Brain areas coactivating with motor cortex during chronic motor tics and intentional movements

Chronic tic disorders are characterized by motor tics that are often preceded by premonitory urges to tic. Functional neuroimaging studies have documented brain activity patterns prior to and during tics, but these studies have not examined whether the activation patterns differ from those seen in normal control subjects performing similar acts.

A novel method was used to compare brain patterns during tics and intentional movements. First, the part of motor cortex specific to each patient's tic movement was identified. The brain areas activating prior to, during, and after that part of motor cortex during tics were then identified by temporally cross-correlating the time course of the localized motor region with activity in other brain areas. Given that motor cortex was active during tic execution, this yielded information regarding the brain areas active prior to, during, and after the movements. The spatiotemporal pattern of coactivation with motor cortex during tics was contrasted with that seen in healthy control subjects during intentional tic-like movements.

Data from 16 adult subjects with tic disorders and 16 matched control subjects, who performed intentional movements similar to the patients' tics, revealed nearly identical patterns of cross-correlation to motor cortex throughout the brain in the two groups. However, the supplementary motor area showed a significantly broader profile of cross-correlation to motor cortex during tics than during intentional movements.

These findings highlight the importance of the supplementary motor area in tic generation and may point toward novel intervention strategies for individuals suffering with severe tics.