCL Institute of Neurology, University College London, London, UK
| | - Eva Kocovska
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT UK
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
| | - Norbert Mueller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Markus Schwarz
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Ute-Christiane Meier
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,Ludwig-Maximilians-University Munich, Munich, Germany
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Mi Y, Zhao R, Sun X, Yu P, Wang W, Li J, Liang Z, Wang H, Wang G, Sun K. Sleep disturbances and sleep patterns in children with tic disorder: A case-control study. Front Pediatr 2022; 10:911343. [PMID: 35979406 PMCID: PMC9376246 DOI: 10.3389/fped.2022.911343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY OBJECTIVES To characterize sleep disturbances and sleep patterns in children with Tic disorder (TD), and explore their association with TD severity and types. METHODS A case-control study was conducted in 271 children with TD recruited from a clinical setting and 271 non-TD children recruited from a primary school, matched by age (mean = 8.47 years, SD = 1.53 years) and gender (15.1% female). The Children's Sleep Habits Questionnaire (CSHQ) was used to assess sleep patterns and sleep disturbances. The TD types and severity were assessed with the Yale Global Tic Severity Scale (YGTSS). RESULTS The TD children scored higher on CSHQ total score than non-TD group (t = 29.50, p < 0.001) and demonstrated severer global sleep disturbance. Compared to non-TD children, TD children presented with increased risks for global sleep disturbance (aOR: 1.95; 95% CI = 1.20-3.06), and most specific sleep disturbances, including bedtime resistance (aOR: 3.15; 95% CI = 1.96-5.06), sleep onset delay (aOR: 3.43; 95% CI = 1.58-7.46), sleep anxiety (aOR: 2.83; 95%CI = 1.83-4.38), parasomnias (aOR: 3.68; 95% CI = 2.02-6.62), night waking (aOR: 9.29; 95% CI = 2.64-32.65), sleep disordered breathing (aOR: 1.72; 95% CI = 1.03-2.90) and daytime sleepiness (aOR: 1.72; 95% CI = 1.09-2.74). Children with mild and moderate tics, Provisional Tic Disorder (PTD), Chronic Tic Disorder (CTD) and Tourette Syndrome (TS) presented with more global and more specific sleep disturbances. In addition, combined ADHD, etc. CONCLUSION Children with TD are major risks for increased sleep disturbances, especially for those with severe and chronic symptoms. Furthermore, comorbid ADHD increases risk in certain areas of sleep. These findings highlight the importance to consider sleep outcomes in the assessment and treatment for children with TD.
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Affiliation(s)
- Yunhui Mi
- Department of Traditional Chinese Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Runzhi Zhao
- Shanghai Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoning Sun
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Pediatric Translational Medicine Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Pingbo Yu
- Department of Traditional Chinese Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenqin Wang
- Traditional Chinese Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Jijun Li
- Department of Traditional Chinese Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhenwen Liang
- Shanghai University of Medicine and Health Sciences, College of Rehabilitation Sciences, Shanghai, China
| | - Hui Wang
- Psychology Teaching and Research Section, Zhabei No.1 Central Primary School, Shanghai, China
| | - Guanghai Wang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Pediatric Translational Medicine Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Kexing Sun
- Department of Traditional Chinese Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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20
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Sense of agency disturbances in movement disorders: A comprehensive review. Conscious Cogn 2021; 96:103228. [PMID: 34715456 DOI: 10.1016/j.concog.2021.103228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/08/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022]
Abstract
Sense of agency refers to the experience that one's self-generated action causes an event in the external environment. Here, we review the behavioural and brain evidence of aberrant experiences of agency in movement disorders, clinical conditions characterized by either a paucity or an excess of movements unrelated to the patient's intention. We show that specific abnormal agency experiences characterize several movement disorders. Those manifestations are typically associated with structural and functional brain abnormalities. However, the evidence is sometimes conflicting, especially when considering results obtained through different agency measures. The present review aims to create order in the existing literature on sense of agency investigations in movement disorders and to provide a coherent overview framed within current neurocognitive models of motor awareness.
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21
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Towards an Ideology-Free, Truly Mechanistic Health Psychology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111126. [PMID: 34769644 PMCID: PMC8583446 DOI: 10.3390/ijerph182111126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 01/04/2023]
Abstract
Efficient transfer of concepts and mechanistic insights from the cognitive to the health sciences and back requires a clear, objective description of the problem that this transfer ought to solve. Unfortunately, however, the actual descriptions are commonly penetrated with, and sometimes even motivated by, cultural norms and preferences, a problem that has colored scientific theorizing about behavioral control—the key concept for many psychological health interventions. We argue that ideologies have clouded our scientific thinking about mental health in two ways: by considering the societal utility of individuals and their behavior a key criterion for distinguishing between healthy and unhealthy people, and by dividing what actually seem to be continuous functions relating psychological and neurocognitive underpinnings to human behavior into binary, discrete categories that are then taken to define clinical phenomena. We suggest letting both traditions go and establish a health psychology that restrains from imposing societal values onto individuals, and then taking the fit between behavior and values to conceptualize unhealthiness. Instead, we promote a health psychology that reconstructs behavior that is considered to be problematic from well-understood mechanistic underpinnings of human behavior.
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Yang C, Yao L, Liu N, Zhang W, Tao B, Cao H, Gong Q, Lui S. Microstructural Abnormalities of White Matter Across Tourette Syndrome: A Voxel-Based Meta-Analysis of Fractional Anisotropy. Front Neurol 2021; 12:659250. [PMID: 34566829 PMCID: PMC8458640 DOI: 10.3389/fneur.2021.659250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/07/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: Tourette syndrome (TS) is a neuropsychiatric disorder with multiple motor and vocal tics whose neural basis remains unclear. Diffusion tensor imaging (DTI) studies have demonstrated white matter microstructural alternations in TS, but the findings are inconclusive. In this study, we aimed to elucidate the most consistent white matter deficits in patients with TS. Method: By systematically searching online databases up to December 2020 for all DTI studies comparing fractional anisotropy (FA) between patients with TS and healthy controls (HCs), we conducted anisotropic effect size-signed differential mapping (AES-SDM) meta-analysis to investigate FA differences in TS, as well as performed meta-regression analysis to explore the effects of demographics and clinical characteristics on white matter abnormalities among TS. Results: A total of eight datasets including 168 patients with TS and 163 HCs were identified. We found that TS patients showed robustly decreased FA in the corpus callosum (CC) and right inferior longitudinal fasciculus (ILF) compared with HCs. These two regions preserved significance in the sensitivity analysis. No regions of increased FA were reported. Meta-regression analysis revealed that age, sex, tic severity, or illness duration of patients with TS were not linearly correlated with decreased FA. Conclusion: Patients with TS display deficits of white matter microstructure in the CC and right ILF known to be important for interhemispheric connections as well as long association fiber bundles within one hemisphere. Because the results reported in the primary literature were highly variable, future investigations with large samples would be required to support the identified white matter changes in TS.
