The microstructural change and its clinical severity association in pediatric Tourette syndrome patients

• Main Authors: Chia-Jui Hsu, 許家睿
• Other Authors: Wang-Tso Lee
• Format: Others
• Language: en_US
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/km63pr

碩士 === 國立臺灣大學 === 腦與心智科學研究所 === 107 === Background: Gilles de la Tourette syndrome (GTS) is a common pediatric neurological disorder manifested with involuntary movements and sounds with premonitory urge. Although the full pathogenic mechanism is still fully recognized, most studies reported the abnormality of cortico-striato-thalamo-cortical (CSTC) circuits. The neuroimage studies of GTS showed the widespread influence in the whole brain. Besides, the components of CSTC circuits, the involvement of corticospinal tracts, occipital region, or cerebellum were also reported. However, Due to participant heterogeneity such as comorbidities, treatment, disease duration or age, the result could be inconsistent. This study is the first study of microstructural change in treatment naïve pure GTS pediatric patients in diffusion spectrum imaging (DSI). Methods: This is a single center prospective study. We totally enrolled 30 patients and 30 age- and gender-matched healthy volunteers. All of the scans were acquired by 3 tesla scanner with 32-channel phased array coil. MR imaging consisted of sagittal T1-weighted and axial T2-weighted imaging. A total 102 diffusion encoding gradients with the maximum diffusion sensitivity were applied in DSI. The generalized fractional anisotropy (GFA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were analyzed by tract-based automatic analysis and calculated by independent t-test with false discovery rate adjusted q value. The neural fiber tracts with significant difference between patients and healthy controls were selected to calculate clinical association with tics severity scores by simple and multiple linear regression Result: The GFA value of right fronto-striatal (FS) tract of dorsolateral prefrontal cortex (DLPFC), right FS tract of precentral gyrus and bilateral thalamic radiation of DLPFC showed significant higher in the patient group. The RD value of those neural fiber tracts also showed the borderline lower in the patient group. Both of these results suggested increased connectivity in patient groups. The GFA value of right FS tract of precentral gyrus had negative correlation with the total tic severity scores at the most severe condition and the RD value of left thalamic radiation of DLPFC had positive correlation with motor tics severity at presence. Conclusion: The microstructural change of treatment naïve pure pediatric GTS patients showed increased connectivity within the CSTC circuit. The clinical association revealed negative correlation between GFA values of right FS tracts of precentral gyrus and total tics severity score at the most severe condition and positive correlation between RD values of left thalamic radiation of DLPFC and motor tics severity score at presence. The above results suggested the compensatory mechanism