Investigations of the Pathophysiology of Gilles de la Tourette Syndrome. Part 1: Simultaneous PET and 3T MRI
NCT ID: NCT05232955
Last Updated: 2024-04-01
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.
Recruitment Status
COMPLETED
Total Enrollment
40 participants
Study Classification
OBSERVATIONAL
Study Start Date
2022-05-04
Study Completion Date
2023-07-04
Brief Summary
Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.
Gilles de la Tourette syndrome (GTS; also known as Tourette syndrome) is a congenital neuropsychiatric disorder. Characteristic symptoms are so-called tics-rapid, repetitive movements (motor tics) or vocalizations (vocal tics) that start suddenly without any apparent purpose. Previous research supports the hypothesis of defective regulation (dysregulation) of the dopaminergic system, with particular discussion of dysfunction of tonic/phasic dopamine release or dopaminergic hyperinnervation. Moreover, given the complex interaction of different neurotransmitters, especially in the basal ganglia, it can be assumed that abnormal dopaminergic transmission also affects other transmitter systems, such as glutamate (Glu) or γ-aminobutyrate (GABA). Furthermore, recent results suggest an abnormality in cerebral iron metabolism in GTS. Since iron is accumulated in dopamine vesicles and plays a central role in dopamine synthesis, this observation may also be related to dysfunction of the dopaminergic system. Therefore, in this multimodal study, the investigators aim to combine positron emission tomography (PET), magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS) methods comparing patients with GTS and a control cohort.
In Part 1 of this study, MRI and MRS at 3 Tesla are employed to investigate (i) the binding potential of D1 dopamine receptors, (ii) the concentrations of Glu, glutamine and GABA in the corpus striatum and the cortex cingularis anterior and (iii) the subcortical iron concentration.
In Part 1 of this study, MRI and MRS at 3 Tesla are employed to investigate (i) the binding potential of D1 dopamine receptors, (ii) the concentrations of Glu, glutamine and GABA in the corpus striatum and the cortex cingularis anterior and (iii) the subcortical iron concentration.
Related Clinical Trials
Explore similar clinical trials based on study characteristics and research focus.
Investigations of the Pathophysiology of Gilles de la Tourette Syndrome. Part 2: 7T MRI
NCT05233306
Gilles de la Tourette Syndrome
Tourette Syndrome
COMPLETED
Exploration of Glutamatergic System With PET Radiotracer in Gilles de la Tourette Patients: Pilot Study (GlutaTour)
NCT03681795
Tourette Syndrome
UNKNOWN
NA
Role of Frontal Cortex in the Pathophysiology of Gilles de la Tourette Syndrome (GTS)
NCT03604510
Tourette Syndrome
COMPLETED
NA
Objective Characterizatoion of Repetitive Behaviors
NCT06050369
OCD
Tic Disorders
Gilles De La Tourette Syndrome
RECRUITING
NA
Cognitive and Brain Development in Adolescents With Gilles de la Tourette Syndrome
NCT04179435
Tourette Syndrome in Adolescence
UNKNOWN
NA
Detailed Description
Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.
State of the Art
Gilles de la Tourette Syndrome (GTS) is characterized by the presence of motor and vocal tics, which have been defined as rapid, habitual, burst-like movements or utterances that typically mimic fragments of normal behavior. Patients often report unpleasant premonitory urge sensations preceding tics that are relieved by their execution. Although the therapeutic spectrum for GTS has recently been expanding, current treatment strategies are often unsatisfactory, thus provoking the need for further elucidation of the underlying pathophysiology.
In current models of GTS pathophysiology, symptoms are thought to arise as a result of the inappropriate activation of specific clusters of striatal neurons, which lead to a burst-like disinhibition of thalamocortical output. The bulk of current literature suggests a dysregulated dopaminergic system. This is supported by clinical evidence of improvements in tics following the administration of dopamine antagonists, synthesis blockers or depletion drugs, and the exacerbation of symptoms following the administration of dopaminergic stimulants. Dopamine drives movement by activating a direct, net excitatory basal ganglia pathway involving the dopamine receptor D1 or an indirect, net inhibitory basal ganglia pathway involving the dopamine receptor D2. Currently, the vast majority of the antipsychotics used for the treatment of tics in GTS aim at the D2 receptor, with aripiprazole, risperidone and pimozide being selective D2 receptor antagonists and haloperidol being mainly a D2 receptor antagonist. However, recent randomized controlled trials further indicate promising results for the selective dopamine receptor D1 antagonist ecopipam.
