1. Motor Processing and Brain Activity Are Related to Cognitive-Behavioural Improvement
Marc E. Lavoie
Kieron P. O’Connor, Geneviève Thibault,
Frederick Aardema, Marie-Claude Pélissier, Emmanuel Stip
Louis-H Lafontaine Hospital
University of Montréal
Montréal, Québec, Canada

2. Definition of tic and habit disorders
Chronic tic disorder (CTD): simple or complex repetitive muscle contraction
Phonic
Motor
Habit disorders (HD): include destructive impulsive habits such as trichotillomania, onychophagia, scabiomania.
Tics are defined as repetitive nonvoluntary contractions of functionally related groups of skeletal muscles in one or
more parts of the body. Simple tics include blinking, cheek twitches, head or knee jerks, and shoulder shrugs.1–3 Complex
tics involve sequences of movements and may also take the form of repetitive actions or mannerisms such as gestures and
dystonic postures involving limbs, face, head, torso, or extremities.
Habit Disorders (HD) is a term covering a variety of destructive impulsive habits including trichotillomania,
bruxism, onychophagia, and scabiomania.
TD and HD have been viewed as part of the Obsessive-Compulsive Disorder (OCD) spectrum.7 Although TD and HD
have been compared independently with OCD, there has been little systematic inquiry into the common or distinguishing
features between TD and HD

3. Neuropsychology and brain imaging
Sensori-motor region subactivation.
CTD impaired in visuo-motor performance and motor skills.(1)
CTD and Tourette impaired in motor inhibition tasks.(2)
CTD and HD showed similar lack of synchrony between cortical activity and motor preparation.(2)
On the neuropsychological level, the most robust results involve trouble with visuo-motor integration. However, this problem could be subtended by other difficulties with attentional, visuo-spatial or inhibitory functions, as well as fine motor coordination.
There is good reason to think that CTD patients are impaired in various aspects of motor functions such as : motor dexterity, inhibition and preparation.
Bornstein et al. (1985, 1990, 1991)
O’Connor et al. (2005); Channon et al. (2000); Hollander et al. (1990)

4. Neuropsychological rehabilitation in press
First Questions …
Study 1 CBT modifies motor performance in adults with chronic tic and habit disorder
Neuropsychological rehabilitation in press
Is there any differences in motor functions between CTD, HD and controls?
Do CTD and HD react similarly to Cognitive-Behavioral Therapy?
For this first section, there is two main questions we want to address.
First:
Is there any differences in motor functions between CTD and HD?
And secondly:
Do they react similarly to Cognitive-Behavioral Therapy?

5. Design Screening Chronic tic disorder Baseline Control Habit Disorders
Random waitlist (33%)
Baseline
Cognitive-Behavioral Therapy
Post-CBT evaluation (75%)

6. Demographic data Chronic tic (n=54) Habit disorder (n=51) Control
ANOVA
Age 39 37 38 ns
F|M
21|33
31|20
21|11
Gen Health Quest 26 25 22
State anxiety 41 42 34
Trait anxiety 43 35
Overactivity -3 -2 8 *
Beck depression 10 12 -
Wisconsin card sorting test
Normal

7. Symptom distribution
Habit disorder
Chronic tic disorder

8. Motor function measures
Groove
Purdue pegboard
Hole steadiness

9. Hole Steadiness test (dominant hand)
No group effect
No CBT effect

10. Purdue pegboard (dominant hand)
Significant difference between control and both client groups at baseline and waitlist.
No difference between client groups.
Significant improvement after CBT.
Correlated with proportion of clinical change
r = 0.26
r = 0.25
ANOVA: F[1,81] = 14.36, p<0.0001)

11. Groove test (dominant hand)
Significant difference between control and CTD at baseline.
No difference between client groups.
Significant improvement after CBT for the CTD. *
significant effect over time (F[1,80] = 4.23, p<0.04)

12. Conclusion (study 1) Intact function Impaired function
Hole steadiness test
regulation of position on the basis of proprioceptive feedback
Impaired function
Motor coordination and dexterity
CTDs are mainly more impaired than HD.
Purdue pegboard improvement correlated with symptom improvement.

13. Next Questions … Low to moderate symptoms Tourette syndrome ?
Level of task complexity ?
Motor inhibition and brain activity ?

14. Study 2 CBT Modifies Brain Activity Related to Motor Performance in Adults with Tourette Syndrome
A pilot study

15. Demographic variables
Demographic data
Tourette Syndrome
(n=10)
Control
(n=14)
Mean σ
T-Test p
Demographic variables
Age (years) 40 13 36 11
-0,77 ns
Schooling (years) 15 3 2
-0,59
Raven intelligence (percentiles) 75 19 70 21
-0,65
Laterality (right %)
100 -
Gender (M/F ratio)
7/3
9/5
Visual acuity (Snellen)
1,32
0,38
1,34
0,36
0,14
Colour perception (Ishihara) 10
2,49
0,51
0,79
Clinical Variables
Tourette Syndrome Global Scale
Beck depression (BDI) 6 4
-3,31 **
Beck anxiety (BAI) 9 5
-3,25
PADUA - OCD (Global) 32 22 12 8
-2,78

16. EEG recordings Purdue pegboard 32 EEG channels
Event-Related Potentials
Purdue pegboard

17. Stop
Response GO

18. Automatic response

19. Complex response

20. Purdue pegboard Significant difference between TS and control pre CBT.
Normalization of motor dexterity post-CBT. *

21. Conclusion (study 2) Intact function Impaired function
Complex responses
Intact ability to inhibit complex responses.
Normal brain activity related to complex responses.
Impaired function
Automatic responses
Lower brain activation related to inhibition of automatic responses.
Impaired ability to inhibit automatic responses.
Normalized brain activity post-CBT.

22. Final conclusion
Tourette and CTD have similar impairment in motor dexterity.
Impairment in motor inhibition after automatic motor responses.
Could originate from dysfunction in the sensorimotor cortex in TS.
Reversible after CBT.

23. Thanks for your attention
Acknowledgments
Canadian Institute for Health Research
Fonds de la Recherche en Santé du Québec