In 2011 a working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines for Tourette syndrome (TS). Now, we present an ...updated version 2.0 of these European clinical guidelines for Tourette syndrome and other tic disorders, part I: assessment. Therefore, the available literature has been thoroughly screened, supplemented with national guidelines across countries and discussions among ESSTS experts. Diagnostic changes between DSM-IV and DSM-5 classifications were taken into account and new information has been added regarding differential diagnoses, with an emphasis on functional movement disorders in both children and adults. Further, recommendations regarding rating scales to evaluate tics, comorbidities, and neuropsychological status are provided. Finally, results from a recently performed survey among ESSTS members on assessment in TS are described. We acknowledge that the Yale Global Tic Severity Scale (YGTSS) is still the gold standard for assessing tics. Recommendations are provided for scales for the assessment of tics and psychiatric comorbidities in patients with TS not only in routine clinical practice, but also in the context of clinical research. Furthermore, assessments supporting the differential diagnosis process are given as well as tests to analyse cognitive abilities, emotional functions and motor skills.
•We use a novel approach (EEG tensor decomposition) to study cognitive control.•We delineate overarching neurophysiological processes of cognitive control.•Results relate cognitive concepts with ...neurophysiology through tensor decomposition.
Executive functions are essential for adaptive behavior. One executive function is the so-called ‘interference control’ or conflict monitoring another one is inhibitory control (i.e., action restraint and action cancelation). Recent evidence suggests an interplay of these processes, which is conceptually relevant given that newer conceptual frameworks imply that nominally different action/response control processes are explainable by a small set of cognitive and neurophysiological processes. The existence of such overarching neural principles has as yet not directly been examined. In the current study, we therefore use EEG tensor decomposition methods, to look into possible common neurophysiological signatures underlying conflict-modulated action restraint and action cancelation as mechanism underlying response inhibition. We show how conflicts differentially modulate action restraint and action cancelation processes and delineate common and distinct neural processes underlying this interplay. Concerning the spatial information modulations are similar in terms of an importance of processes reflected by parieto-occipital electrodes, suggesting that attentional selection processes play a role. Especially theta and alpha activity seem to play important roles. The data also show that tensor decomposition is sensitive to the manner of task implementation, thereby suggesting that switch probability/transitional probabilities should be taken into consideration when choosing tensor decomposition as analysis method. The study provides a blueprint of how to use tensor decomposition methods to delineate common and distinct neural mechanisms underlying action control functions using EEG data.
Non-invasive brain stimulation techniques including repetitive transcranial magnetic stimulation (rTMS), continuous theta-burst stimulation (cTBS), paired associative stimulation (PAS), and ...transcranial direct current stimulation (tDCS) have been applied over the cerebellum to induce plasticity and gain insights into the interaction of the cerebellum with neo-cortical structures including the motor cortex. We compared the effects of 1 Hz rTMS, cTBS, PAS and tDCS given over the cerebellum on motor cortical excitability and interactions between the cerebellum and dorsal premotor cortex / primary motor cortex in two within subject designs in healthy controls. In experiment 1, rTMS, cTBS, PAS, and tDCS were applied over the cerebellum in 20 healthy subjects. In experiment 2, rTMS and PAS were compared to sham conditions in another group of 20 healthy subjects. In experiment 1, PAS reduced cortical excitability determined by motor evoked potentials (MEP) amplitudes, whereas rTMS increased motor thresholds and facilitated dorsal premotor-motor and cerebellum-motor cortex interactions. TDCS and cTBS had no significant effects. In experiment 2, MEP amplitudes increased after rTMS and motor thresholds following PAS. Analysis of all participants who received rTMS and PAS showed that MEP amplitudes were reduced after PAS and increased following rTMS. rTMS also caused facilitation of dorsal premotor-motor cortex and cerebellum-motor cortex interactions. In summary, cerebellar 1 Hz rTMS and PAS can effectively induce plasticity in cerebello-(premotor)-motor pathways provided larger samples are studied.
Information processing in the brain is governed by oscillatory activity. Activity oscillations in specific frequency bands (theta, alpha, beta and gamma) have been associated with various cognitive ...functions. A drawback of this is that the plethora of findings led to considerable uncertainty as to the functional relevance of activity in different frequency bands and their interrelation. Here, we use a novel cognitive-science theoretical framework to better understand and conceptually harmonize neurophysiological research on human action control. We outline how this validated starting point can systematize and probably reframe the functional relevance of oscillatory activity relevant for action control and beyond.
•Neural principles underlying perception-action integration depend on the immediate past.•Theta, alpha and beta band activities play specific roles in the outlined interdependencies.•The study ...delineates neural principles for a recently formulated cognitive concept on perception-action integration.