Methodologically varied work has revealed that patients with GTS exhibit alterations in (i) D2 receptor density or binding, (ii) Dopamine Active Transporter (DAT) density/binding, and (iii) phasic dopamine transmission in striatal and cortical regions. A very small number of post-mortem examinations further suggest potential abnormalities in D1 (and D2 and DAT) receptor densities in cortical regions. While this would be in line with the therapeutic efficiency of selective D1 receptor antagonists, thorough experimental verification is missing. In particular, D1 receptors in GTS patients have not yet been investigated in vivo, suggesting a need for additional research.
Both postsynaptic and presynaptic mechanisms have been postulated to offer explanations of the above observations:
1. Supersensitive postsynaptic dopamine receptors were proposed, in particular to explain findings of reduced levels of homovanillic Acid (HVA) in cerebrospinal fluid (CSF) in GTS despite the premise of a hyperdopaminergic system. The validity of this view has been questioned as HVA levels may be confounded by medication, and previous positron emission tomography (PET) studies on dopamine receptors (although likely involved in the neurobiology of GTS) have produced inconsistent results.
2. Dopamine hyperinnervation, that is, an overabundance of striatal dopamine terminals was suggested to reflect observations of generally increased binding to the DAT and to the vesicular monoamine transporter type 2 (VMAT2).
3. Tonic-phasic dysfunction assumes reduced tonic dopamine levels as well as a hyperresponsive (spike-dependent) phasic dopaminergic system. A low tonic dopamine tone could be caused by an overactive DAT preventing efficient spillage to the extrasynaptic space and/or altered presynaptic dopamine D2 autoreceptor binding.
Apart from such considerations specific to dopamine one can postulate that if a dopaminergic abnormality were present, other neurotransmitter systems would exhibit perturbations as well. In particular, this is suggested by (i) the close synergy exhibited between excitatory, inhibitory and modulatory neurotransmitter systems within the striatum and throughout the brain; and (ii) the interdependent metabolic relationship exhibited between glutamate (Glu), and γ-aminobutyric acid (GABA) via the non-neuroactive metabolic intermediate glutamine (Gln). Moreover, an irregular afferent modulation of dopaminergic nuclei would have profound effects on tonic/phasic dopaminergic release in the striatum and the control of subsequent thalamocortical output. Consistently, separate groups have demonstrated that adult patients with GTS exhibit alterations within the GABAergic system in cortical regions using in vivo proton (1H) magnetic resonance spectroscopy (MRS) and subcortical regions using PET. Employing 1H MRS, the investigators recently found reductions in striatal concentrations of Gln and the sum of Glu plus Gln (Glx) in GTS patients as well as negative correlations between striatal Gln and actual tic severity and between thalamic Glu and premonitory urges. While these findings do not rule out alternative mechanisms, they lend support to the hypothesis of an alteration in the dynamics of the tonic/phasic dopaminergic signaling because chronic perturbations in the subcortical GABA-Glu-Gln cycle flux could lead to spatially focalized alterations in excitatory and inhibitory neurotransmitter ratios.
Another aspect of dopamine neurobiology that has recently gained interest in the context of neuroimaging is the relation to brain iron. Besides supporting myelination and cellular respiration, brain iron is crucial for the synthesis of neurotransmitters, in particular dopamine. It is stored primarily as ferritin and co-localizes with dopamine vesicles having the greatest concentration in the dopamine-rich basal ganglia and midbrain. As the major brain iron compounds have (super)paramagnetic properties, they can be detected via susceptibility-sensitive magnetic resonance (MR) techniques, such as quantitative susceptibility mapping (QSM) or measurements of the effective or the reversible transverse relaxation rates, R2\* or R2', respectively. Recent multimodal imaging targeted at (normal) developmental changes of the striatal dopamine system demonstrated that R2'-based estimates of tissue iron content were associated with carbon-11 \[11C\]dihydrotetrabenazine PET of presynaptic vesicular dopamine. This suggests that susceptibility-sensitive MR imaging (MRI), which does not require an intravenously applied radiotracer, might serve as a proxy for obtaining information on dopamine that could substitute measurements of HVA in CSF without sharing the same confounds. More recently, the investigators already obtained preliminary indications of disturbed iron homeostasis in GTS patients as evidenced by reduced serum ferritin and magnetic susceptibility in the striatum and further subcortical structures.
Objectives and Hypotheses
In continuation of previous investigations, the investigators plan to perform examinations with MRI and MRS in GTS patients in comparison to age- and sex-matched healthy controls within Part 2 of this combined study. This includes (indirect) information on the interplay of different neurotransmitter systems (Glu, and GABA), as well as on the role of brain iron in GTS.
