Rehabilitative rewiring: Treating Tourette syndrome with fMRI and neurofeedback

Illustration by Erin Cutler for rehabINK

News & Reports

By Kathleen Waterston


According to Tourette Canada, Tourette syndrome, or “Tourette’s”, affects 1% of the population (1). This neurological disorder is characterized by “tics” that develop during childhood, which are random and involuntary movements or sounds. While the exact cause of tics is unknown, a combination of genetic and environmental factors is suspected. Tics can be verbal or physical and are often embarrassing, uncomfortable, or even painful for people diagnosed with Tourette’s. A major concern with this condition is the psychological impact of these tics happening in public.

But trying to suppress tics is exhausting and only temporary. Pop artist Billie Eilish, who was diagnosed with Tourette’s as a child, said in a recent interview (2), “The thing is, the longer you suppress them, the worse they get afterwards. I’m sure one day everyone will see the tic attacks that happen when I’m stressed and haven’t slept.”

Current treatments for Tourette’s include behavioural therapy and medication. However, these treatments are not effective for everyone, and medication may have negative side effects. Alternate solutions are needed, and hope is on the horizon in the form of a technology-based therapy.

Recently, Yale University researchers were able to help adolescents diagnosed with Tourette syndrome significantly reduce the frequency of their tics (3). In their study published in the journal Biological Psychiatry, researchers reduced tic severity through a technology-based therapy which targets the brain region that produces tics. The technology used in this therapy was functional magnetic resonance imaging (fMRI), as well as neurofeedback. In clinical trials involving patients with Parkinson’s Disease (4) and Huntington’s Disease (5) ― neurodegenerative diseases with random involuntary movements like Tourette’s ― neurofeedback had a significantly positive effect on brain function. The Yale University study was the first to investigate the effects of neurofeedback in people with Tourette’s (3).

“The thing is, the longer you suppress them, the worse they get afterwards. I’m sure one day everyone will see the tic attacks that happen when I’m stressed and haven’t slept.” – Billie Eilish, pop artist

Imaging with fMRI is a method of measuring and mapping the brain activity of a person performing a task by tracking the volume of blood flow to different areas of the brain. Think of the brain as a big gas-powered machine composed of many smaller mechanisms. Blood flowing through the brain acts like the gas powering the function of each mechanism. As neural activity changes in certain brain regions, so does blood flow in these regions. It is these regional changes in blood flow which can be tracked using fMRI. Therefore, fMRI is technology that allows researchers to see in real-time, the brain areas being used when a person sees a certain image or performs a task ― and how intensely (6).

Neurofeedback is a therapeutic technique that uses fMRI imaging as a form of “feedback” to help pinpoint areas of disrupted connection in the brain. Imagine you have a sky-high view, gazing down on the public transit system in your city. When all the connections between each bus and train are made with exact, coordinated timing, the whole system runs smoothly. However, if one bus is always late because of construction or frequent interruptions, you never arrive at your destination on time. Looking down on the transit grid, you can see which link is not being made and then rearrange your route to try arriving in good time.

8_TS(in-text2)
Image source: Free-Photos (pixabay)

Getting used to your updated transit route can take time, and neurofeedback works similarly. The fMRI machine allows researchers to see where the problematic connections are occurring in the patient’s brain by tracking blood flow to different regions. To reorganize activity in the specific brain area with the problematic connections, fMRI blood flow information is used to direct repeated targeted thinking by the patient (7).

Targeted thinking by the patient involves thinking about specific actions or activities in order to activate particular brain regions. In neurofeedback therapy, targeted thinking allows patients to have more control over the direction of blood flow in their brain, which they can see in real-time fMRI visualizations. Although not a cure, neurofeedback as a therapy for seizure conditions, behaviour disorders, and other diseases can strengthen existing connections in the brain or even make new ones (7), thereby altering patients’ overall behaviours and the symptoms associated with their condition.

In the Yale University study, adolescent participants were guided in using fMRI and neurofeedback to alter their brain activity. First, they were instructed to imitate their tics while their brain activity was recorded using fMRI. This procedure allowed researchers to pinpoint which area of the brain, specific to each person, was active during the tics. Next, using the fMRI machine to visualize brain activity, the researchers helped participants target their thinking towards the tic-affected brain regions.

After only two sessions using fMRI and neurofeedback therapy, participants significantly reduced their tic severity, gaining some relief from Tourette’s defining symptom.

Michelle Hampson, lead researcher on the study, highlights the great potential of neurofeedback therapy for people with Tourette’s: “It is a non-invasive, neuroscience-based intervention for training human brain function towards healthier patterns” (8).

“It is a non-invasive, neuroscience-based intervention for training human brain function towards healthier patterns.” – Michelle Hampson, Yale University Researcher

The ability to identify the problematic areas in their brain is like the ability to deal with unreliable transit routes: making conscious changes to improve connections can be life changing. Neurofeedback is a promising, non-invasive therapy for significantly decreasing tic severity. As future research efforts enroll more participants into fMRI and neurofeedback studies, this novel therapy may prove to better the quality of life for people with Tourette’s.

Acknowledgements

Featured illustration by Erin Cutler for rehabINK.

Did you enjoy this article? Please help us improve by completing a short reader feedback survey. Thank you!

To refer to this article, it can be cited as:

Waterston K. Rehabilitative rewiring: Treating Tourette syndrome with fMRI and neurofeedback. rehabINK. 2020;8. Available from: https://rehabinkmag.com


References

  1. Tourette Canada. What is a tic? [Internet]. Tourette Canada; 2019 [Cited 2020 Jan 15]. Available from: https://tourette.ca/about-tourette-syndrome/questions-answers/what-is-ts/
  2. Garvey M. Who’s Billie Eilish? [Internet]. The Fader; 2019 [Cited 2020 Jan 15]. Available from: https://www.thefader.com/2019/03/05/billie-eilish-cover-story
  3. Sukhodolsky DG, Walsh C, Koller WN, Eilbott J, Rance M, Fulbright RK, Zhao Z. Randomized, sham-controlled trial of real-time fMRI neurofeedback for tics in adolescents with Tourette Syndrome. Biological Psychiatry. 2019; In Press, Journal Pre-proof.
  4. Subramanian L, Morris MB, Brosnan M, Turner DL, Morris HR, Linden DEJ. Functional Magnetic Resonance Imaging Neurofeedback-guided Motor Imagery Training and Motor Training for Parkinson’s Disease: Randomized Trial. Frontiers in Behavioral Neuroscience. 2016; 10:111.
  5. Papoutsi M, Weiskopf N, Langbehn D, Reilmann R, Rees G, Tabrizi SJ. Stimulating neural plasticity with real‐time fMRI neurofeedback in Huntington’s disease: A proof of concept study. 2017; Human Brain Mapping 39:3.
  6. UC San Diego School of Medicine. What is fMRI? [Internet]. Center for Functional MRI; [Cited 2020 Jan 15]. Available from: http://fmri.ucsd.edu/Research/whatisfmri.html
  7. Psychology Today. Neurofeedback [Internet]. Sussex Publishers, LLC; 2019 [Cited 2020 Jan 15]. Available from: https://www.psychologytoday.com/ca/therapy-types/neurofeedback
  8. Vaca N. Yale study uses real-time fMRI to treat Tourette Syndrome [Internet]. YaleNews; 21 August 2019 [Cited 2020 Jan 15]. Available from: https://news.yale.edu/2019/08/21/yale-study-uses-real-time-fmri-treat-tourette-syndrome