SMA Neurofeedback for Tourette Syndrome
Recruiting in Palo Alto (17 mi)
Overseen ByMichelle Hampson, PhD
Age: < 18
Sex: Any
Travel: May be covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Yale University
Disqualifiers: Autism, Bipolar, Psychotic, Heart disease, others
No Placebo Group
Trial Summary
What is the purpose of this trial?This trial involves using real-time brain scans to help adolescents with Tourette Syndrome or chronic tic disorder learn to control their brain activity. Participants see a graph of their brain activity and try to change it, which may help reduce their tics.
Do I have to stop taking my current medications for the trial?
No, you don't have to stop taking your current medications. The trial requires that your medication treatment is stable and that there are no planned changes during the study.
What data supports the effectiveness of the treatment SMA Neurofeedback for Tourette Syndrome?
Research suggests that using neurofeedback to control activity in the supplementary motor area (SMA) can help reduce tics in people with Tourette Syndrome. Studies have shown that participants can learn to control this brain area, which may help manage symptoms by altering brain connectivity patterns associated with tics.
12345Is SMA neurofeedback safe for humans?
Research on neurofeedback, including studies involving the supplementary motor area (SMA), suggests it is generally safe for humans. These studies have been conducted on both healthy individuals and those with conditions like Tourette Syndrome, with no significant safety concerns reported.
12367How does the SMA neurofeedback treatment differ from other treatments for Tourette Syndrome?
SMA neurofeedback is unique because it uses real-time brain imaging to help patients learn to control activity in a specific brain area linked to tics, the supplementary motor area (SMA). This approach is different from traditional treatments, as it focuses on altering brain activity patterns rather than using medication or behavioral therapy.
12346Eligibility Criteria
This trial is for boys and girls aged 10-16 with Tourette Syndrome or chronic tic disorder, who can perform tics without moving their head. They must have a certain score on the YGTSS scale, be stable on current medications, live within 2 hours of Yale Medical Center, speak English, and not have metal implants/braces or claustrophobia.Participant Groups
Adolescents are randomly assigned to receive either real neurofeedback from the supplementary motor area (SMA) or from a control region using fMRI technology. The goal is to see if targeting the SMA helps manage symptoms of Tourette Syndrome better than the control.
2Treatment groups
Experimental Treatment
Active Control
Group I: Neurofeedback from the SMAExperimental Treatment1 Intervention
Group II: Neurofeedback from control regionActive Control1 Intervention
Find A Clinic Near You
Research locations nearbySelect from list below to view details:
Yale University School of MedicineNew Haven, CT
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Who is running the clinical trial?
Yale UniversityLead Sponsor
National Institute of Mental Health (NIMH)Collaborator
References
Randomized, Sham-Controlled Trial of Real-Time Functional Magnetic Resonance Imaging Neurofeedback for Tics in Adolescents With Tourette Syndrome. [2021]Activity in the supplementary motor area (SMA) has been associated with tics in Tourette syndrome (TS). The aim of this study was to test a novel intervention-real-time functional magnetic resonance imaging neurofeedback from the SMA-for reduction of tics in adolescents with TS.
Biofeedback of real-time functional magnetic resonance imaging data from the supplementary motor area reduces functional connectivity to subcortical regions. [2021]Recent studies have reported that biofeedback of real-time functional magnetic resonance imaging data can enable people to gain control of activity in specific parts of their brain and can alter functional connectivity between brain areas. Here we describe a study using biofeedback of real-time functional magnetic resonance imaging data to train healthy subjects to control activity in their supplementary motor area (SMA), a region of interest in Tourette syndrome (TS). Although a significant increase in control over the SMA during biofeedback was not found, subjects were able to exert significant control over the SMA in later biofeedback sessions despite not having control in the first biofeedback session. Further, changes were found in their resting state functional connectivity. Specifically, when comparing functional connectivity to the SMA before and after biofeedback, the strength of functional connectivity with subcortical regions was reduced after the biofeedback. This suggests that biofeedback may allow subjects to develop greater conscious control over activity in their SMA by reducing the influence of corticostriatothalamocortical loops on the region. This possibility is promising for TS, where aberrant dynamics in corticostriatothalamocortical loops have long been suspected to give rise to tic symptoms. Further studies in TS patients are needed.
Protocol description for a randomized controlled trial of fMRI neurofeedback for tics in adolescents with Tourette Syndrome. [2023]This article describes the protocol for a randomized, controlled clinical trial of a neurofeedback (NF) intervention for Tourette Syndrome (TS) and chronic tic disorder. The intervention involves using functional magnetic resonance imaging (fMRI) to provide feedback regarding activity in the supplementary motor area: participants practice controlling this brain area while using the feedback as a training signal. The previous version of this NF protocol was tested in a small study (n = 21) training adolescents with TS that yielded clinically promising results. Therefore, we plan a larger trial. Here we describe the background literature that motivated this work, the design of our original neurofeedback study protocol, and adaptations of the research study protocol for the new trial. We focus on those ideas incorporated into our protocol that may be of interest to others designing and running NF studies. For example, we highlight our approach for defining an unrelated brain region to be trained in the control group that is based on identifying a region with low functional connectivity to the target area. Consistent with a desire for transparency and open science, the new protocol is described in detail here prior to conducting the trial.