In particular, the investigators plan to use (i) iron-sensitive MRI techniques, such as QSM and R2\* mapping, for obtaining indirect information on presynaptic dopamine availability; (ii) \[11C\]SCH23390 PET measures of cortical D1 receptor binding/densities in vivo in GTS patients; and (iii) 1H MRS with standard single-voxel techniques and spectral-editing methods, for obtaining neurochemical profiles and quantitative information on Glu, Gln, and GABA in the striatum and cortical areas.
Neuropsychological tests:
At the time of the MR and/or PET exams, an established, comprehensive test battery will be performed with all patients for a detailed clinical assessment, including the severity of tics or the presence of comorbidities. These tests may be performed online as a video conference questionnaire and include:
* DSM-IV-symptom list for attention deficit hyperactivity disorder (ADHD), rage attack questionnaire (RAQ), Pittsburgh sleep quality index (PSQI);
* Clinical ratings : Yale global tic severity scale (YGTSS-R), Yale-Brown obsessive-compulsive scale (Y-BOCS), clinical global impression scale (CGI).
* Self-assessment questionnaires: adult tic questionnaire (ATQ), Beck depression inventory (BDI), Beck anxiety inventory (BAI), Conners' adult ADHA rating scales (CAARS), autism spectrum quotient (AQ); premotory urge for tics scale (PUTS), GTS quality of life scale (GTS-QOL).
MR exams within Part 1 (Simultaneous PET and 3T MR):
PET investigations of D1 receptor binding/density will be performed with the 11C-based tracer \[11C\]SCH23390, which has already revealed abnormalities in cortical D1 receptor in other neuropsychiatric disorders. Before starting the PET measurement, the subject is positioned on the scanner's patient table and asked to relax for several minutes while an intravenous line is in-serted into an arm vein for injection of the radionuclide. Subsequently, \[11C\]SCH23390 is administered during 90 s following established procedures for the specific radionuclide. The administered radioactivity varies around 500 MBq, depending on the specific activity and the subject's body mass. Following injection, dynamic emission data are collected for approx. 90 min. The acquired frames (4 during 15 s, 4 during 1 min, 5 during 2 min, 5 during 5 min, and 5 during 10 min) are reconstructed into a series of three-dimensional (3D) PET images for evaluations of the D1 receptor distribution volume ratio and binding potential.
Simultaneous MR scanning at 3 Tesla (3 T) will be performed during PET scanning. These acquisitions are based on a protocol that has been established in previous investigations of GTS patients comprising the following acquisitions:
* Scout acquisition for automated alignment of imaging or spectroscopy volumes ("auto align").
* Structural MR scan ("MP2RAGE") for image registration, tissue segmentation, morphometry of cortical and subcortical structures, and for measuring the longitudinal relaxation time T1 to obtain information on myelin and brain iron content.
* Susceptibility-sensitive acquisition ("multi-echo FLASH") for measurements of the magnetic susceptibility (QSM) and R2\* to obtain information on brain iron and myelin.
* Single-voxel proton MRS of the basal ganglia and the anterior cingulate cortex to measure metabolic profiles, in particular to obtain concentration estimates of local Glu and Gln (or Glx).
* Resting-state functional MRI acquisition to extract information on functional connectivity.
* Diffusion-weighted MRI to extract information on structural connectivity. The total time for the combined PET/MR acquisitions including preparations and patient positioning will not exceed 100 min. From all subjects (GTS patients and healthy controls) 10ml of venous blood will be collected at the time of the exam for subsequent measurement of blood ferritin levels. These levels will be compared with the results from susceptibility-related measures of brain iron.
10ml of venous blood will be collected from all subjects (GTS patients and healthy controls) at the time of the exam for subsequent measurement of blood ferritin levels. These levels will be compared with the results from susceptibility-related measures of brain iron.
Gilles de la Tourette Syndrome (GTS) is characterized by the presence of motor and vocal tics, which have been defined as rapid, habitual, burst-like movements or utterances that typically mimic fragments of normal behavior. Patients often report unpleasant premonitory urge sensations preceding tics that are relieved by their execution. Although the therapeutic spectrum for GTS has recently been expanding, current treatment strategies are often unsatisfactory, thus provoking the need for further elucidation of the underlying pathophysiology.
