Neurofeedback from the supplementary motor area for Tourette Syndrome

抽动秽语综合症辅助运动区的神经反馈

• 批准号: 10619647
• 负责人: Michelle Hampson
• 金额: $ 81.03万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-09 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619647
• 关键词: Adolescent; Adopted; Affect; Affective; Age; Area; Attention; Basic Science; Behavior Therapy; Behavioral; Biological Psychiatry; Brain; Child; Chronic; Clinical; Clinical Trials; Cognitive; Complex; Control Groups; Corpus striatum structure; Crossover Design; Cues; Data; Disease; Double-Blind Method; Down-Regulation; Electric Stimulation; Ensure; Evidence based treatment; Feedback; Forms Controls; Functional Magnetic Resonance Imaging; Functional disorder; Generations; Gilles de la Tourette syndrome; Intervention; Involuntary Movements; Learning; Manuals; Measures; Monitor; Morphologic artifacts; Motivation; Motor; Motor Activity; Movement; Neurodevelopmental Disorder; Participant; Patients; Pattern; Performance; Pharmaceutical Preparations; Psyche structure; Publishing; Randomized; Relaxation; Reporting; Research Design; Rest; Running; Sensory; Severities; Signal Transduction; Structure; Symptoms; Techniques; Testing; Time; Training; Treatment Efficacy; Up-Regulation; Visual; association cortex; clinical application; clinical effect; clinical efficacy; cognitive task; design; experimental group; follow-up; frontier; improved; interest; intervention effect; mental imagery; neural; neural circuit; neurofeedback; phenomenological models; stress reduction; symptomatic improvement

Abstract The proposed project is a clinical trial to confirm the efficacy of a real-time fMRI neurofeedback intervention that involves training adolescents with Tourette Syndrome to control a region of their supplementary motor area (SMA) believed to be involved in tic generation. The intervention involves providing feedback on SMA activity to participants while they practice regulating the region. They are cued to up-regulate and to down-regulate the area at different times and encouraged to try mental strategies for both up-regulating and down-regulating that have the potential to improve their symptoms. For up-regulation, this includes engaging in mental imagery of complex motor activities, or doing mentally demanding cognitive tasks, in order to co-opt the relevant neural circuitry for tasks other than tic generation. For down-regulation, this includes imagining relaxing scenarios that tend to be associated with reduced stress levels and an associated reduction in tic severity. This intervention was previously compared with a yoked sham control intervention in a small crossover design study that yielded very promising results: large clinical effects were observed and the groups showed differences in their ability to regulate the SMA during neurofeedback. Here we attempt to confirm that preliminary finding of efficacy in a larger, purely randomized design that includes follow-up of participants, and critically, employs a different form of control condition. In the proposed study, the control group will be trained via neurofeedback to control a region of their visual association cortex that is believed to be unrelated to their symptoms. This control region will be defined for each control subject in a manner that ensures it is not functionally connected to their SMA. By using this new form of control condition, this study ensures that the intervention has been tested against two of the most rigorous forms of control conditions used in clinical applications of real-time fMRI neurofeedback (yoked sham and training on a control region). Given that the different types of control conditions rule out different kinds of confounds, this is the most rigorous approach to testing this intervention: if results are promising, they cannot be dismissed as an artifact of the kind of control condition used. In short, with the proposed clinical trial, we aim to confirm the clinical efficacy of this new intervention, and to verify that it is acting via the hypothesized mechanism of action (enhancement of control over the SMA via neurofeedback). In addition, effects of the intervention on resting state functional connectivity patterns will be examined to better inform our understanding of the network changes induced by the training.

抽象的 拟议的项目是一项临床试验，以确认实时fMRI神经反馈干预的功效 这涉及培训与图雷特综合症的青少年，以控制其补充运动区域的区域 （SMA）被认为参与了抽动生成。干预涉及提供有关SMA活动的反馈 参与者在练习监管该地区的过程中。他们被提示上调并下调 在不同时间的区域，并鼓励尝试进行心理策略，以进行上调和下调 有可能改善其症状。对于上调，这包括参与 复杂的运动活动或做精神上要求的认知任务，以选择相关的神经 用于发电以外的任务的电路。对于下调，这包括想象一下放松的场景 倾向于与降低的应力水平和TIC严重程度降低有关。这种干预 以前已与小型跨界设计研究中的Yok Yokemhon对照干预进行了比较 产生的结果非常有希望：观察到很大的临床效应，并且组显示出差异 在神经反馈期间调节SMA的能力。在这里，我们试图确认初步发现 在包括参与者随访的较大，纯粹随机设计中的功效，并批判性地采用了 不同形式的控制条件。在拟议的研究中，对照组将通过神经反馈进行训练 控制其视觉关联皮层的区域，该区域被认为与其症状无关。这 将以确保其功能连接的方式为每个控制主题定义控制区域 到他们的SMA。通过使用这种新形式的控制条件，本研究确保了干预措施 针对实时临床应用中使用的两种最严格的控制条件形式测试 fMRI神经反馈（对照区域上的假手术和训练）。鉴于不同类型的控制 条件排除了不同种类的混杂，这是测试这种干预措施的最严格方法：如果 结果是有希望的，不能将其视为所使用的控制条件的工件。简而言之， 通过拟议的临床试验，我们旨在确认这种新干预的临床功效，并验证 它正在通过假设的作用机理作用（通过 神经反馈）。此外，干预对静止状态功能连接模式的影响将是 检查以更好地了解我们对培训引起的网络变化的理解。