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 拟议项目是一项临床试验，旨在确认实时功能磁共振成像神经反馈干预的功效 涉及训练患有图雷特综合症的青少年控制其辅助运动区的区域 （SMA）被认为参与抽动的产生。干预措施包括提供 SMA 活动的反馈 在参与者练习监管该地区时向他们提供。他们被提示上调和下调 并鼓励尝试上调和下调的心理策略 有潜力改善他们的症状。对于上调，这包括参与以下心理想象： 复杂的运动活动，或进行精神要求高的认知任务，以便选择相关的神经 用于除抽动生成之外的任务的电路。对于下调，这包括想象轻松的场景 往往与压力水平的降低和抽动严重程度的降低有关。此次干预 之前在一项小型交叉设计研究中将其与假对照干预进行了比较， 取得了非常有希望的结果：观察到了巨大的临床效果，并且各组在其方面表现出差异 在神经反馈过程中调节 SMA 的能力。在这里，我们试图确认初步发现 在更大的、纯随机设计中的功效，包括对参与者的随访，并且重要的是，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 控制他们的视觉关联皮层的一个区域，该区域被认为与他们的症状无关。这 将为每个控制主体定义控制区域，以确保其没有功能连接 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进行了测试 功能磁共振成像神经反馈（假轭和控制区域训练）。鉴于不同类型的控制 条件排除了不同类型的混杂因素，这是测试此干预的最严格方法：如果 结果是有希望的，但不能将它们视为所使用的控制条件类型的产物而被忽视。简而言之， 通过拟议的临床试验，我们的目的是确认这种新干预措施的临床疗效，并验证 它通过假设的作用机制发挥作用（通过增强对 SMA 的控制） 神经反馈）。此外，干预对静息状态功能连接模式的影响将是 检查以更好地帮助我们理解训练引起的网络变化。