In current models of GTS pathophysiology, symptoms are thought to arise as a result of the inappropriate activation of specific clusters of striatal neurons, which lead to a burst-like disinhibition of thalamocortical output. The bulk of current literature suggests a dysregulated dopaminergic system. This is supported by clinical evidence of improvements in tics following the administration of dopamine antagonists, synthesis blockers or depletion drugs, and the exacerbation of symptoms following the administration of dopaminergic stimulants. Dopamine drives movement by activating a direct, net excitatory basal ganglia pathway involving the dopamine receptor D1 or an indirect, net inhibitory basal ganglia pathway involving the dopamine receptor D2. Currently, the vast majority of the antipsychotics used for the treatment of tics in GTS aim at the D2 receptor, with aripiprazole, risperidone and pimozide being selective D2 receptor antagonists and haloperidol being mainly a D2 receptor antagonist. However, recent randomized controlled trials further indicate promising results for the selective dopamine receptor D1 antagonist ecopipam.
Methodologically varied work has revealed that patients with GTS exhibit alterations in (i) D2 receptor density or binding, (ii) Dopamine Active Transporter (DAT) density/binding, and (iii) phasic dopamine transmission in striatal and cortical regions. A very small number of post-mortem examinations further suggest potential abnormalities in D1 (and D2 and DAT) receptor densities in cortical regions. While this would be in line with the therapeutic efficiency of selective D1 receptor antagonists, thorough experimental verification is missing. In particular, D1 receptors in GTS patients have not yet been investigated in vivo, suggesting a need for additional research.
Both postsynaptic and presynaptic mechanisms have been postulated to offer explanations of the above observations:
1. Supersensitive postsynaptic dopamine receptors were proposed, in particular to explain findings of reduced levels of homovanillic Acid (HVA) in cerebrospinal fluid (CSF) in GTS despite the premise of a hyperdopaminergic system. The validity of this view has been questioned as HVA levels may be confounded by medication, and previous positron emission tomography (PET) studies on dopamine receptors (although likely involved in the neurobiology of GTS) have produced inconsistent results.
2. Dopamine hyperinnervation, that is, an overabundance of striatal dopamine terminals was suggested to reflect observations of generally increased binding to the DAT and to the vesicular monoamine transporter type 2 (VMAT2).
3. Tonic-phasic dysfunction assumes reduced tonic dopamine levels as well as a hyperresponsive (spike-dependent) phasic dopaminergic system. A low tonic dopamine tone could be caused by an overactive DAT preventing efficient spillage to the extrasynaptic space and/or altered presynaptic dopamine D2 autoreceptor binding.
Apart from such considerations specific to dopamine one can postulate that if a dopaminergic abnormality were present, other neurotransmitter systems would exhibit perturbations as well. In particular, this is suggested by (i) the close synergy exhibited between excitatory, inhibitory and modulatory neurotransmitter systems within the striatum and throughout the brain; and (ii) the interdependent metabolic relationship exhibited between glutamate (Glu), and γ-aminobutyric acid (GABA) via the non-neuroactive metabolic intermediate glutamine (Gln). Moreover, an irregular afferent modulation of dopaminergic nuclei would have profound effects on tonic/phasic dopaminergic release in the striatum and the control of subsequent thalamocortical output. Consistently, separate groups have demonstrated that adult patients with GTS exhibit alterations within the GABAergic system in cortical regions using in vivo proton (1H) magnetic resonance spectroscopy (MRS) and subcortical regions using PET. Employing 1H MRS, the investigators recently found reductions in striatal concentrations of Gln and the sum of Glu plus Gln (Glx) in GTS patients as well as negative correlations between striatal Gln and actual tic severity and between thalamic Glu and premonitory urges. While these findings do not rule out alternative mechanisms, they lend support to the hypothesis of an alteration in the dynamics of the tonic/phasic dopaminergic signaling because chronic perturbations in the subcortical GABA-Glu-Gln cycle flux could lead to spatially focalized alterations in excitatory and inhibitory neurotransmitter ratios.
Another aspect of dopamine neurobiology that has recently gained interest in the context of neuroimaging is the relation to brain iron. Besides supporting myelination and cellular respiration, brain iron is crucial for the synthesis of neurotransmitters, in particular dopamine. It is stored primarily as ferritin and co-localizes with dopamine vesicles having the greatest concentration in the dopamine-rich basal ganglia and midbrain. As the major brain iron compounds have (super)paramagnetic properties, they can be detected via susceptibility-sensitive magnetic resonance (MR) techniques, such as quantitative susceptibility mapping (QSM) or measurements of the effective or the reversible transverse relaxation rates, R2\* or R2', respectively. Recent multimodal imaging targeted at (normal) developmental changes of the striatal dopamine system demonstrated that R2'-based estimates of tissue iron content were associated with carbon-11 \[11C\]dihydrotetrabenazine PET of presynaptic vesicular dopamine. This suggests that susceptibility-sensitive MR imaging (MRI), which does not require an intravenously applied radiotracer, might serve as a proxy for obtaining information on dopamine that could substitute measurements of HVA in CSF without sharing the same confounds. More recently, the investigators already obtained preliminary indications of disturbed iron homeostasis in GTS patients as evidenced by reduced serum ferritin and magnetic susceptibility in the striatum and further subcortical structures.
