Neurofeedback for Tourette Syndrome

Study Overview
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Brief Summary
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The aim of this study is to train patients with tic disorders to control activity in a region of their brain that has been associated with the urge to tic. Patients will be given direct feedback regarding activity in this brain area while they are undergoing functional magnetic resonance imaging (fMRI) scanning, and will try to learn to control activity in the region during these feedback sessions. In separate sessions, patients will be given sham feedback based on the brain patterns of a prior subject rather than their own brain patterns. Our primary hypothesis is that the biofeedback training will reduce their tic symptoms more than the sham feedback.

Official Title
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Neurofeedback of Activity in the Supplementary Motor Area for Tourette Syndrome

Conditions
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Tourette Syndrome, Chronic Tic Disorder

Intervention / Treatment
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* Procedure: Neurofeedback
* Procedure: Sham feedback


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of Tourette Syndrome or Chronic Tic Disorder currently active tics aged 11-19 ability to execute most common tics without moving head while lying on back Exclusion Criteria: Blindness (because feedback is provided visually) Lifetime diagnosis of pervasive developmental disorder, bipolar disorder, or psychotic disorder. Presence of any serious psychiatric or psychosocial condition requiring initiation of new treatment or change in current treatment. Neurological conditions affecting central nervous system, with the exception that predisposition to migraine will not be grounds for exclusion Change in medication in the month prior to beginning the study Unwillingness to keep medication stable over the course of the intervention Full braces (but some retainers are OK) Claustrophobia of a degree that they cannot comfortably be scanned If common tics involve dramatic changes in breathing that could alter blood oxygenation measurements Inability to keep head still while executing most common tics Inability to keep head still in mock scanner Inability or unwillingness to understand or follow the instructions Pregnancy or possible pregnancy Subjects may also be excluded after the first magnetic resonance scan if we are unable to localize a region of their supplementary motor area involved in tics - leaving us without a target area for biofeedback.

Ages Eligible for Study
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Minimum Age: 11 Years
Maximum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Neurofeedback first<br>Neurofeedback then sham feedback | Procedure: Neurofeedback<br> <br> * Other names: real-time fMRI biofeedback;Procedure: Sham feedback<br> <br> |
| Experimental: Sham first<br>Sham feedback then neurofeedback | Procedure: Neurofeedback<br> <br> * Other names: real-time fMRI biofeedback;Procedure: Sham feedback<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Tic severity | A modified version of the Yale Global Tic Severity Scale (YGTSS) will be used, that queries subjects regarding symptoms over the last 3 days (rather than the 2 week period used in the standard scale). Total YGTSS score on this modified scale will be used as the measure of tic severity. | Tic severity assessed approximately half a week PRIOR TO beginning biofeedback/sham feedback. | 
| Tic severity | A modified version of the Yale Global Tic Severity Scale (YGTSS) will be used, that queries subjects regarding symptoms over the last 3 days (rather than the 2 week period used in the standard scale). Total YGTSS score on this modified scale will be used as the measure of tic severity. | Tic severity assessed approximately half a week AFTER completing biofeedback/sham feedback. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Control over target brain area | Control task scans will be conducted in which subjects are cued to alternately increase and decrease activity in their target area without receiving any feedback. The percent signal change in the BOLD signal in the target area during increase relative to decrease blocks will be used as the measure of control over the brain area. | Assessed approximately half a week BEFORE biofeedback/sham biofeedback. | 
| Control over target brain area | Control task scans will be conducted in which subjects are cued to alternately increase and decrease activity in their target area without receiving any feedback. The percent signal change in the BOLD signal in the target area during increase relative to decrease blocks will be used as the measure of control over the brain area. | Assessed approximately half a week AFTER biofeedback/sham biofeedback. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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neurofeedback, biofeedback, real-time fMRI, rt-fMRI, functional connectivity, fMRI