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Affiliation(s)
- Chengmin Yang
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Li Yao
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Naici Liu
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Wenjing Zhang
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Bo Tao
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Hengyi Cao
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China.,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, United States.,Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Su Lui
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
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Jung DH, Lee SJ. Prevalence of Ophthalmic Manifestations Related to Tourette Syndrome Based on Big Data. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.9.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To investigate the prevalence of ophthalmic manifestations in patients with Tourette syndrome using big data based on samples extracted from the Health Insurance Review and Assessment Service. Methods: The study participants included Korean patients under the age of 18 years who had received a Tourette syndrome diagnostic code (F95.2) between January 1, 2012, and December 31, 2016. Ophthalmic manifestations reported to be related to Tourette syndrome such as tic disorder, blepharospasm, involuntary gaze abnormality, and strabismus were selected as ophthalmic clinical diagnostic codes; amblyopia and refractive errors that had never been investigated in conjunction with Tourette syndrome were also selected. Prevalence was investigated using big data. Results: A total of 3,643 Tourette syndrome patients (2,777 men and 866 women) were included in the study. The number of patients receiving a tic disorder diagnostic code was 3,643 (100%); blepharospasm, 48 (1.3%); involuntary gaze abnormalities, 9 (0.2%); and strabismus, 109 (3%). In addition, the number of patients receiving an amblyopia diagnostic code was 29 (0.8%), and the number of patients with a refractive errors code was 1,306 (35.8%). Conclusions: Tourette syndrome can be accompanied by several ophthalmic manifestations. Thus, cooperation between a neuropsychiatrist and an ophthalmologist, and regular ophthalmological examinations, are considered necessary.
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24
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Joung YS, Lee MS. The therapeutic approaches in children and adolescent with Tourette’s disorder. PRECISION AND FUTURE MEDICINE 2021. [DOI: 10.23838/pfm.2020.00191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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25
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Gorodetski L, Loewenstern Y, Faynveitz A, Bar-Gad I, Blackwell KT, Korngreen A. Endocannabinoids and Dopamine Balance Basal Ganglia Output. Front Cell Neurosci 2021; 15:639082. [PMID: 33815062 PMCID: PMC8010132 DOI: 10.3389/fncel.2021.639082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/18/2021] [Indexed: 12/04/2022] Open
Abstract
The entopeduncular nucleus is one of the basal ganglia's output nuclei, thereby controlling basal ganglia information processing. Entopeduncular nucleus neurons integrate GABAergic inputs from the Striatum and the globus pallidus, together with glutamatergic inputs from the subthalamic nucleus. We show that endocannabinoids and dopamine interact to modulate the long-term plasticity of all these primary afferents to the entopeduncular nucleus. Our results suggest that the interplay between dopamine and endocannabinoids determines the balance between direct pathway (striatum) and indirect pathway (globus pallidus) in entopeduncular nucleus output. Furthermore, we demonstrate that, despite the lack of axon collaterals, information is transferred between neighboring neurons in the entopeduncular nucleus via endocannabinoid diffusion. These results transform the prevailing view of the entopeduncular nucleus as a feedforward “relay” nucleus to an intricate control unit, which may play a vital role in the process of action selection.
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Affiliation(s)
- Lilach Gorodetski
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Yocheved Loewenstern
- The Leslie and Susan Gonda Interdisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Anna Faynveitz
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Izhar Bar-Gad
- The Leslie and Susan Gonda Interdisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Kim T Blackwell
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - Alon Korngreen
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel.,The Leslie and Susan Gonda Interdisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
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26
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The α6 GABA A Receptor Positive Allosteric Modulator DK-I-56-1 Reduces Tic-Related Behaviors in Mouse Models of Tourette Syndrome. Biomolecules 2021; 11:biom11020175. [PMID: 33525455 PMCID: PMC7912006 DOI: 10.3390/biom11020175] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 12/22/2022] Open
Abstract
Tourette syndrome (TS) is a disabling neurodevelopmental disorder characterized by multiple, recurrent tics. The pharmacological treatment of TS is currently based on dopaminergic antagonists; however, these drugs are associated with extrapyramidal symptoms and other serious adverse events. Recent evidence suggests that positive allosteric modulators (PAMs) of GABAA receptors containing α6 subunits (α6 GABAARs) oppose the behavioral effects of dopamine. Building on this evidence, in the present study, we tested the efficacy of DK-I-56-1, a highly selective PAM for α6 GABAARs, in mouse models of TS exhibiting tic-related responses. DK-I-56-1 significantly reduced tic-like jerks and prepulse inhibition (PPI) deficits in D1CT-7 transgenic mice, a well-documented mouse model of TS. DK-I-56-1 also prevented the exacerbation of spontaneous eyeblink reflex induced by the potent dopamine D1 receptor agonist SKF 82958, a proxy for tic-like responses. We also showed that both systemic and prefrontal cortical administration of DK-I-56-1 countered the PPI disruption caused by SKF 82958. Although the effects of DK-I-56-1 were akin to those elicited by dopaminergic antagonists, this drug did not elicit extrapyramidal effects, as measured by catalepsy. These results point to α6 GABAAR PAMs as promising TS therapies with a better safety profile than dopaminergic antagonists.
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27
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Kakusa B, Saluja S, Barbosa DAN, Cartmell S, Espil FM, Williams NR, McNab JA, Halpern CH. Evidence for the role of the dorsal ventral lateral posterior thalamic nucleus connectivity in deep brain stimulation for Gilles de la Tourette syndrome. J Psychiatr Res 2021; 132:60-64. [PMID: 33045620 DOI: 10.1016/j.jpsychires.2020.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 09/08/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022]
Abstract
Gilles de la Tourette syndrome (GTS) can manifest as debilitating, medically-refractory tics for which deep brain stimulation (DBS) of the centromedian-parafascicular complex (CM) can provide effective treatment. However, patients have reported benefit with activation of contacts dorsal to the CM and likely in the ventro-lateral thalamus (VL). At our institution, a case of a robust and durable response in a GTS patient required stimulation in the CM and more dorsally. We explore the structural connectivity of thalamic subregions associated with GTS using diffusion MRI tractography. Diffusion weighted images from 40 healthy Human Connectome Project (HCP) subjects and our GTS patient were analyzed. The VL posterior nucleus (VLp) and the CM were used as seeds for whole-brain probabilistic tractography. Leads were localized via linear registration of pre-/post-operative imaging and cross-referenced with the DBS Intrinsic Template Atlas. Tractography revealed high streamline probability from the CM and VLp to the superior frontal gyrus, rostral middle frontal gyrus, brainstem, and ventral diencephalon. Given reported variable responses to DBS along the thalamus, we segmented the VLp based on its connectivity profile. Ventral and dorsal subdivisions emerged, with streamline probability patterns differing between the dorsal VLp and CM. The CM, the most reported DBS target for GTS, and the dorsal VLp have different but seemingly complimentary connectivity profiles as evidenced by our patient who, at 1-year post-operatively, had significant therapeutic benefit. Stimulation of both regions may better target reward and motor circuits, resulting in enhanced symptom control for GTS.