Objectives and Hypotheses
In continuation of previous investigations, the investigators plan to perform examinations with MRI and MRS in GTS patients in comparison to age- and sex-matched healthy controls within Part 2 of this combined study. This includes (indirect) information on the interplay of different neurotransmitter systems (Glu, and GABA), as well as on the role of brain iron in GTS.
In particular, the investigators plan to use (i) iron-sensitive MRI techniques, such as QSM and R2\* mapping, for obtaining indirect information on presynaptic dopamine availability; (ii) \[11C\]SCH23390 PET measures of cortical D1 receptor binding/densities in vivo in GTS patients; and (iii) 1H MRS with standard single-voxel techniques and spectral-editing methods, for obtaining neurochemical profiles and quantitative information on Glu, Gln, and GABA in the striatum and cortical areas.
Neuropsychological tests:
At the time of the MR and/or PET exams, an established, comprehensive test battery will be performed with all patients for a detailed clinical assessment, including the severity of tics or the presence of comorbidities. These tests may be performed online as a video conference questionnaire and include:
* DSM-IV-symptom list for attention deficit hyperactivity disorder (ADHD), rage attack questionnaire (RAQ), Pittsburgh sleep quality index (PSQI);
* Clinical ratings : Yale global tic severity scale (YGTSS-R), Yale-Brown obsessive-compulsive scale (Y-BOCS), clinical global impression scale (CGI).
* Self-assessment questionnaires: adult tic questionnaire (ATQ), Beck depression inventory (BDI), Beck anxiety inventory (BAI), Conners' adult ADHA rating scales (CAARS), autism spectrum quotient (AQ); premotory urge for tics scale (PUTS), GTS quality of life scale (GTS-QOL).
MR exams within Part 1 (Simultaneous PET and 3T MR):
PET investigations of D1 receptor binding/density will be performed with the 11C-based tracer \[11C\]SCH23390, which has already revealed abnormalities in cortical D1 receptor in other neuropsychiatric disorders. Before starting the PET measurement, the subject is positioned on the scanner's patient table and asked to relax for several minutes while an intravenous line is in-serted into an arm vein for injection of the radionuclide. Subsequently, \[11C\]SCH23390 is administered during 90 s following established procedures for the specific radionuclide. The administered radioactivity varies around 500 MBq, depending on the specific activity and the subject's body mass. Following injection, dynamic emission data are collected for approx. 90 min. The acquired frames (4 during 15 s, 4 during 1 min, 5 during 2 min, 5 during 5 min, and 5 during 10 min) are reconstructed into a series of three-dimensional (3D) PET images for evaluations of the D1 receptor distribution volume ratio and binding potential.
Simultaneous MR scanning at 3 Tesla (3 T) will be performed during PET scanning. These acquisitions are based on a protocol that has been established in previous investigations of GTS patients comprising the following acquisitions:
* Scout acquisition for automated alignment of imaging or spectroscopy volumes ("auto align").
* Structural MR scan ("MP2RAGE") for image registration, tissue segmentation, morphometry of cortical and subcortical structures, and for measuring the longitudinal relaxation time T1 to obtain information on myelin and brain iron content.
* Susceptibility-sensitive acquisition ("multi-echo FLASH") for measurements of the magnetic susceptibility (QSM) and R2\* to obtain information on brain iron and myelin.
* Single-voxel proton MRS of the basal ganglia and the anterior cingulate cortex to measure metabolic profiles, in particular to obtain concentration estimates of local Glu and Gln (or Glx).
* Resting-state functional MRI acquisition to extract information on functional connectivity.
* Diffusion-weighted MRI to extract information on structural connectivity. The total time for the combined PET/MR acquisitions including preparations and patient positioning will not exceed 100 min. From all subjects (GTS patients and healthy controls) 10ml of venous blood will be collected at the time of the exam for subsequent measurement of blood ferritin levels. These levels will be compared with the results from susceptibility-related measures of brain iron.
10ml of venous blood will be collected from all subjects (GTS patients and healthy controls) at the time of the exam for subsequent measurement of blood ferritin levels. These levels will be compared with the results from susceptibility-related measures of brain iron.
Conditions
See the medical conditions and disease areas that this research is targeting or investigating.
