A new Yale study successfully trained a group of adolescents with Tourette’s syndrome to control their tics using functional magnetic resonance imaging. This marks the first time that fMRI— a technique which enables participants to look at their own brain function in real time — has been tested on patients with Tourette’s syndrome.

The study, which was a collaboration between Michelle Hampson, professor of psychiatry and of radiology and biomedical imaging at the Yale School of Medicine, and Denis Sukhodolsky, professor in the Yale Child Study Center, indicates that neurofeedback therapy, or the process of teaching a patient to self-regulate his or her brain function through real-time displays of brain activity, may be a promising new treatment of tic symptoms. The study was published on Aug. 13 in the journal Biological Psychiatry.

“I’m always looking for a neuropsychiatric disorder where we have a hypothesis about a causal aspect of the brain function, where intervening might result in symptom improvements,” Hampson said. “In Tourette’s syndrome, we had a hypothesis that the supplementary motor cortex might have a role like that, so it was a natural choice to look at this disorder.”

Tourette’s syndrome, which affects about 14 in 1,000 children, causes vocal and motor tics in children and adolescents, persisting into adulthood in some cases. Typically, these tics are treated with behavioral therapy and medications.

Neurofeedback therapy falls under a broader category of biofeedback, a method that uses various medical instruments to detect the activity of physiological functions. The patient can then use that feedback to learn to manipulate their physiological functions.

The supplementary motor cortex seems to play an important role in generating the tics associated with Tourette’s syndrome, as stimulation of the region produces movements and urges to move that are strikingly similar to tics. When Hampson noticed in previous work that neuroimaging of patients with Tourette’s syndrome highlighted this part of the brain, she became interested in testing neurofeedback therapy as a potential way to treat the disorder.

Presently, medications used to treat tics can cause unforeseen side effects, whereas neurofeedback therapy can be tailored to more accurately target the area of the brain that needs changing, Hampson explained.

“When you give someone a drug, you may be changing a whole lot you don’t want to change and you can’t control that very well, whereas with fMRI neurofeedback, you can really decide what you want to change and what you don’t want to change, in terms of patterns of brain activity,” she said.

Mitchell Ostrow ’21, who also researches Tourette’s syndrome at Yale and was not involved with the study, noted that neurofeedback training may have the potential to become a mainstream psychiatric treatment similar to cognitive behavioral therapy, a therapeutic method that aims to improve emotional regulation and develop coping skills.

“In terms of understanding the brain, the study emphasizes the control that the frontal cortex has over other modules of the brain. This study might indicate that the frontal cortex has a higher influence in the disorder than expected,” he added.

Although the study shows promising clinical potential for neurofeedback in controlling tics among adolescents with Tourette syndrome, Hampson said that far more work must be done before fMRI neurofeedback can be used clinically.

“fMRI neurofeedback has a lot of clinical potential in the long-term, but none of these impacts are short-term. A lot of development is still needed,” she said. “This study is not demonstrating efficacy — you need large trials to do that, but it is a promising start.”

The Child Study Center at Yale was established in 1911.

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