Somatosensory perception-action binding in Tourette syndrome.

It is a common phenomenon that somatosensory sensations can trigger actions to alleviate experienced tension. Such "urges" are particularly relevant in patients with Gilles de la Tourette (GTS) syndrome since they often precede tics, the cardinal feature of this common neurodevelopmental disorder. Altered sensorimotor integration processes in GTS as well as evidence for increased binding of stimulus- and response-related features ("hyper-binding") in the visual domain suggest enhanced perception-action binding also in the somatosensory modality. In the current study, the Theory of Event Coding (TEC) was used as an overarching cognitive framework to examine somatosensory-motor binding. For this purpose, a somatosensory-motor version of a task measuring stimulus-response binding (S-R task) was tested using electro-tactile stimuli. Contrary to the main hypothesis, there were no group differences in binding effects between GTS patients and healthy controls in the somatosensory-motor paradigm. Behavioral data did not indicate differences in binding between examined groups. These data can be interpreted such that a compensatory "downregulation" of increased somatosensory stimulus saliency, e.g., due to the occurrence of somatosensory urges and hypersensitivity to external stimuli, results in reduced binding with associated motor output, which brings binding to a "normal" level. Therefore, "hyper-binding" in GTS seems to be modality-specific.

Perception-action integration in young age-A cross-sectional EEG study.

Humans differ in their capacity for integrating perceived events and related actions. The "Theory of event coding" (TEC) conceptualizes how stimuli and actions are cognitively bound into a common functional representation (or "code"), known as the "event file". To date, however, the neural processes underlying the development of event file coding mechanisms across age are largely unclear. We investigated age-related neural changes of event file coding from late childhood to early adulthood, using EEG signal decompositions methods. We included a group of healthy participants (n = 91) between 10 and 30 years, performing an event file paradigm. Results of this study revealed age-related effects on event file coding processes both at the behavioural and the neurophysiological level. Performance accuracy data showed that event file unbinding und rebinding processes become more efficient from late childhood to early adulthood. These behavioural effects are reflected by age-related effects in two neurophysiological subprocesses associated with the superior parietal cortex (BA7) as revealed in the analyses using EEG signal decomposition. The first process entails mapping and association processes between stimulus and response; whereas, the second comprises inhibitory control subprocesses subserving the selection of the relevant motor programme amongst competing response options.

Networks in the Field of Tourette Syndrome.

Gilles de la Tourette syndrome (TS) is a neuropsychiatric neurodevelopmental disorder with the cardinal clinical features of motor and phonic tics. Clinical phenomenology can be complex since, besides tics, there are other features including premonitory urges preceding tics, pali-, echo-, and coprophenomena, hypersensitivity to external stimuli, and symptom dependency on stress, attention, and other less well-defined factors. Also, the rate of comorbidities, particularly attention deficit hyperactivity disorder and obsessive-compulsive disorder, is high. Mirroring the complexities of the clinical course and phenomenology, pathophysiological findings are very diverse, and etiology is disputed. It has become clear, though, that abnormalities in the basal ganglia and their connections with cortical areas are key for the understanding of the pathophysiology and as regards etiology, genetic factors are crucial. Against this background, both adequate clinical management of TS and TS-related research require multidisciplinary preferably international cooperation in larger groups or networks to address the multiple facets of this disorder and yield valid and useful data. In particular, large numbers of patients are needed for brain imaging and genetic studies. To meet these requirements, a number of networks and groups in the field of TS have developed over the years creating an efficient, lively, and supportive international research community. In this review, we will provide an overview of these groups and networks.

Tourette syndrome as a motor disorder revisited - Evidence from action coding.

Because tics are the defining clinical feature of Tourette syndrome, it is conceptualized predominantly as a motor disorder. There is some evidence though suggesting that the neural basis of Tourette syndrome is related to perception-action processing and binding between perception and action. However, binding processes have not been examined in the motor domain in these patients. If it is particularly perception-action binding but not binding processes within the motor system, this would further corroborate that Tourette syndrome it is not predominantly, or solely, a motor disorder. Here, we studied N = 22 Tourette patients and N = 24 healthy controls using an established action coding paradigm derived from the Theory of Event Coding framework and concomitant EEG-recording addressing binding between a planned but postponed, and an interleaved immediate reaction with different levels of overlap of action elements. Behavioral performance during interleaved action coding was normal in Tourette syndrome. Response locked lateralized readiness potentials reflecting processes related to motor execution were larger in Tourette syndrome, but only in simple conditions. However, pre-motor processes including response preparation and configuration reflected by stimulus-locked lateralized readiness potentials were normal. This was supported by a Bayesian data analysis providing evidence for the null hypothesis. The finding that processes integrating different action-related elements prior to motor execution are normal in Tourette syndrome suggests that Tourette it is not solely a motor disorder. Considering other recent evidence, the data show that changes in "binding" in Tourette syndrome are specific for perception-action integration but not for action coding.

