- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03914664
Neural Correlates of Sensory Phenomena in Tourette Syndrome
Study Overview
Status
Conditions
Detailed Description
Tourette syndrome (TS) is a multifaceted disorder that affects 0.6-1% of the global population. Across the lifespan, individuals with TS suffer worse quality of life (QOL) than the general population. While tics are the defining feature of TS, it is the widespread psychiatric and sensory symptoms that exert greater impact on QOL: more than 85% of individuals with TS are diagnosed with a psychiatric disorder, and 90% experience distressing sensory symptoms. The latest TS disease models and practice guidelines account for common psychiatric symptoms, but sensory symptoms remain under-recognized and under-studied. Progress in understanding and treating TS requires deepening insight into the disorder's sensory dimension.
The most pervasive sensory manifestation of TS is sensory over-responsivity (SOR). SOR is defined as excessive behavioral response to commonplace environmental stimuli. SOR is associated with avoidant behavior and functional impairment. More than 50% of children and 80% of adults with TS report SOR. Across age groups, SOR is positively correlated with severity of tics and psychiatric symptoms and negatively correlated with QOL. Thus, SOR is an integral facet of the TS phenotype, one intertwined with core elements of the disorder and worse QOL. This proposal seeks to clarify the mechanistic bases of SOR in TS (Aims 1 and 2).
Enhanced understanding of SOR's neurobiological basis is crucial to a more complete knowledge of TS pathophysiology. Two neurophysiologic mechanisms are implicated in SOR: sensory gating impairment and autonomic hyperarousal. Sensory gating is the physiologic process whereby redundant environmental stimuli are filtered out in the early stages of perception. Impairment of sensory gating gives rise to altered sensory perception. Autonomic hyperarousal is a state of excessive sympathetic tone and/or reduced parasympathetic tone, which hampers behavioral adaptation to sensory input. In TS, multiple lines of evidence suggest both sensory gating and autonomic function are impaired. However, prior investigations have suffered from methodologic limitations and have not examined the link between neurophysiologic dysfunction and sensory symptoms.
Aim 1. Identify an electroencephalographic (EEG) signature of SOR in TS. Hypotheses: (1a) relative to healthy controls, TS adults exhibit impaired sensory gating; (1b) extent of impaired sensory gating in TS correlates with degree of SOR. We will recruit 60 TS adults and 60 age- and sex-matched healthy controls to complete rating scales for SOR, psychiatric symptoms, and tics. Subjects will then be monitored on dense-array scalp EEG during sequential auditory and tactile sensory gating paradigms.
Aim 2. Identify an autonomic signature of SOR in TS. Hypotheses: (2a) relative to healthy controls, TS adults exhibit autonomic hyperarousal in response to non-aversive sensory stimuli; (2b) extent of autonomic hyperarousal correlates with SOR severity in TS. Heart rate and electrodermal activity will be monitored during the Aim 1 sensory gating paradigms and during a 10-minute rest period. Heart rate variability and electrodermal activity will serve as indices of parasympathetic and sympathetic activity, respectively.
Impact: Results will clarify the extent of sensory gating impairment in TS, the nature of autonomic dysfunction in TS, and the clinical correlates of neurophysiologic dysfunction in TS.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: David A Isaacs, MD
- Phone Number: 615-875-7394
- Email: david.a.isaacs@vumc.org
Study Contact Backup
- Name: Michelle R Eckland, BS
- Phone Number: 615-875-7394
- Email: michelle.r.eckland.1@vumc.org
Study Locations
-
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Tennessee
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Nashville, Tennessee, United States, 37232-5400
- Recruiting
- Vanderbilt University Medical Center
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Contact:
- Michelle R Eckland, BS
- Phone Number: 615-875-7394
- Email: michelle.r.eckland.1@vumc.org
-
Principal Investigator:
- David A Isaacs, MD
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Sub-Investigator:
- Heather Riordan, MD
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
The two groups of participants will include:
- adult with Tourette syndrome or other chronic tic disorder
- healthy controls
Description
Inclusion criteria for TS arm:
- Diagnosis of Tourette syndrome or other chronic tic disorder
- ≥ 18 years of age
- Ability to complete survey instruments
- English fluency (given that all scales are validated in English)
Exclusion criteria for TS arm:
- Known diagnosis of autism spectrum disorder, developmental delay, cerebral palsy, other significant neurologic disease, schizophrenia, or psychotic disorders will be excluded, in order to lessen potentially confounding factors.
(Note: Patients with OCD, ADHD, anxiety, and/or depression will be permitted, given that these diagnoses are widely prevalent in the adult TS population.)
- Use of anti-seizure medications, stimulants, or other psychotropic medications known to alter EEG signal
- Recreational substance use within past 30 days
Inclusion criteria for healthy control arm:
- ≥ 18 years of age AND age within 5 years of a participant in the TS arm of same biological sex (for purposes of age- and sex-matching)
- Ability to complete survey instruments
- English fluency (given that all scales are validated in English)
Exclusion criteria for healthy control arm:
- Any neurologic or psychiatric diagnoses
- History of tics
- Use of any psychotropic medications within the past 30 days
- Recreational substance use within past 30 days
Study Plan
How is the study designed?