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Affiliation(s)
- Bina Kakusa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Sabir Saluja
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Daniel A N Barbosa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Sam Cartmell
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Jennifer A McNab
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA.
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28
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Coffey BJ. Potential New Tourette Syndrome Treatments: Will Real-Time Neurofeedback Have a Role? Biol Psychiatry 2020; 87:1019-1021. [PMID: 32498788 DOI: 10.1016/j.biopsych.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.
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29
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Kawahata I, Fukunaga K. Degradation of Tyrosine Hydroxylase by the Ubiquitin-Proteasome System in the Pathogenesis of Parkinson's Disease and Dopa-Responsive Dystonia. Int J Mol Sci 2020; 21:ijms21113779. [PMID: 32471089 PMCID: PMC7312529 DOI: 10.3390/ijms21113779] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022] Open
Abstract
Nigrostriatal dopaminergic systems govern physiological functions related to locomotion, and their dysfunction leads to movement disorders, such as Parkinson’s disease and dopa-responsive dystonia (Segawa disease). Previous studies revealed that expression of the gene encoding nigrostriatal tyrosine hydroxylase (TH), a rate-limiting enzyme of dopamine biosynthesis, is reduced in Parkinson’s disease and dopa-responsive dystonia; however, the mechanism of TH depletion in these disorders remains unclear. In this article, we review the molecular mechanism underlying the neurodegeneration process in dopamine-containing neurons and focus on the novel degradation pathway of TH through the ubiquitin-proteasome system to advance our understanding of the etiology of Parkinson’s disease and dopa-responsive dystonia. We also introduce the relation of α-synuclein propagation with the loss of TH protein in Parkinson’s disease as well as anticipate therapeutic targets and early diagnosis of these diseases.
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Affiliation(s)
- Ichiro Kawahata
- Correspondence: (I.K.); (K.F.); Tel.: +81-22-795-6838 (I.K.); +81-22-795-6836 (K.F.); Fax: +81-22-795-6835 (I.K. & K.F.)
| | - Kohji Fukunaga
- Correspondence: (I.K.); (K.F.); Tel.: +81-22-795-6838 (I.K.); +81-22-795-6836 (K.F.); Fax: +81-22-795-6835 (I.K. & K.F.)
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30
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Black KJ, Kim S, Schlaggar BL, Greene DJ. The New Tics study: A Novel Approach to Pathophysiology and Cause of Tic Disorders. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2020; 5:e200012. [PMID: 32587895 PMCID: PMC7316401 DOI: 10.20900/jpbs.20200012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We report on the ongoing project "The New Tics Study: A Novel Approach to Pathophysiology and Cause of Tic Disorders," describing the work completed to date, ongoing studies and long-term goals. The overall goals of this research are to study the pathophysiology of Provisional Tic Disorder, and to study tic remission (or improvement) in a prospective fashion. Preliminary data collection for the project began almost 10 years ago. The current study is nearing completion of its third year, and has already reported several novel and important results. First, surprisingly, at least 90% of children who had experienced tics for only a mean of 3 months still had tics at the 12-month anniversary of their first tic, though in some cases tics were seen only with remote video observation of the child sitting alone. Thus almost all of them now had a DSM-5 diagnosis of Tourette's Disorder or Persistent (Chronic) Tic Disorder. Baseline clinical features that predicted 12-month outcome included tic severity, subsyndromal autism spectrum symptoms, an anxiety disorder, and a history of 3 or more phonic tics. Second, we found that poorer tic suppression ability when immediately rewarded for suppression predicted greater tic severity at follow-up. Third, striatal volumes did not predict outcome as hypothesized, but a larger hippocampus at baseline predicted worse severity at follow-up. Enrollment and data collection continue, including functional connectivity MRI (fcMRI) imaging, and additional analyses are planned once the full sample is enrolled.
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Affiliation(s)
- Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Soyoung Kim
- Departments of Psychiatry and Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Bradley L. Schlaggar
- Kennedy Krieger Institute, Baltimore, MD 21205; and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Deanna J. Greene
- Departments of Psychiatry and Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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31
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Karki U, Sravanti L, Jacob P, Sharma E, Kommu JVS, Seshadri SP. Clinical Profile of Tic Disorders in Children and Adolescents from a Tertiary Care Center in India. Indian J Psychol Med 2020; 42:262-267. [PMID: 32612331 PMCID: PMC7320724 DOI: 10.4103/ijpsym.ijpsym_324_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/26/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Tic disorders (TDs) are common neurodevelopmental disorders in children and adolescents. To date, there is very scant literature on TDs in children and adolescents in the Indian setting. AIM The objectives of this study were to characterize the clinical profile, including comorbidities and pattern of medication use in the treatment of TDs, in children and adolescents. MATERIALS AND METHODS The present study is a retrospective chart review of children and adolescents up to age 18 years diagnosed with TD in a tertiary care center in India. Data were derived from case records of patients with a diagnosis of TD, coded as F 95 according to ICD 10, from 1st January 2014 to 31st December 2017. RESULTS We recruited 85 subjects. The majority (95.29%, n = 81) of them were male, and the mean age of onset was 8.4 years. Chronic tic disorder was the most common subtype, followed by Tourette syndrome and provisional or transient tic disorder. Eighty patients (94%) had a comorbid disorder, with attention deficit hyperactivity disorder being the most common, followed by obsessive compulsive disorder. Eighty-two percent of patients received pharmacotherapy. Risperidone was the most frequently used medication, followed by clonidine, haloperidol, and aripiprazole. Moderate to significant improvement with medications was seen in 88% of the patients. CONCLUSION The present study of children and adolescents with TDs highlights very high rate of comorbidity and a favorable short-term course with medication use.
