Transcranial Magnetic Stimulation to Augment Behavior Therapy for Tics

经颅磁刺激增强抽动行为疗法

• 批准号: 10041139
• 负责人: Christine A Conelea
• 金额: $ 124.89万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-10 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10041139
• 关键词: Acute; Adolescent; Adverse event; Affect; Aftercare; Age; Analysis of Variance; Area; Behavior; Behavior Therapy; Behavior assessment; Behavioral; Brain; Child; Childhood; Chronic; Clinical; Clinical assessments; Corpus striatum structure; Data; Development; Dose; Double-Blind Method; Functional Magnetic Resonance Imaging; Gilles de la Tourette syndrome; Gold; Hyperactive behavior; Intervention; Link; Literature; Measures; Mediating; Mental disorders; Modeling; Motor; Motor Cortex; Movement; Outcome; Pathway interactions; Patients; Phase; Pilot Projects; Randomized; Regimen; Research; Rest; Safety; Sampling; Severities; Symptoms; Testing; Tic disorder; Time; Transcranial magnetic stimulation; Youth; associated symptom; base; control trial; design; electric field; follow-up; functional outcomes; improved; neuromechanism; neuropsychiatric symptom; putamen; repetitive transcranial magnetic stimulation; response; tic suppression; vocalization

PROJECT SUMMARY/ABSTRACT Chronic tics affect 1-3% of youth in the US and are a disabling neuropsychiatric symptom associated with multiple childhood-onset mental disorders. Tic suppression using Comprehensive Behavioral Intervention for Tics (CBIT) is the current first-line, gold-standard therapy for tics. However, many patients do not fully benefit from CBIT, likely because they lack the fundamental tic suppression ability that CBIT aspires to enhance. Our preliminary data and the literature show that tic suppression ability can be enhanced with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the supplementary motor area (SMA). SMA is a key node of cortico-striatal circuits and is known to be hyperactive and hyperconnected in tic disorders. We therefore anticipate that combining CBIT with inhibitory stimulation of SMA may facilitate higher CBIT response rates. This study will test whether augmenting CBIT with inhibitory, noninvasive stimulation of SMA normalizes activity in SMA-mediated circuits and enhances tic suppression ability in young people with tic disorder. The R61 phase will compare two rTMS regimens, 1 Hz rTMS and continuous theta burst stimulation (cTBS), against sham stimulation. R61 aims will test engagement of brain (SMA-mediated circuits) and behavior (tic suppression ability) targets and identify the optimal rTMS regimen. To this end, 60 youth ages 12-21 years with chronic tics will complete 10 daily sessions of CBIT plus randomly assigned rTMS regimen, with fMRI, behavioral, and clinical assessments before and after treatment. The R33 phase will investigate the effects of CBIT augmentation with the optimal rTMS regimen in a double blinded randomized control trial in a new sample of 60 youth with chronic tics. R33 aims test the link between target engagement and functional outcomes, examine the clinical trajectory of the dose-response relationship, and assess intervention durability at 1 month follow-up. TMS targeting in both phases will be informed by individualized electric field modeling. This project will establish CBIT+rTMS as a treatment for chronic tics and provide a model for mechanistically studying pediatric interventions combining behavior therapy with neurostimulation. Results from this line of research will inform TMS therapy augmentation strategies and improve our understanding of neural mechanisms underlying CBIT, TMS, and tics.

项目摘要/摘要 慢性抽动影响美国1-3％的青年，是一种与之相关的神经精神症状 多种儿童期精神障碍。使用全面的行为干预措施进行抽动抑制 TICS（CBIT）是目前针对抽动的一线金标准疗法。但是，许多患者没有完全受益 来自CBIT，可能是因为它们缺乏CBIT渴望增强的基本抽动抑制能力。我们的 初步数据和文献表明，可以通过抑制重复来增强抽动抑制能力 补充运动区域（SMA）的经颅磁刺激（RTMS）。 SMA是关键节点 皮质 - 纹状体回路，已知在抽动疾病中是多动和超连接的。因此，我们 预计将CBIT与SMA的抑制刺激相结合可能会促进更高的CBIT响应率。 这项研究将测试通过抑制性，无创刺激SMA归一化的CBIT是否使CBIT归一化 SMA介导的电路中的活性并增强了血腥疾病年轻人的TIC抑制能力。这 R61相将比较两个RTMS方案，1 Hz RTM和连续的theta爆发刺激（CTBS）， 反对假刺激。 R61 AIMS将测试大脑（SMA介导的电路）和行为的参与度（TIC） 抑制能力）目标并确定最佳RTMS方案。为此，有60名12-21岁的青年与 慢性抽搐将完成10个每日CBIT和随机分配的RTMS方案，并使用fMRI， 治疗前后的行为和临床评估。 R33阶段将研究 在新的一项新的盲目的随机对照试验中，具有最佳RTMS方案的CBIT增强 样本的60名患有慢性抽动的青年。 R33目标测试目标参与与功能之间的链接 结果，检查剂量反应关系的临床轨迹，并评估干预耐用性 在1个月的随访中。两个阶段的TMS靶向将通过个性化的电场建模来告知。 该项目将建立CBIT+RTMS作为慢性抽动的治疗，并为机械提供模型 研究将行为疗法与神经刺激结合的小儿干预措施。这条线的结果 研究将为TMS治疗增强策略提供信息，并提高我们对神经的理解 CBIT，TMS和TICS的机制。

项目成果

Considerations for Pairing Cognitive Behavioral Therapies and Non-invasive Brain Stimulation: Ignore at Your Own Risk.

• DOI: 10.3389/fpsyt.2021.660180
• 发表时间: 2021
• 期刊: Frontiers in psychiatry
• 影响因子: 4.7
• 作者: Conelea CA;Jacob S;Redish AD;Ramsay IS
• 通讯作者: Ramsay IS

The CBIT+TMS Trial: study protocol for a two-phase randomized controlled trial testing neuromodulation to augment behavior therapy for youth with chronic tics.

CBIT TMS 试验：两阶段随机对照试验的研究方案，测试神经调节以增强患有慢性抽动症的青少年的行为治疗。

• DOI: 10.21203/rs.3.rs-2949388/v1
• 发表时间: 2023
• 期刊: Research square
• 作者: Conelea,Christine;Greene,Deanna;Alexander,Jennifer;Houlihan,Kerry;Hodapp,Sarah;Wellen,Brianna;Francis,Sunday;Mueller,Bryon;Hendrickson,Timothy;Tseng,Angela;Chen,Mo;Fiecas,Mark;Lim,Kelvin;Opitz,Alexander;Jacob,Suma
• 通讯作者: Jacob,Suma

The CBIT + TMS trial: study protocol for a two-phase randomized controlled trial testing neuromodulation to augment behavior therapy for youth with chronic tics.

• DOI: 10.1186/s13063-023-07455-1
• 发表时间: 2023-07-03
• 期刊: Trials
• 影响因子: 2.5