Perception-Action Integration Is Modulated by the Catecholaminergic System Depending on Learning Experience.

BACKGROUND: The process underlying the integration of perception and action is a focal topic in neuroscientific research and cognitive frameworks such as the theory of event coding have been developed to explain the mechanisms of perception-action integration. The neurobiological underpinnings are poorly understood. While it has been suggested that the catecholaminergic system may play a role, there are opposing predictions regarding the effects of catecholamines on perception-action integration. METHODS: Methylphenidate (MPH) is a compound commonly used to modulate the catecholaminergic system. In a double-blind, randomized crossover study design, we examined the effect of MPH (0.25 mg/kg) on perception-action integration using an established "event file coding" paradigm in a group of n = 45 healthy young adults. RESULTS: The data reveal that, compared with the placebo, MPH attenuates binding effects based on the established associations between stimuli and responses, provided participants are already familiar with the task. However, without prior task experience, MPH did not modulate performance compared with the placebo. CONCLUSIONS: Catecholamines and learning experience interactively modulate perception-action integration, especially when perception-action associations have to be reconfigured. The data suggest there is a gain control-based mechanism underlying the interactive effects of learning/task experience and catecholaminergic activity during perception-action integration.

Neurophysiological mechanisms underlying motor feature binding processes and representations.

Coherent, voluntary action requires an integrated representation of these actions and their defining features. Although theories delineate how action integration requiring binding between different action features may be accomplished, the underlying neurophysiological mechanisms are largely elusive. The present study examined the neurophysiological mechanisms underlying binding processes in actions. To this end, we conducted EEG recordings and applied standard event-related potential analyses, temporal EEG signal decomposition and multivariate pattern analyses (MVPA). According to the code occupation account, an overlap between a planned and a to-be-performed action impairs performance. The level, to which performance is attenuated depends on the strength of binding of action features. This binding process then determines the representation of them, the so-called action files. We show that code occupation and bindings between action features specifically modulate processes preceding motor execution as showed by the stimulus-locked lateralized readiness potential (LRP). Conversely, motor execution processes reflected by the response-locked LRP were not modulated by action file binding. The temporal decomposition of the EEG signal, further distinguished between action file related processes: the planned response determining code occupation was reflected in general (voluntary) response selection but not in involuntary (response priming-related) activation. Moreover, MVPA on temporally decomposed neural signals indicated that action files are represented as a continuous chain of activations. Within this chain, inhibitory and response re-activation patterns can be distinguished. Taken together, the neurophysiological correlates of action file binding suggest that parallel, stimulus- and response-related pre-motor processes are responsible for the code occupation in the human motor system.

Gilles de la Tourette Syndrome-A Disorder of Action-Perception Integration.

Gilles de la Tourette syndrome is a multifaceted and complex neuropsychiatric disorder. Given that tics as motor phenomena are the defining and cardinal feature of Tourette syndrome, it has long been conceptualized as a motor/movement disorder. However, considering premonitory urges preceding tics, hypersensitivity to external stimuli and abnormalities in sensorimotor integration perceptual processes also seem to be relevant in the pathophysiology of Tourette syndrome. In addition, tic expression depends on attention and tics can, at least partly and transiently, be controlled, so that cognitive processes need to be considered as well. Against this background, explanatory concepts should encompass not only the motor phenomenon tic but also perceptual and cognitive processes. Representing a comprehensive theory of the processing of perceptions and actions paying particular attention to their interdependency and the role of cognitive control, the Theory of Event Coding seems to be a suitable conceptual framework for the understanding of Tourette syndrome. In fact, recent data suggests that addressing the relation between actions (i.e., tics) and perceptions (i.e., sensory phenomena like premonitory urges) in the context of event coding allows to gaining relevant insights into perception-action coding in Tourette syndrome indicating that perception action binding is abnormally strong in this disorder.

Non-invasive Brain Stimulation for the Treatment of Gilles de la Tourette Syndrome.