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Affiliation(s)
- Utkarsh Karki
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Lakshmi Sravanti
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Preeti Jacob
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - John Vijay Sagar Kommu
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shekhar P Seshadri
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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32
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Schüller T, Fischer AG, Gruendler TOJ, Baldermann JC, Huys D, Ullsperger M, Kuhn J. Decreased transfer of value to action in Tourette syndrome. Cortex 2020; 126:39-48. [PMID: 32062469 DOI: 10.1016/j.cortex.2019.12.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/13/2019] [Accepted: 12/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Tourette syndrome is a neurodevelopmental disorder putatively associated with a hyperdopaminergic state. Therefore, it seems plausible that excessive dopamine transmission in Tourette syndrome alters the ability to learn based on rewards and punishments. We tested whether Tourette syndrome patients exhibited altered reinforcement learning and corresponding feedback-related EEG deflections. METHODS We used a reinforcement learning task providing factual and counterfactual feedback in a sample of 15 Tourette syndrome patients and matched healthy controls whilst recording EEG. The paradigm presented various reward probabilities to enforce adaptive adjustments. We employed a computational model to derive estimates of the prediction error, which we used for single-trial regression analysis of the EEG data. RESULTS We found that Tourette syndrome patients showed increased choice stochasticity compared to controls. The feedback-related negativity represented an axiomatic prediction error for factual feedback and did not differ between groups. We observed attenuated P3a modulation specifically for factual feedback in Tourette syndrome patients, representing impaired coding of attention allocation. CONCLUSION Our findings indicate that cortical prediction error coding is unaffected by Tourette syndrome. Nonetheless, the transfer of learned values into choice formation is degraded, in line with a hyperdopaminergic state.
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Affiliation(s)
- Thomas Schüller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany.
| | - Adrian G Fischer
- Otto von Guericke University, Center for Behavioral Brain Sciences, Magdeburg, Germany; Freie Universität Berlin, Center for Cognitive Neuroscience, Berlin, Germany
| | - Theo O J Gruendler
- Otto von Guericke University, Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Juan Carlos Baldermann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Daniel Huys
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Markus Ullsperger
- Otto von Guericke University, Center for Behavioral Brain Sciences, Magdeburg, Germany; Otto von Guericke University, Institute of Psychology, Magdeburg, Germany
| | - Jens Kuhn
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany; Johanniter Hospital Oberhausen, Department of Psychiatry, Psychotherapy and Psychosomatic, Oberhausen, Germany
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Chartove JAK, McCarthy MM, Pittman-Polletta BR, Kopell NJ. A biophysical model of striatal microcircuits suggests gamma and beta oscillations interleaved at delta/theta frequencies mediate periodicity in motor control. PLoS Comput Biol 2020; 16:e1007300. [PMID: 32097404 PMCID: PMC7059970 DOI: 10.1371/journal.pcbi.1007300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/06/2020] [Accepted: 12/19/2019] [Indexed: 01/02/2023] Open
Abstract
Striatal oscillatory activity is associated with movement, reward, and decision-making, and observed in several interacting frequency bands. Local field potential recordings in rodent striatum show dopamine- and reward-dependent transitions between two states: a "spontaneous" state involving β (∼15-30 Hz) and low γ (∼40-60 Hz), and a state involving θ (∼4-8 Hz) and high γ (∼60-100 Hz) in response to dopaminergic agonism and reward. The mechanisms underlying these rhythmic dynamics, their interactions, and their functional consequences are not well understood. In this paper, we propose a biophysical model of striatal microcircuits that comprehensively describes the generation and interaction of these rhythms, as well as their modulation by dopamine. Building on previous modeling and experimental work suggesting that striatal projection neurons (SPNs) are capable of generating β oscillations, we show that networks of striatal fast-spiking interneurons (FSIs) are capable of generating δ/θ (ie, 2 to 6 Hz) and γ rhythms. Under simulated low dopaminergic tone our model FSI network produces low γ band oscillations, while under high dopaminergic tone the FSI network produces high γ band activity nested within a δ/θ oscillation. SPN networks produce β rhythms in both conditions, but under high dopaminergic tone, this β oscillation is interrupted by δ/θ-periodic bursts of γ-frequency FSI inhibition. Thus, in the high dopamine state, packets of FSI γ and SPN β alternate at a δ/θ timescale. In addition to a mechanistic explanation for previously observed rhythmic interactions and transitions, our model suggests a hypothesis as to how the relationship between dopamine and rhythmicity impacts motor function. We hypothesize that high dopamine-induced periodic FSI γ-rhythmic inhibition enables switching between β-rhythmic SPN cell assemblies representing the currently active motor program, and thus that dopamine facilitates movement in part by allowing for rapid, periodic shifts in motor program execution.
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Affiliation(s)
- Julia A. K. Chartove
- Graduate program in Neuroscience, Center for Systems Neuroscience, Boston University, Boston, Massachusetts, United States of America
| | - Michelle M. McCarthy
- Department of Mathematics & Statistics, Boston University, Boston, Massachusetts, United States of America
| | | | - Nancy J. Kopell
- Department of Mathematics & Statistics, Boston University, Boston, Massachusetts, United States of America
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Çam Ray P, Gül Çelik G, Tahiroğlu A, Jaicks ÇCD, Avcı A. Çocukluk çağı tik bozukluklarının sosyodemografik ve klinik özellikleri. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.628103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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35
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Zapparoli L, Macerollo A, Joyce EM, Martino D, Kilner JM. Voluntary tic suppression and the normalization of motor cortical beta power in Gilles de la Tourette syndrome: an
EEG
study. Eur J Neurosci 2019; 50:3944-3957. [DOI: 10.1111/ejn.14548] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/30/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022]
Affiliation(s)
| | - Antonella Macerollo
- School of Psychology Faculty of Health and Life Sciences University of Liverpool Liverpool UK
- The Walton Centre NHS Foundation Trust Fazakerley UK
| | - Eileen M. Joyce
- Department of Clinical and Movement Neurosciences UCL Institute of Neurology London UK
| | - Davide Martino
- Department of Clinical Neurosciences University of Calgary Calgary Canada
- Hotchkiss Brain Institute University of Calgary Calgary Canada
| | - James M. Kilner
- Department of Clinical and Movement Neurosciences UCL Institute of Neurology London UK
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Wang Y, Li A. Regulatory effects of Ningdong granule on dopaminergic and serotonergic neurotransmission in a rat model of Tourette syndrome assessed by PET. Mol Med Rep 2019; 20:191-197. [PMID: 31115527 DOI: 10.3892/mmr.2019.10243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/20/2019] [Indexed: 11/06/2022] Open
Abstract
Dysfunctions in dopamine (DA) and serotonin (5‑HT) metabolism have been widely implicated in Tourette syndrome (TS); however, the exact nature of these dysfunctions remains unclear. The objective of the present study was to investigate the variation in DA and 5‑HT metabolism in a rat model of TS, and to evaluate the therapeutic effect of Ningdong granule (NDG), a traditional Chinese medicine (TCM) preparation used specifically for the treatment of TS. Rats were treated with 3,3'‑iminodipropionitrile for 7 days to induce the model of TS, and were then intragastrically administered NDG each day. After 8 weeks of treatment, micro‑positron emission tomography was used to measure the binding of DA D2 receptors (D2Rs), DA transporters (DATs), 5‑HT2A receptors (5‑HT2ARs) and 5‑HT transporters (SERTs) in brain regions of interest. The results indicated that NDG could significantly reduce the typical characteristics of TS in the rat model. Decreased D2R binding and increased DAT binding were detected in the striatum compared with the binding activities in untreated rats. The density of 5‑HT2AR was also significantly increased in the striatum following NDG treatment; however, SERT levels were decreased in certain brain regions, including the striatum, cortex, nucleus accumbens and amygdala. Taken together, the current results demonstrated that NDG may be effective in treating patients with TS.
