Influence of sympathetic autonomic arousal on tics: Implications for a therapeutic behavioral intervention for Tourette syndrome

Nagai, Yoko; Cavanna, Andrea E.; Critchley, Hugo

doi:10.1016/j.jpsychores.2009.06.004

Cited by 64 publications

(45 citation statements)

References 39 publications

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“…Also, direct observation revealed tics are aggravated by easy reading assignments, reading in a quiet classroom, and by the period between assignments (Watson, Dufrene et al 2005). Conversely, it has been shown that periods of focused attention to tasks and reduced peripheral sympathetic tone inhibit tic expression (Nagai, Cavanna et al 2009). Another study revealed tic-related conversations increase the frequency of phonic tics (not motor tics) as compared to conversations that do not have to do with tics (Woods, Watson et al 2001).…”

Section: Exacerbating/alleviating Factorsmentioning

confidence: 99%

Clinical assessment of Tourette syndrome and tic disorders

Cohen

Leckman

Bloch

2013

Neuroscience & Biobehavioral Reviews

190

158

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Tourette Syndrome (TS) is a neuropsychiatric disorder involving multiple motor and phonic tics. Tics, which usually begin between the ages of 6 and 8, are sudden, rapid, stereotyped, and apparently purposeless movements or sounds that involve discrete muscle groups. Individuals with TS experience a variety of different sensory phenomena, including premonitory urges prior to tics and somatic hypersensitivity due to impaired sensorimotor gating. In addition to other conditions, stress, anxiety, fatigue, or other heightened emotional states tend to exacerbate tics, while relaxation, playing sports, and focused concentration on a specific task tend to alleviate tic symptoms. Ninety percent of children with TS also have comorbid conditions, such as Attention deficit hyperactivity disorder (ADHD), Obsessive-compulsive disorder (OCD), or an impulse control disorder. These disorders often cause more problems for the child both at home and at school than tics do alone. Proper diagnosis and treatment of TS involves appropriate evaluation and recognition, not only of tics, but also of these associated conditions.

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Section: Exacerbating/alleviating Factorsmentioning

confidence: 99%

Clinical assessment of Tourette syndrome and tic disorders

Cohen

Leckman

Bloch

2013

Neuroscience & Biobehavioral Reviews

190

158

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“…One study determined that relaxation biofeedback on galvanic skin response was successful in reducing tic frequency (Nagai, Cavanna, & Critchley, 2009). …”

Section: Stress Reduction In the Treatment Of Tsmentioning

confidence: 99%

The Modulating Role of Stress in the Onset and Course of Tourette’s Syndrome

et al. 2014

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Accumulating data indicate a common occurrence of tic exacerbations and periods of psychosocial stress. Patients with Tourette's syndrome (TS) also exhibit aberrant markers of hypothalamic-pituitary-adrenal (HPA) axis activation. Based on these findings, a functional relationship between stress and tic disorders has been suggested, but the underlying mechanism of how stress may affect tic pathology remains to be elucidated. We suggest that dopaminergic and noradrenergic neurotransmission as well as immunology play a crucial role in mediating this relationship. Two possibilities of causal direction might be assumed: (a) psychosocial stress might lead to an exacerbation of tics via activation of HPA axis and subsequent changes in neurotransmission or immunology and (b) TS-related abnormalities in neurotransmission or immunology result in a higher vulnerability of affected patients to respond to psychosocial stress with a strong activation of the HPA axis. It may also be the case that both assumptions hold true and interact with each other.

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“…Thus, there is evidence that both sympathetic and parasympathetic factors influence tic expression, and our pilot TS study (Nagai et al, 2009a) suggested that acute attenuation of sympathetic activity promptly reduced tic activity. In the current study, we conducted a randomized controlled trial to examine the possible translation of electrodermal biofeedback to a treatment for patients with TS.…”

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confidence: 65%

“…In a pilot study of biofeedback in TS (Nagai et al, 2009a), we tested an easy-to-implement approach targeting peripheral sympathetic arousal indexed by electrodermal activity, which reflects sympathetic nervous control of the activity of eccrine sweat glands. In an earlier neuroimaging study (Nagai et al, 2004a), we had found that reduction of electrodermal sympathetic tone was associated with greater activity within the orbitofrontal and ventromedial prefrontal cortex, regions also associated with affective responses and default (disengaged) brain states.…”

mentioning

confidence: 99%

“…In our proof-of-principle TS study (Nagai et al, 2009a), which lacked an explicit control condition, we tested the short-term effects of using electrodermal biofeedback to raise and lower sympathetic activity on the expression of tics in 15 patients. We found that a reduction in sympathetic tone, elicited using electrodermal biofeedback for 5 minutes, was associated with a reduction in tic frequency ( Figure 1).…”

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confidence: 99%

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Biofeedback Treatment for Tourette Syndrome

Nagai¹,

Cavanna²,

Critchley³

et al. 2014

Cognitive and Behavioral Neurology

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Our findings indicate that this form of biofeedback training was unable to produce a clinical effect greater than placebo. The main confounding factor appeared to be the 30-minute duration of the training sessions, which made it difficult for patients to sustain a reduction in sympathetic tone when their tics themselves were generating competing phasic electrodermal arousal responses. Despite a negative finding in this study, electrodermal biofeedback training may have a role in managing tics if optimal training schedules can be identified.

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Influence of sympathetic autonomic arousal on tics: Implications for a therapeutic behavioral intervention for Tourette syndrome

Cited by 64 publications

References 39 publications

Clinical assessment of Tourette syndrome and tic disorders

Clinical assessment of Tourette syndrome and tic disorders

The Modulating Role of Stress in the Onset and Course of Tourette’s Syndrome

Biofeedback Treatment for Tourette Syndrome

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