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Am J Psychiatry 1997; 154:1277-1284
Copyright © 1997 by American Psychiatric Association
Decreased motor inhibition in Tourette's disorder: evidence from transcranial magnetic stimulation
U Ziemann, W Paulus and A Rothenberger
Department of Clinical Neurophysiology, University of Gottingen, Germany.
OBJECTIVE: Fluctuating motor and vocal tics are the diagnostic feature of
Tourette's disorder. The pathophysiology of tics is still unclear. One
major hypothesis is a deficient inhibitory control through the
cortical-striatal-thalamic-cortical motor loop. The authors tested this
hypothesis by investigating motor cortex excitability through use of the
technique of transcranial magnetic stimulation. METHOD: Twenty patients
with Tourette's disorder and a comparison group of 21 healthy subjects were
studied. Focal transcranial magnetic stimulation was applied to the left
motor cortex, and surface electromyography (EMG) was recorded from the
right abductor digiti minimi muscle. As measures of motor cortex
excitability, motor threshold, cortical silent period, and intracortical
inhibition and facilitation were studied. The peripheral silent period and
the maximum M wave after supramaximal electrical stimulation of the ulnar
nerve at the wrist were also determined. RESULTS: Motor threshold and
peripheral motor excitability were normal in the Tourette's disorder group,
but the cortical silent period was shortened and the intracortical
inhibition reduced. A subgroup analysis of the patients with Tourette's
disorder revealed that these abnormalities were seen mainly when tics were
present in the EMG target muscle or in patients without neuroleptic
treatment. Age, sex, attention deficit hyperactivity disorder,
obsessive-compulsive disorder, and sensory urges had no significant effect
on motor excitability. CONCLUSIONS: Findings are consistent with the
hypothesis that tics in Tourette's disorder originate either from a
primarily subcortical disorder affecting the motor cortex through
disinhibited afferent signals or from impaired inhibition directly at the
level of the motor cortex or both.
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