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Affiliation(s)
- Yuan Wang
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Anyuan Li
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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37
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Corbit VL, Manning EE, Gittis AH, Ahmari SE. Strengthened Inputs from Secondary Motor Cortex to Striatum in a Mouse Model of Compulsive Behavior. J Neurosci 2019; 39:2965-2975. [PMID: 30737313 PMCID: PMC6462450 DOI: 10.1523/jneurosci.1728-18.2018] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/19/2018] [Accepted: 12/19/2018] [Indexed: 12/15/2022] Open
Abstract
Hyperactivity in striatum is associated with compulsive behaviors in obsessive-compulsive disorder (OCD) and related illnesses, but it is unclear whether this hyperactivity is due to intrinsic striatal dysfunction or abnormalities in corticostriatal inputs. Understanding the cellular and circuit properties underlying striatal hyperactivity could help inform the optimization of targeted stimulation treatments for compulsive behavior disorders. To investigate the cellular and synaptic abnormalities that may underlie corticostriatal dysfunction relevant to OCD, we used the Sapap3 knock-out (Sapap3-KO) mouse model of compulsive behaviors, which also exhibits hyperactivity in central striatum. Ex vivo electrophysiology in double-transgenic mice was used to assess intrinsic excitability and functional synaptic input in spiny projection neurons (SPNs) and fast-spiking interneurons (FSIs) in central striatum of Sapap3-KOs and wild-type (WT) littermates. While we found no differences in intrinsic excitability of SPNs or FSIs between Sapap3-KOs and WTs, excitatory drive to FSIs was significantly increased in KOs. Contrary to predictions, lateral orbitofrontal cortex-striatal synapses were not responsible for this increased drive; optogenetic stimulation revealed that lateral orbitofrontal cortex input to SPNs was reduced in KOs (∼3-fold) and unchanged in FSIs. However, secondary motor area (M2) postsynaptic responses in central striatum were significantly increased (∼6-fold) in strength and reliability in KOs relative to WTs. These results suggest that increased M2-striatal drive may contribute to both in vivo striatal hyperactivity and compulsive behaviors, and support a potential role for presupplementary/supplementary motor cortical regions in the pathology and treatment of compulsive behavior disorders.SIGNIFICANCE STATEMENT These findings highlight an unexpected contribution of M2 projections to striatal dysfunction in the Sapap3-KO obsessive-compulsive disorder (OCD)-relevant mouse model, with M2 inputs strengthened by at least sixfold onto both spiny projection neurons and fast-spiking interneurons in central striatum. Because M2 is thought to be homologous to presupplementary/supplementary motor areas (pre-SMA/SMA) in humans, regions important for movement preparation and behavioral sequencing, these data are consistent with a model in which increased drive from M2 leads to excessive selection of sequenced motor patterns. Together with observations of hyperactivity in pre-SMA/SMA in both OCD and Tourette syndrome, and evidence that pre-SMA is a potential target for repetitive transcranial magnetic stimulation treatment in OCD, these results support further dissection of the role of M2 in compulsivity.
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Affiliation(s)
- Victoria L Corbit
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania 15260
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, and
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15219
| | - Elizabeth E Manning
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania 15260
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15219
| | - Aryn H Gittis
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, and
| | - Susanne E Ahmari
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213,
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania 15260
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15219
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Abstract
PURPOSE OF REVIEW This article was written in order to bring the reader up to date with developments that have occurred in the treatment of Tourette disorder (TD) over the last 5 years. RECENT FINDINGS Despite the fact that TD has been recognized for over a century, the understanding of the underlying mechanisms remains poor. There has been limited development in the last 5 years for new therapeutic options. Aripipazole is the only newly approved pharmaceutical therapy for TD in the last 5 years, although several medications are under active study. For the most severely affected individuals, there is increasing experience with surgical interventions. One of the most promising areas of research is the work of genetic consortiums currently looking into identifying the underlying pathogenetic basis which in turn will hopefully lead to the development of safer and more effective therapies.
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Rae CL, Critchley HD, Seth AK. A Bayesian Account of the Sensory-Motor Interactions Underlying Symptoms of Tourette Syndrome. Front Psychiatry 2019; 10:29. [PMID: 30890965 PMCID: PMC6412155 DOI: 10.3389/fpsyt.2019.00029] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/17/2019] [Indexed: 11/17/2022] Open
Abstract
Tourette syndrome is a hyperkinetic movement disorder. Characteristic features include tics, recurrent movements that are experienced as compulsive and "unwilled"; uncomfortable premonitory sensations that resolve through tic release; and often, the ability to suppress tics temporarily. We demonstrate how these symptoms and features can be understood in terms of aberrant predictive (Bayesian) processing in hierarchical neural systems, explaining specifically: why tics arise, their "unvoluntary" nature, how premonitory sensations emerge, and why tic suppression works-sometimes. In our model, premonitory sensations and tics are generated through over-precise priors for sensation and action within somatomotor regions of the striatum. Abnormally high precision of priors arises through the dysfunctional synaptic integration of cortical inputs. These priors for sensation and action are projected into primary sensory and motor areas, triggering premonitory sensations and tics, which in turn elicit prediction errors for unexpected feelings and movements. We propose experimental paradigms to validate this Bayesian account of tics. Our model integrates behavioural, neuroimaging, and computational approaches to provide mechanistic insight into the pathophysiological basis of Tourette syndrome.
