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Limbic and motor circuits involved in symmetry behavior in Tourette's syndrome

Published online by Cambridge University Press:  03 December 2012

Froukje E. de Vries ,
Odile A. van den Heuvel ,
Danielle C. Cath ,
Henk J. Groenewegen ,
Anton J. L. M. van Balkom ,
Ronald Boellaard ,
Adriaan A. Lammertsma  and
Dick J. Veltman
Froukje E. de Vries*
Affiliation:
Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
Odile A. van den Heuvel
Affiliation:
Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
Danielle C. Cath
Affiliation:
Department of Clinical Psychology, University of Utrecht & Academic Anxiety Center Altrecht, Utrecht, the Netherlands
Henk J. Groenewegen
Affiliation:
Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
Anton J. L. M. van Balkom
Affiliation:
Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
Ronald Boellaard
Affiliation:
Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, the Netherlands
Adriaan A. Lammertsma
Affiliation:
Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, the Netherlands
Dick J. Veltman
Affiliation:
Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
*
*Address for correspondence: Froukje E. de Vries, VU University Medical Center, Medical Faculty, Department of Anatomy and Neuroscience, Room G 102-b, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands. (Email [email protected])
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Abstract

Objective

The need for symmetry and ordering objects related to a “just right”-feeling is a common symptom in Tourette's syndrome (TS) and resembles symmetry behavior in obsessive-compulsive disorder, but its pathophysiology is unknown. We used a symptom provocation paradigm to investigate the neural correlates of symmetry behavior in TS and hypothesized the involvement of frontal-striatal and limbic brain areas.

Methods

Pictures of asymmetrically and symmetrically arranged objects were presented in randomized blocks (4 blocks of each condition) to 14 patients with TS and 10 matched healthy controls (HC). A H215O positron emission tomography scan was acquired during each stimulus block, resulting in 8 scans per subject. After each scan, state anxiety and symmetry behavior (the urge to rearrange objects) were measured using a visual analogue scale.

Results

During the asymmetry condition, TS patients showed increased regional cerebral blood flow (rCBF) in the anterior cingulate cortex, supplementary motor area, and inferior frontal cortex, whereas HC showed increased rCBF in the visual cortex, primary motor cortex, and dorsal prefrontal cortex. Symmetry ratings during provocation correlated positively with orbitofrontal activation in the TS group and sensorimotor activation in the HC group, and negatively with dorsal prefrontal activity in HC.

Conclusions

Results suggest that both motor and limbic circuits are involved in symmetry behavior in TS. Motor activity may relate to an urge to move or perform tics, and limbic activation may indicate that asymmetry stimuli are salient for TS patients. In contrast, symmetry provocation in HC resulted in activation of brain regions implicated in sensorimotor function and cognitive control.

Keywords

Limbicobsessive-compulsivePETsymmetryTourette's syndrome
Type
Original Research
Information
CNS Spectrums , Volume 18 , Issue 1 , February 2013 , pp. 34 - 42
Copyright
Copyright © Cambridge University Press 2012

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