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Behavioral Therapy May Reduce Tourette Tics, Symptoms
Date:4/21/2011

By Ellin Holohan
HealthDay Reporter

THURSDAY, April 21 (HealthDay News) -- Tics and other problems plaguing people with Tourette syndrome can be significantly reduced with relaxation techniques and cognitive behavioral therapy, according to a small new study.

By using tests that measured symptoms common to the illness, the study found that 10 adult Tourette patients improved by 57 percent after cognitive behavioral therapy. Their brain activity also became more typical as measured electronically, the study found.

Cognitive behavioral therapy includes relaxation techniques, biofeedback and "habit reversal." The latter teaches patients to inhibit uncontrolled movement by practicing reverse "competitive" motions.

The study's lead author noted that the findings show that adult brains may be more malleable than once thought.

"Even during adulthood the brain is sufficiently plastic to reorganize its network concomitantly with behavioral change," said Marc Lavoie, a certified researcher at the University of Montreal, where the study was done. "The research showed that psychotherapy can modify cerebral activation," he said.

The study, done at the Louis-H. Lafontaine Hospital's Fernand-Seguin Research Centre, also showed significant fine motor skill improvement among study group members. The findings were published in April in a special edition of the International Journal of Cognitive Therapy.

According to the U.S. Centers for Disease Control, three out of every 1,000 children, mostly boys, are diagnosed with Tourette syndrome, a genetically based disorder often accompanied by anxiety and depression. Symptoms, usually peaking between 10 and 12 years of age, can include physical tics and verbal outbursts, as well as nail biting, hair pulling, face scratching and other repetitive self-inflicted injuries.

In the study, 10 Tourette patients were matched with a control group of 14 people who had no symptoms of Tourette or any other psychiatric disorder, based on age, sex, and intelligence. Both groups were tested on several scales measuring tic severity and other problems including anxiety and depression.

In one task, subjects were signaled by traffic lights on a computer screen, starting with a yellow light warning that in four seconds they would be asked to perform one of two actions, either pressing a lever three times in a row, or giving a Morse code signal with dashes and dots. In half the trials, subjects were signaled to stop by a red stop sign prior to a green "go" light. The aim was to measure problems with stopping an action, something difficult for Tourette patients, according to Lavoie.

After four months of behavioral therapy, the study group was retested, serving as its own control group, which Lavoie called a "more powerful" approach than comparing groups with and without therapy.

The study also examined changes in brain activity, measured by an electroencephalogram, as patients did the traffic light task, both before and after therapy.

Research cited in the study points to basal ganglia dysfunction as a suspected cause. Basal ganglia are brain structures involved with physical coordination.

Common conditions sometimes associated with Tourette syndrome include obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and other learning problems, noted Dr. Ian Butler, a pediatric neurologist at Children's Memorial Hermann Hospital/UTHealth in Houston.

"If we could solve Tourette, we would solve a lot of things," he said.

Yet those who have Tourette are also "resilient" and do "amazingly well" when diagnosed and treated, according to Butler, who said he had reservations about using cognitive behavior therapy.

"The big problem with cognitive behavior therapy is how long do (the results) actually last?" asked Butler, adding, "I'm a big believer in educating the brain, so I don't have a problem with the study."

But, he noted, patients also usually improve on their own. Only about 11 percent of pediatric Tourette sufferers still have moderate symptoms as adults, according to previous research cited in the study. Butler also cautioned that because the study was small, it was open to question.

Medications used to treat Tourette should be used only for severe tics temporarily, added Butler. Negative side effects from medication can be a problem, the study noted.

A larger study is planned, according to Lavoie.

"We should be able to use our physiological assessment in order to refine the therapy in a more individualized manner," said Lavoie, adding that the techniques developed "can be adapted to other associated psychopathology such as ADHD or OCD in children as well as in adults."

More information

To learn more about Tourette syndrome, visit National Tourette Syndrome Association.

SOURCES: Marc Lavoie, Ph.D., certified researcher, Fernand-Seguin Research Centre, Louis-H. Lafontaine Hospital, Department of Psychiatry, University of Montreal; Ian Butler, M.D., pediatric neurologist, Children's Memorial Hospital/UTHealth, Houston, Texas; Houston, Texas, Special Edition, April 2011, International Journal of Cognitive Therapy


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