Gilles de la Tourette Syndrome is a multifaceted neuropsychiatric disorder typically commencing in childhood and characterized by motor and phonic tics. Its pathophysiology is still incompletely understood. However, there is convincing evidence that structural and functional abnormalities in the basal ganglia, in cortico-striato-thalamo-cortical circuits, and some cortical areas including medial frontal regions and the prefrontal cortex as well as hyperactivity of the dopaminergic system are key findings. Conventional therapeutic approaches in addition to counseling comprise behavioral treatment, particularly habit reversal therapy, oral pharmacotherapy (antipsychotic medication, alpha-2-agonists) and botulinum toxin injections. In treatment-refractory Tourette syndrome, deep brain stimulation, particularly of the internal segment of the globus pallidus, is an option for a small minority of patients. Based on pathophysiological considerations, non-invasive brain stimulation might be a suitable alternative. Repetitive transcranial magnetic stimulation appears particularly attractive. It can lead to longer-lasting alterations of excitability and connectivity in cortical networks and inter-connected regions including the basal ganglia through the induction of neural plasticity. Stimulation of the primary motor and premotor cortex has so far not been shown to be clinically effective. Some studies, though, suggest that the supplementary motor area or the temporo-parietal junction might be more appropriate targets. In this manuscript, we will review the evidence for the usefulness of repetitive transcranial magnetic stimulation and transcranial electric stimulation as treatment options in Tourette syndrome. Based on pathophysiological considerations we will discuss the rational for other approaches of non-invasive brain stimulation including state informed repetitive transcranial magnetic stimulation.

Electro-Myo-Stimulation Induced Tic Exacerbation - Increased Tendencies for the Formation of Perception-Action Links in Tourette Syndrome.

Background: Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder defined by motor and phonic tics. Sensory stimuli can trigger tics, which suggests that GTS is a disorder of perception-action processing rather than a pure motor disorder. Case report: We describe a GTS patient that developed exacerbation of tics after transcutaneous electro-myo-stimulation (YGTSS pre-EMS 27/100, post-EMS 69/100). Discussion: If behaviorally irrelevant stimuli exacerbate tics, there might be a high readiness of the motor system to respond to any stimulus in these patients. In addition to tighter binding between previously established perception-action links, the likelihood for the formation of automatic perception-action links might also be higher in GTS.

Neurophysiological correlates of perception-action binding in the somatosensory system.

Action control requires precisely and flexibly linking sensory input and motor output. This is true for both, visuo-motor and somatosensory-motor integration. However, while perception-action integration has been extensively investigated for the visual modality, data on how somatosensory and action-related information is associated are scarce. We use the Theory of Event Coding (TEC) as a framework to investigate perception-action integration in the somatosensory-motor domain. Based on studies examining the neural mechanisms underlying stimulus-response binding in the visuo-motor domain, the current study investigates binding mechanisms in the somatosensory-motor domain using EEG signal decomposition and source localization analyses. The present study clearly demonstrates binding between somatosensory stimulus and response features. Importantly, repetition benefits but no repetition costs are evident in the somatosensory modality, which differs from findings in the visual domain. EEG signal decomposition indicates that response selection mechanisms, rather than stimulus-related processes, account for the behavioral binding effects. This modulation is associated with activation differences in the left superior parietal cortex (BA 7), an important relay of sensorimotor integration.

Increased perception-action binding in Tourette syndrome.

Gilles de la Tourette syndrome is a multifaceted neurodevelopmental disorder characterized by multiple motor and vocal tics. Research in Tourette syndrome has traditionally focused on the motor system. However, there is increasing evidence that perceptual and cognitive processes play a crucial role as well. Against this background it has been reasoned that processes linking perception and action might be particularly affected in these patients with the strength of perception-action binding being increased. However, this has not yet been studied experimentally. Here, we investigated adult Tourette patients within the framework of the 'Theory of Event Coding' using an experimental approach allowing us to directly test the strength of perception-action binding. We included 24 adult patients with Tourette syndrome and n = 24 healthy control subjects using a previously established visual-motor event file task with four levels of feature overlap requiring repeating or alternating responses. Concomitant to behavioural testing, EEG was recorded and analysed using temporal signal decomposition and source localization methods. On a behavioural level, perception-action binding was increased in Tourette patients. Tic frequency correlated with performance in conditions where unbinding processes of previously established perception-action bindings were required with higher tic frequency being associated with stronger perception-action binding. This suggests that perception-action binding is intimately related to the occurrence of tics. Analysis of EEG data showed that behavioural changes cannot be explained based on simple perceptual or motor processes. Instead, cognitive processes linking perception to action in inferior parietal cortices are crucial. Our findings suggest that motor or sensory processes alone are less relevant for the understanding of Tourette syndrome than cognitive processes engaged in linking and restructuring of perception-action association. A broader cognitive framework encompassing perception and action appears well suited to opening new routes for the understanding of Tourette syndrome.