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Affiliation(s)
- Charlotte L. Rae
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Hugo D. Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
- Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom
| | - Anil K. Seth
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- School of Engineering and Informatics, University of Sussex, Brighton, United Kingdom
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40
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Ovsepian SV. The dark matter of the brain. Brain Struct Funct 2019; 224:973-983. [PMID: 30659350 DOI: 10.1007/s00429-019-01835-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/12/2019] [Indexed: 02/07/2023]
Abstract
The bulk of brain energy expenditure is allocated for maintenance of perpetual intrinsic activity of neurons and neural circuits. Long-term electrophysiological and neuroimaging studies in anesthetized and behaving animals show, however, that the great majority of nerve cells in the intact brain do not fire action potentials, i.e., are permanently silent. Herein, I review emerging data suggesting massive redundancy of nerve cells in mammalian nervous system, maintained in inhibited state at high energetic costs. Acquired in the course of evolution, these collections of dormant neurons and circuits evade routine functional undertakings, and hence, keep out of the reach of natural selection. Under penetrating stress and disease, however, they occasionally switch in active state and drive a variety of neuro-psychiatric symptoms and behavioral abnormalities. The increasing evidence for widespread occurrence of silent neurons warrants careful revision of functional models of the brain and entails unforeseen reserves for rehabilitation and plasticity.
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Affiliation(s)
- Saak V Ovsepian
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic. .,Faculty of Medicine at Charles University, 116 36, Prague, Czech Republic. .,Institute for Biological and Medical Imaging, Helmholtz Zentrum Munich, Neuherberg, Germany. .,Munich School of Bioengineering, Technical University Munich, Munich, Germany. .,International Centre for Neurotherapeutics, Dublin City University, Dublin, Republic of Ireland.
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Eisinger RS, Cernera S, Gittis A, Gunduz A, Okun MS. A review of basal ganglia circuits and physiology: Application to deep brain stimulation. Parkinsonism Relat Disord 2019; 59:9-20. [PMID: 30658883 DOI: 10.1016/j.parkreldis.2019.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Drawing on the seminal work of DeLong, Albin, and Young, we have now entered an era of basal ganglia neuromodulation. Understanding, re-evaluating, and leveraging the lessons learned from neuromodulation will be crucial to facilitate an increased and improved application of neuromodulation in human disease. METHODS We will focus on deep brain stimulation (DBS) - the most common form of basal ganglia neuromodulation - however, similar principles can apply to other neuromodulation modalities. We start with a brief review of DBS for Parkinson's disease, essential tremor, dystonia, and Tourette syndrome. We then review hallmark studies on basal ganglia circuits and electrophysiology resulting from decades of experience in neuromodulation. The organization and content of this paper follow Dr. Okun's Lecture from the 2018 Parkinsonism and Related Disorders World Congress. RESULTS Information gained from neuromodulation has led to an expansion of the basal ganglia rate model, an enhanced understanding of nuclei dynamics, an emerging focus on pathological oscillations, a revision of the tripartite division of the basal ganglia, and a redirected focus toward individualized symptom-specific stimulation. Though there have been many limitations of the basal ganglia "box model," the construct provided the necessary foundation to advance the field. We now understand that information in the basal ganglia is encoded through complex neural responses that can be reliably measured and used to infer disease states for clinical translation. CONCLUSIONS Our deepened understanding of basal ganglia physiology will drive new neuromodulation strategies such as adaptive DBS or cell-specific neuromodulation through the use of optogenetics.
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Affiliation(s)
- Robert S Eisinger
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Stephanie Cernera
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
| | - Aryn Gittis
- Biological Sciences and Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, Gainesville, FL, USA; Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA; Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neuroscience, University of Florida, Gainesville, FL, USA; Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Cavanna A, Nani A. Gilles de la Tourette syndrome: An overview. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2019. [DOI: 10.4103/amhs.amhs_122_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yang X, Liu W, Yi M, Zhang R, Xu Y, Huang Z, Liu S, Li T. Choline acetyltransferase may contribute to the risk of Tourette syndrome: Combination of family-based analysis and case-control study. World J Biol Psychiatry 2018; 19:521-526. [PMID: 28090804 DOI: 10.1080/15622975.2017.1282176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Twin and family analyses have revealed a genetic contribution to Tourette syndrome (TS) and post-mortem studies have raised the intriguing possibility of a reduction in cholinergic interneuronsin TS patients. METHODS We selected five tag SNPs (rs100824791, rs12264845, rs1880676, rs3793790 and rs3793798) of choline acetyltransferase (CHAT) from the Han Chinese population Hapmap database. Genotyping was conducted on 401 TS nuclear family trios and 405 control subjects. Transmission disequilibrium test (TDT) and haplotype relative risk (HRR) analyses were used to analyse the family-based study and a case-control study was also used to assess the genetic susceptibility to TS. RESULTS The results revealed a significant over-transmission of rs3793790 (TDT, χ2 = 9.121, P = 0.003; HRR, χ2 = 6.579, P = 0.01), while case-control analysis found no differences between the two groups (genotype, χ2 = 0.436, P = 0.804; allele, χ2 = 0.149, P = 0.700). Also, rs3793798 also indicated a positive association associated with TS (TDT, χ2 = 5.025, P = 0.028; HRR, χ2 = 0.250, P = 0.617). However, the other three SNPs investigated were found not to be associated with TS in both in the family-based and case-control studies. CONCLUSIONS Our association analysis demonstrates that CHAT may contribute to TS susceptibility in the Han Chinese population. This gives strong support to the involvement of cholinergic interneurons in the aetiology of TS and reveals a potential therapeutic target.