Gilles de la Tourette syndrome and voluntary movement: a functional MRI study. [2008]Tourette syndrome (TS) is hypothesised to be caused by an abnormal organization of movement control. The aim of this study was to use functional magnetic resonance imaging to study motor cortex activation in a TS patient. Usual and unusual self-paced voluntary movements were performed. The TS patient displayed supplementary motor area (SMA) activation during both tasks. This activation reflects a continuous use of the SMA to perform the voluntary motor movements required in both tasks. Moreover, the absence of tics during the execution of these voluntary motor tasks suggests that tic activity may be suppressed by additional mental effort.
Upregulation of Supplementary Motor Area Activation with fMRI Neurofeedback during Motor Imagery. [2022]Functional magnetic resonance imaging (fMRI) neurofeedback (NF) is a promising tool to study the relationship between behavior and brain activity. It enables people to self-regulate their brain signal. Here, we applied fMRI NF to train healthy participants to increase activity in their supplementary motor area (SMA) during a motor imagery (MI) task of complex body movements while they received a continuous visual feedback signal. This signal represented the activity of participants' localized SMA regions in the NF group and a prerecorded signal in the control group (sham feedback). In the NF group only, results showed a gradual increase in SMA-related activity across runs. This upregulation was largely restricted to the SMA, while other regions of the motor network showed no, or only marginal NF effects. In addition, we found behavioral changes, i.e., shorter reaction times in a Go/No-go task after the NF training only. These results suggest that NF can assist participants to develop greater control over a specifically targeted motor region involved in motor skill learning. The results contribute to a better understanding of the underlying mechanisms of SMA NF based on MI with a direct implication for rehabilitation of motor dysfunctions.
Neurofeedback and its possible relevance for the treatment of Tourette syndrome. [2022]Neurofeedback is an increasingly recognized therapeutic option in various neuropsychiatric disorders to treat dysfunctions in cognitive control as well as disorder-specific symptoms. In this review we propose that neurofeedback may also reflect a valuable therapeutic option to treat executive control functions in Gilles-de-la-Tourette syndrome (GTS). Deficits in executive control functions when ADHD symptoms appear in GTS likely reflect pathophysiological processes in cortico-thalamic-striatal circuits and may also underlie the motor symptoms in GTS. Such executive control deficits evident in comorbid GTS/ADHD depend on neurophysiological processes well-known to be modifiable by neurofeedback. However, so far efforts to use neurofeedback to treat cognitive dysfunctions are scarce. We outline why neurofeedback should be considered a promising treatment option, what forms of neurofeedback may prove to be most effective and how neurofeedback may be implemented in existing intervention strategies to treat comorbid GTS/ADHD and associated dysfunctions in cognitive control. As cognitive control deficits in GTS mostly appear in comorbid GTS/ADHD, neurofeedback may be most useful in this frequent combination of disorders.
Enhancing Motor Network Activity Using Real-Time Functional MRI Neurofeedback of Left Premotor Cortex. [2020]Neurofeedback by functional magnetic resonance imaging (fMRI) is a technique of potential therapeutic relevance that allows individuals to be aware of their own neurophysiological responses and to voluntarily modulate the activity of specific brain regions, such as the premotor cortex (PMC), important for motor recovery after brain injury. We investigated (i) whether healthy human volunteers are able to up-regulate the activity of the left PMC during a right hand finger tapping motor imagery (MI) task while receiving continuous fMRI-neurofeedback, and (ii) whether successful modulation of brain activity influenced non-targeted motor control regions. During the MI task, participants of the neurofeedback group (NFB) received ongoing visual feedback representing the level of fMRI responses within their left PMC. Control (CTL) group participants were shown similar visual stimuli, but these were non-contingent on brain activity. Both groups showed equivalent levels of behavioral ratings on arousal and MI, before and during the fMRI protocol. In the NFB, but not in CLT group, brain activation during the last run compared to the first run revealed increased activation in the left PMC. In addition, the NFB group showed increased activation in motor control regions extending beyond the left PMC target area, including the supplementary motor area, basal ganglia and cerebellum. Moreover, in the last run, the NFB group showed stronger activation in the left PMC/inferior frontal gyrus when compared to the CTL group. Our results indicate that modulation of PMC and associated motor control areas can be achieved during a single neurofeedback-fMRI session. These results contribute to a better understanding of the underlying mechanisms of MI-based neurofeedback training, with direct implications for rehabilitation strategies in severe brain disorders, such as stroke.