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PI: Kevin Black (contact), Brad Schlaggar WUSTL
Summary:
At least 20% of all children have tics at some time in their life, making tic disorders a subject of substantial public health interest. In many children the tics will disappear before they’ve lasted as long as a year, but in others they go on to become Tourette syndrome or Chronic Tic Disorder (TS/CTD). Prior research generally has not clarified whether abnormalities of brain structure and function in children with TS/CTD are related to tic appearance or to the more important process of tic disappearance. This project will study children with recent-onset tics using clinical evaluation, MRI, and neuropsychological measures, and repeat these measures at the earliest time point that TS/CTD can be diagnosed. The results from the first assessment will be compared to results from two matching comparison groups: children with no personal or family history of tics, and children who have had tics for more than a year (Existing TS/CTD). This new approach may provide a new angle on research into Tourette syndrome, in addition to providing sorely needed information about prognosis for children who just started ticcing.
Funding:
Details:
At least 20% of all children have tics at some time in their life, making tic disorders a subject of substantial public health interest. However, only about 3% of all children have tics that last for a year or more. Thus chronic tic disorders, including Tourette syndrome, can be conceptualized as a two-step process: tics start, and then they fail to remit. By the numbers, the second part of this process is the more unusual and perhaps more closely related to disease, yet surprisingly, almost no research has examined this critical period after the first tic appears but before it is clear whether the child will go on to have a chronic tic disorder. Therefore prior research that has identified abnormalities of brain structure and function in children with TS generally does not clarify whether these abnormalities are related to tic appearance or to the more important process of tic disappearance. Furthermore, tic disappearance can be observed prospectively, allowing powerful within-subject analyses to test whether features of brain structure or function shortly after tic onset predict remission of tics before TS can be diagnosed, and whether such features are state-related or more durable markers of vulnerability to tics.
Colleagues in the TS field have agreed that such studies would be valuable, but have suspected that recruitment would be extremely difficult. However, we have now demonstrated enrollment of 40 subjects with New Tics (defined as beginning within the previous 6 months, median 3.5 months). When recruitment efforts were at their peak—though still on a shoestring budget without full staffing or media advertisements—we were recruiting at a rate of 16 subjects per year. We have implemented subject preparation and quality control methods that have allowed us to acquire structural and functional MRI data of high quality in most subjects.
We now propose to enroll an additional 70 subjects with New Tics and characterize them carefully at baseline and at the 1-year anniversary of tic onset (when TS can first be diagnosed). Both time points will include clinical data, structural and functional MRI, and neuropsychological measures including ability to suppress tics. We expect that complete data will be available for 55-70 subjects (including those already collected), since MRI is sensitive to movement and we are selecting for subjects with tics and additional difficulty holding still (about half of children with tics also have ADHD). We will compare baseline data from this sample to matched tic-free control subjects, and to matched subjects who already have TS or a chronic tic disorder. We will leverage existing data in our laboratories to provide clinical and MRI data for the control groups. Analyses will include tests of specific a priori hypotheses as well as machine learning analyses of the complete dataset. These comparisons will allow us to discover whether imaging differences in children with TS are present long before TS can be diagnosed, whether they fade when tics improve, and whether they predict outcome in children with new tics.
Investigation of this “pre-Tourette” population opens an entirely new window for etiologic discovery in tic disorders. It may also have clinical consequences, if the results identify which newly-ticcing children are at highest risk for development of a chronic tic disorder.