Gilles de la Tourette Syndrome
Tourette Syndrome
Study Design
Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.
Observational Model Type
CASE_CONTROL
Study Time Perspective
PROSPECTIVE
Study Groups
Review each arm or cohort in the study, along with the interventions and objectives associated with them.
GTS patient group
Cohort of adult GTS patients, males and females, age range 18 to 50 years
PET/MR scanner
Intervention Type
DEVICE
Simultaneous PET and 3T MR scanning; protocol duration of approx. 100 min
Control group
Cohort of healthy control subjects, males and females, age range 18 to 50 years
PET/MR scanner
Intervention Type
DEVICE
Simultaneous PET and 3T MR scanning; protocol duration of approx. 100 min
Interventions
Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.
PET/MR scanner
Simultaneous PET and 3T MR scanning; protocol duration of approx. 100 min
Intervention Type
DEVICE
Eligibility Criteria
Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.
Inclusion Criteria
* GTS according to DSM-IV-TR criteria
* mild or moderate tics
* drug-free for a minimum of 4 weeks prior to the exam
• no known neurological or psychiatric disease
* mild or moderate tics
* drug-free for a minimum of 4 weeks prior to the exam
• no known neurological or psychiatric disease
Exclusion Criteria
* severe tics of the head and/or face
* psychiatric medication within 4 weeks prior to the exam
* consumption of alcohol during 24 hours prior to the exam
* consumption of cannabis during 24 hours prior to the exam • pregnancy
* general contra-indications for MRI exams
Control Group:
* psychiatric medication within 4 weeks prior to the exam
* consumption of alcohol during 24 hours prior to the exam
* consumption of cannabis during 24 hours prior to the exam • pregnancy
* general contra-indications for MRI exams
* psychiatric medication within 4 weeks prior to the exam
* consumption of alcohol during 24 hours prior to the exam
* consumption of cannabis during 24 hours prior to the exam • pregnancy
* general contra-indications for MRI exams
Control Group:
* psychiatric medication within 4 weeks prior to the exam
* consumption of alcohol during 24 hours prior to the exam
* consumption of cannabis during 24 hours prior to the exam • pregnancy
* general contra-indications for MRI exams
Minimum Eligible Age
18 Years
Maximum Eligible Age
50 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
Yes
Sponsors
Meet the organizations funding or collaborating on the study and learn about their roles.
Leipzig University Medical Center
OTHER
Sponsor Role
collaborator
Hannover Medical School
OTHER
Sponsor Role
collaborator
Max Planck Institute for Human Cognitive and Brain Sciences
OTHER
Sponsor Role
lead
Responsible Party
Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.
Responsibility Role
SPONSOR
Principal Investigators
Learn about the lead researchers overseeing the trial and their institutional affiliations.
Harald E Möller, PhD
Role: PRINCIPAL_INVESTIGATOR
Max Planck Institute for Human Cognitive and Brain Sciences
Locations
Explore where the study is taking place and check the recruitment status at each participating site.
Max Planck Institute for Human Cognitive and Brain Sciences
Leipzig, , Germany
Site Status
Countries
Review the countries where the study has at least one active or historical site.
Germany
References
Explore related publications, articles, or registry entries linked to this study.
Albin RL, Mink JW. Recent advances in Tourette syndrome research. Trends Neurosci. 2006 Mar;29(3):175-82. doi: 10.1016/j.tins.2006.01.001. Epub 2006 Jan 23.
Reference Type
BACKGROUND
Bourne JA. SCH 23390: the first selective dopamine D1-like receptor antagonist. CNS Drug Rev. 2001 Winter;7(4):399-414. doi: 10.1111/j.1527-3458.2001.tb00207.x.
Reference Type
BACKGROUND
Draper A, Stephenson MC, Jackson GM, Pepes S, Morgan PS, Morris PG, Jackson SR. Increased GABA contributes to enhanced control over motor excitability in Tourette syndrome. Curr Biol. 2014 Oct 6;24(19):2343-7. doi: 10.1016/j.cub.2014.08.038. Epub 2014 Sep 25.