Design Details
- Observational Models: Case-Control
- Time Perspectives: Cross-Sectional
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Tourette Syndrome
Adults (>18 years of age) with diagnosis of Tourette syndrome
|
EEG testing procedure, comprised of somatosensory and auditory event-related potential paradigms, as well as resting state EEG
Autonomic function testing procedure, comprised of electrodes to determine heart rate variability and electrodermal activity (EDA)
|
Healthy Control
Adults who are generally healthy with no known neurologic or psychiatric diagnoses
|
EEG testing procedure, comprised of somatosensory and auditory event-related potential paradigms, as well as resting state EEG
Autonomic function testing procedure, comprised of electrodes to determine heart rate variability and electrodermal activity (EDA)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Network oscillations in response to sensory stimuli
Time Frame: Baseline
|
Neural activity captured on EEG can be spectrally decomposed into various frequency constituencies.
Neural activity in the gamma frequency range, so-called gamma band oscillations (GBOs), are associated with sensory processing and integration and are postulated to underlie sensory phenomena in TS.
|
Baseline
|
Heart rate variability
Time Frame: Baseline
|
Change beat-to-beat variability in heart rate
|
Baseline
|
Electrodermal activity in response to sensory stimuli
Time Frame: Baseline
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Sweat response changes within 1-3 seconds of non-aversive sensory stimulus
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Baseline
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Premonitory Urge to Tic Scale (PUTS)
Time Frame: Within 1 week of baseline
|
Validated self-report questionnaire comprised of 9 items assessing character and severity of premonitory urges.
Scale range: 9 (least affected) - 36 (most affected)
|
Within 1 week of baseline
|
Yale Global Tic Severity Scale (YGTSS)
Time Frame: Within 1 week of baseline
|
Validated, gold-standard clinician-administered tic assessment scale, comprised of 11 items.
Scale range: 0 (best) - 100 (worst)
|
Within 1 week of baseline
|
Dimensional Obsessive Compulsive Scale (DOCS)
Time Frame: Within 1 week of baseline
|
Validated self-report questionnaire assessing severity of obsessive and compulsive symptoms, comprised of 20 items.
Scale range 0 (least affected) - 80 (most affected)
|
Within 1 week of baseline
|
Adult ADHD Self-Report Screening Scale
Time Frame: Within 1 week of baseline
|
Validated self-report scale, developed since release of Diagnostic and Statistical Manual-V, comprised of 6 items.
Scale range 0 (least affected) - 24 (most affected)
|
Within 1 week of baseline
|
Generalized Anxiety Disorder 7 (GAD-7)
Time Frame: Within 1 week of baseline
|
Validated self-report scale assessing presence and extent of anxiety, comprised of 7 items.
Scale range 0 (least affected) - 21 (most affected)
|
Within 1 week of baseline
|
Patient Health Questionnaire 9 (PHQ-9)
Time Frame: Within 1 week of baseline
|
Validated self-report scale assessing presence and extent of depression, comprised of 9 items.
Scale range 0 (least affected) - 27 (most affected)
|
Within 1 week of baseline
|
Sensory Gating Inventory (SGI)
Time Frame: Within 1 week of baseline
|
Validated self-report questionnaire assessing sensory hypo- or hyper-sensitivity, comprised of 36 items.
The 4 sub-scales include Perceptual Modulation, Distractability, Over-Inclusion, and Fatigue and Stress Vulnerability.
Total scale range 0 (least affected) - 180 (most affected)
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Within 1 week of baseline
|
Sensory Perception Quotient (SPQ)
Time Frame: Within 1 week of baseline
|
Validated self-report questionnaire assessing sensory hypo- or hyper-sensitivity, comprised of 35 items.
Scale range 0 (highest sensory sensitivity) - 105 (lowest sensory sensitivity).
|
Within 1 week of baseline
|
Gilles de la Tourette Syndrome - Quality of Life Scale (GTS-QOL)
Time Frame: Within 1 week of baseline
|
Validated self-report questionnaire assessing health-related quality of life for patients with Tourette syndrome, comprised of 27 items.
Scale range 0 (best quality of life) - 108 (worst quality of life)
|
Within 1 week of baseline
|
Patient Reported Outcomes Measurement Information System (PROMIS) Sleep-Related Impairment
Time Frame: Within 1 week of baseline
|
Validated self-report questionnaire to measures sleep-related impairments, consisting of 8 items.
Scale range 0 - 100 (t-score scaled with lower values indicating less impairment).
|
Within 1 week of baseline
|
Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2)
Time Frame: Within 1 week of baseline
|
Validated self-report questionnaire assessing interoceptive sensibility, comprised of 37 items.
Each scale item is a statement to which respondents must select "never" (0) to "always" (5) on a six-point Likert scale.
No total MAIA-2 score exists.
Rather, individual scale items belong to one of eight MAIA-2 subscales.
For each subscale, higher score signifies more of that construct.
|
Within 1 week of baseline
|
Body Perception Questionnaire - Short Form (BPQ-SF)
Time Frame: Within 1 week of baseline
|
Validated self-report questionnaire assessing interoceptive sensibility, comprised of 46 items total, divided into 3 sections: Body Awareness (raw total score 26-130), Supradiaphragmatic Reactivity (raw total score 15-69), and Subdiaphragmatic Reactivity (raw total score 6-28).
Raw scores are converted to T-scores.
Higher raw and T-scores indicate greater maladaptive body awareness.
|
Within 1 week of baseline
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Mental Disorders
- Pathologic Processes
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Immune System Diseases
- Neurologic Manifestations
- Disease
- Genetic Diseases, Inborn
- Basal Ganglia Diseases
- Movement Disorders
- Neurodegenerative Diseases
- Heredodegenerative Disorders, Nervous System
- Neurodevelopmental Disorders
- Tic Disorders
- Hypersensitivity
- Syndrome
- Tourette Syndrome
- Sensation Disorders
Other Study ID Numbers
- NCoSPTS
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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