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Affiliation(s)
- Xiuling Yang
- a Department of Pediatrics , The Affiliated Hospital of Qingdao University , Qingdao , China.,b Department of Nursing , Medical College of Qingdao University , Qingdao , China
| | - Wenmiao Liu
- c Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University , Qingdao , China.,d Genetic Laboratory , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Mingji Yi
- e Child Health Care Department , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Ru Zhang
- c Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University , Qingdao , China.,d Genetic Laboratory , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Yinglei Xu
- c Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University , Qingdao , China.,d Genetic Laboratory , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Zuzhou Huang
- c Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University , Qingdao , China.,d Genetic Laboratory , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Shiguo Liu
- c Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University , Qingdao , China.,d Genetic Laboratory , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Tang Li
- a Department of Pediatrics , The Affiliated Hospital of Qingdao University , Qingdao , China
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45
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Gorodetski L, Zeira R, Lavian H, Korngreen A. Long-term plasticity of glutamatergic input from the subthalamic nucleus to the entopeduncular nucleus. Eur J Neurosci 2018; 48:2139-2151. [PMID: 30103273 DOI: 10.1111/ejn.14105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/24/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022]
Abstract
The hyperdirect pathway of the basal ganglia bypasses the striatum, and delivers cortical information directly to the subthalamic nucleus (STN). In rodents, the STN excites the two output nuclei of the basal ganglia, the entopeduncular nucleus (EP) and the substantia nigra reticulata (SNr). Thus, during hyperdirect pathway activation, the STN drives EP firing inhibiting the thalamus. We hypothesized that STN activity could induce long-term changes to the STN->EP synapse. To test this hypothesis, we recorded in the whole-cell mode from neurons in the EP in acute brain slices from rats while electrically stimulating the STN. Repetitive pre-synaptic stimulation generated modest long-term depression (LTD) in the STN->EP synapse. However, pairing EP firing with STN stimulation generated robust LTD that manifested for pre-before post-as well as for post- before pre-synaptic pairing. This LTD was highly sensitive to the time difference and was not detected at a time delay of 10 ms. To investigate whether post-synaptic calcium levels were important for LTD induction, we made dendritic recordings from EP neurons that revealed action potential back-propagation and dendritic calcium transients. Buffering the dendritic calcium concentration in the EP neurons with EGTA generated long term potentiation instead of LTD. Finally, mild LTD could be induced by post-synaptic activity alone that was blocked by an endocannabinoid 1 (CB1) receptor blocker. These results thus suggest there may be an adaptive mechanism for buffering the impact of the hyperdirect pathway on basal ganglia output which could contribute to the de-correlation of STN and EP firing.
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Affiliation(s)
- Lilach Gorodetski
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Reut Zeira
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Hagar Lavian
- The Leslie and Susan Gonda Interdisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Alon Korngreen
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel.,The Leslie and Susan Gonda Interdisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
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Striatal dopaminergic alterations in Tourette's syndrome: a meta-analysis based on 16 PET and SPECT neuroimaging studies. Transl Psychiatry 2018; 8:143. [PMID: 30072700 PMCID: PMC6072751 DOI: 10.1038/s41398-018-0202-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/17/2018] [Accepted: 06/05/2018] [Indexed: 01/07/2023] Open
Abstract
Despite intense research, the underlying mechanisms and the etiology of Tourette's syndrome (TS) remain unknown. Data from molecular imaging studies targeting the dopamine system in Tourette patients are inconclusive. For a better understanding of the striatal dopamine function in adult dopamine-antagonist-free patients we performed a systematic review in August 2017 identifying 49 PET and SPECT studies on the topic of TS. A total of 8 studies appraised the dopamine transporter (DAT) with 111 Tourette patients and 93 healthy controls, and could be included in a meta-analytic approach. We found a significantly increased striatal DAT binding in Tourette patients (Hedges' g = 0.49; 95% CI: (0.01-0.98)), although this effect did not remain significant after correcting for age differences between cohorts. A second meta-analysis was performed for the striatal dopamine receptor including 8 studies with a total of 72 Tourette patients and 71 controls. This analysis revealed a nonsignificant trend toward lower dopamine 2/3 receptor binding in striatum of Tourette patients. Other analyses regarding study population characteristics in both the DAT and receptor meta-analysis did not show any meaningful results. Our results indicate that dopaminergic alterations in TS are likely and thereby this data would be in line with the current pathophysiological hypotheses of a dysfunction in the dopamine system, e.g., the hypothesis of tonic-phasic dysfunction. However, these analyses suffer from low effect sizes probably due to the heterogeneity of TS and highlight the need for further large-scaled neuroimaging studies.
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Sun N, Nasello C, Deng L, Wang N, Zhang Y, Xu Z, Song Z, Kwan K, King RA, Pang ZP, Xing J, Heiman GA, Tischfield JA. The PNKD gene is associated with Tourette Disorder or Tic disorder in a multiplex family. Mol Psychiatry 2018; 23:1487-1495. [PMID: 28894297 PMCID: PMC5847395 DOI: 10.1038/mp.2017.179] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/24/2017] [Accepted: 06/07/2017] [Indexed: 01/29/2023]
Abstract
Tourette Disorder (TD) is a childhood-onset neuropsychiatric and neurodevelopmental disorder characterized by the presence of both motor and vocal tics. The genetic architecture of TD is believed to be complex and heterogeneous. Nevertheless, DNA sequence variants co-segregating with TD phenotypes within multiplex families have been identified. This report examines whole exomes of affected and unaffected individuals in a multiplex TD family to discover genes involved in the TD etiology. We performed whole exome sequencing on six out of nine members in a three-generation TD multiplex family. Putative deleterious sequence variants co-segregating with TD patients were identified by our in-house bioinformatics pipeline. Induced pluripotent stem cells (iPSCs) were generated from one unaffected and two TD affected individuals. Neurons were derived from the iPSCs and biochemical assays were conducted to evaluate possible molecular differences between affected and unaffected. A rare heterozygous nonsense mutation in PNKD was co-segregated with TD in this multiplex family. Transcript and protein levels of the PNKD long isoform were reduced in neurons derived from the individuals with TD due to the nonsense mutation, indicating nonsense-mediated mRNA decay. We demonstrated that the PNKD long isoform monomer oligomerizes with itself as well as interacts with the synaptic active zone protein RIMS1α. We concluded that reduced PNKD long isoform levels are detected in all affected individuals and we provide evidence for a mechanism whereby this might contribute to the TD phenotype.
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Affiliation(s)
- Nawei Sun
- Department of Genetics, Rutgers University, Piscataway, NJ, USA,Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Cara Nasello
- Department of Genetics, Rutgers University, Piscataway, NJ, USA,Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Li Deng
- Department of Genetics, Rutgers University, Piscataway, NJ, USA,Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Nan Wang
- Department of Genetics, Rutgers University, Piscataway, NJ, USA,Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Yeting Zhang
- Department of Genetics, Rutgers University, Piscataway, NJ, USA,Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Zihui Xu
- Child Health Institute of New Jersey, New Brunswick, NJ, USA
| | - Zhichao Song
- Department of Cell Biology and Neuroscience, Piscataway, NJ, USA
| | - Kelvin Kwan
- Department of Cell Biology and Neuroscience, Piscataway, NJ, USA
| | - Robert A. King
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Zhiping P. Pang
- Child Health Institute of New Jersey, New Brunswick, NJ, USA
| | - Jinchuan Xing
- Department of Genetics, Rutgers University, Piscataway, NJ, USA,Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Gary A. Heiman
- Department of Genetics, Rutgers University, Piscataway, NJ, USA,Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Jay A. Tischfield
- Department of Genetics, Rutgers University, Piscataway, NJ, USA,Human Genetics Institute of New Jersey, Piscataway, NJ, USA
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48
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Abstract
Gilles de la Tourette syndrome is a chronic and complex tic disorder accompanied by specific behavioral problems in the majority of patients. With its multifaceted interplay between motion and emotion, this condition is a paradigmatic example of the science and art of clinical neuropsychiatry. This review article encompasses the clinical phenomenology of motor and vocal tics and associated sensory experiences (premonitory urges), as well as the behavioral spectrum of the most common comorbidities, including obsessive-compulsive disorder, attention-deficit and hyperactivity disorder, affective symptoms, and impulsivity. Knowledge of the contributions of both tics and behavioral problems to patients' health-related quality of life across the lifespan should assist treating clinicians in formulating a targeted management plan. Although the exact pathophysiology of Gilles de la Tourette syndrome remains elusive, research into therapeutic interventions has expanded the range of available interventions across multiple domains. A thorough understanding of the neurology and psychiatry of this condition is of key importance to meet the needs of this patient population, from the formulation of an accurate diagnosis to the implementation of effective treatment strategies.