Reference Type
BACKGROUND
Forde NJ, Kanaan AS, Widomska J, Padmanabhuni SS, Nespoli E, Alexander J, Rodriguez Arranz JI, Fan S, Houssari R, Nawaz MS, Rizzo F, Pagliaroli L, Zilhao NR, Aranyi T, Barta C, Boeckers TM, Boomsma DI, Buisman WR, Buitelaar JK, Cath D, Dietrich A, Driessen N, Drineas P, Dunlap M, Gerasch S, Glennon J, Hengerer B, van den Heuvel OA, Jespersgaard C, Moller HE, Muller-Vahl KR, Openneer TJ, Poelmans G, Pouwels PJ, Scharf JM, Stefansson H, Tumer Z, Veltman DJ, van der Werf YD, Hoekstra PJ, Ludolph A, Paschou P. TS-EUROTRAIN: A European-Wide Investigation and Training Network on the Etiology and Pathophysiology of Gilles de la Tourette Syndrome. Front Neurosci. 2016 Aug 23;10:384. doi: 10.3389/fnins.2016.00384. eCollection 2016.
Reference Type
BACKGROUND
Gilbert DL, Murphy TK, Jankovic J, Budman CL, Black KJ, Kurlan RM, Coffman KA, McCracken JT, Juncos J, Grant JE, Chipkin RE. Ecopipam, a D1 receptor antagonist, for treatment of tourette syndrome in children: A randomized, placebo-controlled crossover study. Mov Disord. 2018 Aug;33(8):1272-1280. doi: 10.1002/mds.27457. Epub 2018 Sep 7.
Reference Type
BACKGROUND
Kaller S, Rullmann M, Patt M, Becker GA, Luthardt J, Girbardt J, Meyer PM, Werner P, Barthel H, Bresch A, Fritz TH, Hesse S, Sabri O. Test-retest measurements of dopamine D1-type receptors using simultaneous PET/MRI imaging. Eur J Nucl Med Mol Imaging. 2017 Jun;44(6):1025-1032. doi: 10.1007/s00259-017-3645-0. Epub 2017 Feb 14.
Reference Type
BACKGROUND
Kanaan AS, Gerasch S, Garcia-Garcia I, Lampe L, Pampel A, Anwander A, Near J, Moller HE, Muller-Vahl K. Pathological glutamatergic neurotransmission in Gilles de la Tourette syndrome. Brain. 2017 Jan;140(1):218-234. doi: 10.1093/brain/aww285. Epub 2016 Dec 22.
Reference Type
BACKGROUND
Kwak C, Dat Vuong K, Jankovic J. Premonitory sensory phenomenon in Tourette's syndrome. Mov Disord. 2003 Dec;18(12):1530-3. doi: 10.1002/mds.10618.
Reference Type
BACKGROUND
Larsen B, Olafsson V, Calabro F, Laymon C, Tervo-Clemmens B, Campbell E, Minhas D, Montez D, Price J, Luna B. Maturation of the human striatal dopamine system revealed by PET and quantitative MRI. Nat Commun. 2020 Feb 12;11(1):846. doi: 10.1038/s41467-020-14693-3.
Reference Type
BACKGROUND
Leckman JF. Tourette's syndrome. Lancet. 2002 Nov 16;360(9345):1577-86. doi: 10.1016/S0140-6736(02)11526-1.
Reference Type
BACKGROUND
Lerner A, Bagic A, Simmons JM, Mari Z, Bonne O, Xu B, Kazuba D, Herscovitch P, Carson RE, Murphy DL, Drevets WC, Hallett M. Widespread abnormality of the gamma-aminobutyric acid-ergic system in Tourette syndrome. Brain. 2012 Jun;135(Pt 6):1926-36. doi: 10.1093/brain/aws104. Epub 2012 May 10.
Reference Type
BACKGROUND
Maia TV, Conceicao VA. Dopaminergic Disturbances in Tourette Syndrome: An Integrative Account. Biol Psychiatry. 2018 Sep 1;84(5):332-344. doi: 10.1016/j.biopsych.2018.02.1172. Epub 2018 Mar 9.
Reference Type
BACKGROUND
Mink JW. Basal ganglia dysfunction in Tourette's syndrome: a new hypothesis. Pediatr Neurol. 2001 Sep;25(3):190-8. doi: 10.1016/s0887-8994(01)00262-4.
Reference Type
BACKGROUND
Moller HE, Bossoni L, Connor JR, Crichton RR, Does MD, Ward RJ, Zecca L, Zucca FA, Ronen I. Iron, Myelin, and the Brain: Neuroimaging Meets Neurobiology. Trends Neurosci. 2019 Jun;42(6):384-401. doi: 10.1016/j.tins.2019.03.009. Epub 2019 Apr 29.
Reference Type
BACKGROUND
Okubo Y, Suhara T, Suzuki K, Kobayashi K, Inoue O, Terasaki O, Someya Y, Sassa T, Sudo Y, Matsushima E, Iyo M, Tateno Y, Toru M. Decreased prefrontal dopamine D1 receptors in schizophrenia revealed by PET. Nature. 1997 Feb 13;385(6617):634-6. doi: 10.1038/385634a0.