In recent years, there has been many efforts to establish a comprehensive theoretical framework explaining the working mechanisms involved in perception-action integration. This framework stresses the importance of the immediate past on mechanisms supporting perception-action integration. The present study investigates the neurophysiological principles of dynamic perception-action bindings, particularly considering the influence of the immediate history on action control mechanisms. For this purpose, we conducted an established stimulus-response binding paradigm during EEG recording. The SR-task measures stimulus-response binding in terms of accuracy and reaction time differences depending on the degree of feature overlap between conditions. Alpha, beta and theta band activity in distinct time domains as well as associated brain regions were investigated applying time-frequency analyses, a beamforming approach as well as correlation analyses. We demonstrate, for the first time, interdependencies of neuronal processes relying on the immediate past. The reconfiguration of an action seems to overwrite immediately preceding processes. The analyses revealed modulations of theta (TBA), alpha (ABA) and beta band activity (BBA) in connection with fronto-temporal structures supporting the theoretical assumptions of the considered conceptual framework. The close interplay of attentional modulation by gating irrelevant information (ABA) and binding and retrieval processes (TBA) is reflected by the correlation of ABA in all pre-probe-intervals with post-probe TBA. Likewise, the role of BBA in maintaining the event file until retrieval is corroborated by BBA preceding the TBA-associated retrieval of perception-action codes. Following action execution, TBA shifted towards visual association cortices probably reflecting preparation for upcoming information, while ABA and BBA continue to reflect processes of attentional control and information selection for goal-directed behavior. The present work provides the first empirical support for concepts about the neurophysiological mechanisms of dynamic management of perception and action.
Coherent, voluntary action requires an integrated representation of these actions and their defining features. Although theories delineate how action integration requiring binding between different ...action features may be accomplished, the underlying neurophysiological mechanisms are largely elusive. The present study examined the neurophysiological mechanisms underlying binding processes in actions. To this end, we conducted EEG recordings and applied standard event‐related potential analyses, temporal EEG signal decomposition and multivariate pattern analyses (MVPA). According to the code occupation account, an overlap between a planned and a to‐be‐performed action impairs performance. The level, to which performance is attenuated depends on the strength of binding of action features. This binding process then determines the representation of them, the so‐called action files. We show that code occupation and bindings between action features specifically modulate processes preceding motor execution as showed by the stimulus‐locked lateralized readiness potential (LRP). Conversely, motor execution processes reflected by the response‐locked LRP were not modulated by action file binding. The temporal decomposition of the EEG signal, further distinguished between action file related processes: the planned response determining code occupation was reflected in general (voluntary) response selection but not in involuntary (response priming‐related) activation. Moreover, MVPA on temporally decomposed neural signals indicated that action files are represented as a continuous chain of activations. Within this chain, inhibitory and response re‐activation patterns can be distinguished. Taken together, the neurophysiological correlates of action file binding suggest that parallel, stimulus‐ and response‐related pre‐motor processes are responsible for the code occupation in the human motor system.
Coherent, voluntary action requires an integrated representation of these actions and their defining features. We examined the underlying neurophysiological mechanisms using EEG recordings and applied standard event‐related potential analyses, temporal EEG signal decomposition and multivariate pattern analyses (MVPA). We show that the representation of motor features constituting an action depend on parallel, stimulus‐ and response‐related pre‐motor processes in the human motor system and that there is a gradual activation and declines of motor feature representations constituting actions.
Inhibition of inappropriate behavior is relevant in many everyday situations. Nevertheless, the mechanisms that induce response inhibition based on sensory information and what influences these ...mechanisms are not entirely understood. We examined neurophysiological processes of perception–action integration in response inhibition and the impact of the pre-trial neurophysiological functional connectivity state in the theta and alpha band on these integration processes. The study was motivated by the Theory of Event Coding framework. Within the trial, fronto-medial theta band activity and occipital alpha band activity revealed an opposing interplay depending on the necessity of (re-)binding event files, i.e., the disintegration and recombination of stimulus–response associations, during response inhibition. When response inhibition required the reconfiguration of event files, this was associated with increased theta band activity but lower alpha band activity, and vice versa for the retrieval of event files. Notably, the most substantial impact of pre-trial connectivity on the within-trial event file binding effect (the difference between conditions that require reconfiguration and those that do not) during response inhibition occurred between fronto-medial areas and areas of the ventral stream in the theta frequency band. This suggests a preparatory top-down control of sensory areas before stimulus presentation. Increased pre-trial connectivity was associated with a decreased event file binding effect in the alpha frequency band and an increased event file binding effect in the theta frequency band during response inhibition. This implies an impact of the pre-trial functional connectivity state on inhibitory gating processes of relevant information and event file (re-)binding during response inhibition. The study shows how perception–action integration during response inhibition is affected by preceding transient neurophysiological connectivity states.
When facing particular combinations of stimuli and responses, people create temporary event-files integrating the corresponding stimulus and response features. Subsequent repetition of one or more of ...these features retrieves the entire event-file, which impairs performance if not all features are repeated (partial-repetition costs). In the literature, different decay functions have been reported presumably dependent on the type of feature that is repeated (e.g. target vs. distractor features). Here, we use a variant of the S1R1-S2R2 and distractor-response binding task and analyze for the first time target-based and distractor-based event-file decay functions within the same task and sample. While we found evidence for decay functions and also stronger retrieval due to target than distractor repetitions, slopes of the decay functions were comparable suggesting that the decay process itself is equal irrespective of the type of stimulus feature that is repeated. Our study thereby confirms overarching approaches that summarize paradigm specific findings with the same set of core processes.
In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological ...treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients’ self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient’s needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician’s preferences, experience, and local regulatory requirements.
PDF