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49
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Qi C, Ji X, Zhang G, Kang Y, Huang Y, Cui R, Li S, Cui H, Shi G. Haloperidol ameliorates androgen-induced behavioral deficits in developing male rats. J Endocrinol 2018; 237:193-205. [PMID: 29563235 DOI: 10.1530/joe-17-0642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/21/2018] [Indexed: 01/06/2023]
Abstract
The purpose of present study was to infer the potential effects of testosterone increase in some male-based childhood-onset neuropsychiatric disorders, such as Tourette syndrome. Thus, the influence of early postnatal androgen exposure upon the neurobehaviors and its possible neural basis were investigated in the study. Male pup rats received consecutive 14-day testosterone propionate (TP) subcutaneous injection from postnatal day (PND) 7. The TP treatment produced the hyperactive motor behavior and grooming behavior as well as the increased levels of dopamine, tyrosine hydroxylase and dopamine transporter in the mesodopaminergic system and the elevated levels of serotonin in the nucleus accumbens, without affecting the levels of glutamate, γ-aminobutyric acid, norepinephrine and histamine in the caudate putamen and nucleus accumbens of PND21 and PND49 rats. Dopamine D2 receptor antagonist haloperidol was administered to the early postnatal TP-exposed PND21 and PND49 male rats 30 min prior to open field test. Haloperidol significantly ameliorated the motor behavioral and grooming behavioral defects induced by early postnatal TP exposure. The results demonstrated that early postnatal androgen exposure significantly disturbed the brain activity of developing male rats via enhancing the mesodopaminergic activity. It was suggested that abnormal increments of testosterone levels during the early postnatal development might be a potential risk factor for the incidence of some male-based childhood-onset neuropsychiatric disorders by affecting the mesodopaminergic system.
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Affiliation(s)
- Chunxiao Qi
- Department of NeurobiologyHebei Medical University, Shijiazhuang, People's Republic of China
- Department of Human AnatomyHebei Medical University, Shijiazhuang, People's Republic of China
| | - Xiaoming Ji
- Department of NeurobiologyHebei Medical University, Shijiazhuang, People's Republic of China
| | - Guoliang Zhang
- Department of Human AnatomyHebei Medical University, Shijiazhuang, People's Republic of China
| | - Yunxiao Kang
- Department of NeurobiologyHebei Medical University, Shijiazhuang, People's Republic of China
| | - Yuanxiang Huang
- Grade 2015 Eight-year Clinical Medicine ProgramSchool of Basic Medical Sciences, Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Rui Cui
- Department of Human AnatomyHebei Medical University, Shijiazhuang, People's Republic of China
| | - Shuangcheng Li
- Department of Human AnatomyHebei Medical University, Shijiazhuang, People's Republic of China
| | - Huixian Cui
- Department of Human AnatomyHebei Medical University, Shijiazhuang, People's Republic of China
- Neuroscience Research CenterHebei Medical University, Shijiazhuang, People's Republic of China
| | - Geming Shi
- Department of NeurobiologyHebei Medical University, Shijiazhuang, People's Republic of China
- Department of Human AnatomyHebei Medical University, Shijiazhuang, People's Republic of China
- Neuroscience Research CenterHebei Medical University, Shijiazhuang, People's Republic of China
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50
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Adams TG, Kelmendi B, Brake CA, Gruner P, Badour CL, Pittenger C. The role of stress in the pathogenesis and maintenance of obsessive-compulsive disorder. ACTA ACUST UNITED AC 2018. [PMID: 29527593 PMCID: PMC5841259 DOI: 10.1177/2470547018758043] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Individuals with obsessive-compulsive disorder often identify psychosocial stress
as a factor that exacerbates their symptoms, and many trace the onset of
symptoms to a stressful period of life or a discrete traumatic incident.
However, the pathophysiological relationship between stress and
obsessive-compulsive disorder remains poorly characterized: it is unclear
whether trauma or stress is an independent cause of obsessive-compulsive
disorder symptoms, a triggering factor that interacts with a preexisting
diathesis, or simply a nonspecific factor that can exacerbate
obsessive-compulsive disorder along with other aspects of psychiatric
symptomatology. Nonetheless, preclinical research has demonstrated that stress
has conspicuous effects on corticostriatal and limbic circuitry. Specifically,
stress can lead to neuronal atrophy in frontal cortices (particularly the medial
prefrontal cortex), the dorsomedial striatum (caudate), and the hippocampus.
Stress can also result in neuronal hypertrophy in the dorsolateral striatum
(putamen) and amygdala. These neurobiological effects mirror reported neural
abnormalities in obsessive-compulsive disorder and may contribute to an
imbalance between goal-directed and habitual behavior, an imbalance that is
implicated in the pathogenesis and expression of obsessive-compulsive disorder
symptomatology. The modulation of corticostriatal and limbic circuits by stress
and the resultant imbalance between habit and goal-directed learning and
behavior offers a framework for investigating how stress may exacerbate or
trigger obsessive-compulsive disorder symptomatology.
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Affiliation(s)
- T G Adams
- School of Medicine - Department of Psychiatry, Yale University.,Clinical Neuroscience Division of the VA National Center for PTSD
| | - B Kelmendi
- School of Medicine - Department of Psychiatry, Yale University.,Clinical Neuroscience Division of the VA National Center for PTSD
| | - C A Brake
- University of Kentucky, Department of Psychology
| | - P Gruner
- School of Medicine - Department of Psychiatry, Yale University
| | - C L Badour
- University of Kentucky, Department of Psychology
| | - C Pittenger
- School of Medicine - Department of Psychiatry, Yale University.,Clinical Neuroscience Division of the VA National Center for PTSD.,Child Study Center, Yale University.,Department of Psychology, Yale University
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