Reference Type
BACKGROUND
Singer HS. Treatment of tics and tourette syndrome. Curr Treat Options Neurol. 2010 Nov;12(6):539-61. doi: 10.1007/s11940-010-0095-4.
Reference Type
BACKGROUND
Singer HS, Morris C, Grados M. Glutamatergic modulatory therapy for Tourette syndrome. Med Hypotheses. 2010 May;74(5):862-7. doi: 10.1016/j.mehy.2009.11.028. Epub 2009 Dec 21.
Reference Type
BACKGROUND
Tinaz S, Belluscio BA, Malone P, van der Veen JW, Hallett M, Horovitz SG. Role of the sensorimotor cortex in Tourette syndrome using multimodal imaging. Hum Brain Mapp. 2014 Dec;35(12):5834-46. doi: 10.1002/hbm.22588. Epub 2014 Jul 15.
Reference Type
BACKGROUND
Yoon DY, Gause CD, Leckman JF, Singer HS. Frontal dopaminergic abnormality in Tourette syndrome: a postmortem analysis. J Neurol Sci. 2007 Apr 15;255(1-2):50-6. doi: 10.1016/j.jns.2007.01.069. Epub 2007 Mar 6.
Reference Type
BACKGROUND
Other Identifiers
Review additional registry numbers or institutional identifiers associated with this trial.
PETMR_GTS_1-PETMR
Identifier Type: -
Identifier Source: org_study_id
More Related Trials
Additional clinical trials that may be relevant based on similarity analysis.
The Findings of Magnetic Resonance Imaging in Subtypes of Tics-related Disorders
NCT05566496
RECRUITING
Investigation of Neurofeedback With Real-Time fMRI in Healthy Volunteers and Patients With Hyperkinetic Movement Disorders
NCT00885040
TERMINATED
Facial Expression Recognition of Emotion and Categorization of Emotional Words in Gilles de la Tourette's Syndrome
NCT00664300
COMPLETED
Neurofeedback for Tourette Syndrome
NCT01702077
COMPLETED
NA
Brain Function in Focal Dystonia
NCT00102999
COMPLETED
Multimodal Electrophysiological Study of Cortico-subcortical Biomarkers of Tics in Tourette Syndrome
NCT06909656
RECRUITING
NA
Functional Connectivity in Primary Focal Dystonia
NCT01761903
COMPLETED
Surround Inhibition in Patients With Dystonia
NCT00029601
COMPLETED
The Pathophysiology of Tourette Syndrome: a Multimodal Study
NCT02497807
UNKNOWN
Brain Dynamics Involved in Generating Tics and Controlling Voluntary Movement
NCT00056420
COMPLETED
Transcranial Magnetic Stimulation and Electrical Stimulation of Nerves to Study Focal Dystonia
NCT00050024
COMPLETED
Timing of Voluntary Movement in Patients With Tourette Syndrome and Chronic Tic Disorder
NCT00081419
COMPLETED
Transcranial Magnetic Stimulation (TMS) Studies of Dystonia
NCT00017875
COMPLETED
Multicentre RCT of Awake Versus Asleep Tractography Based DBS for ET
NCT05968976
RECRUITING
NA
Study of the Neurobiology of Tourette Syndrome and Related Disorders
NCT00004325
COMPLETED
Next-Generation Pre-Operative Targeting for Thalamic DBS in the Treatment of Tremor
NCT03875404
COMPLETED
NA
rTMS and Retraining in Focal Hand Dystonia
NCT01738581
COMPLETED
PHASE1/PHASE2
Multimodal Investigation of Cortico-Basal Ganglia-Thalamo-Cortical Network Dynamics in Dystonic Patients with Deep Brain Stimulation
NCT06716983
RECRUITING
Transcranial Magnetic Stimulation for Focal Hand Dystonia
NCT01792336
TERMINATED
The Findings of MR Imaging in Rett Syndrome
NCT02903056
UNKNOWN
Impulse Control in Gilles de la Tourette Syndrome
NCT04197804
COMPLETED
Repetitive Transcranial Magnetic Stimulation for the Treatment of Focal Hand Dystonia
NCT01884064
COMPLETED
PHASE1
Interactions Between Striatum and Cerebellum in ADCY5 and PRRT2 Dystonias
NCT03481491
COMPLETED
NA
Accelerating TMS for Cervical Dystonia
NCT06328114
ENROLLING_BY_INVITATION
NA
Neurophysiologic Study of Patient With Essential Tremor and Dystonic Tremor
NCT03041714
COMPLETED