Tic disorders are childhood onset neuropsychiatric disorders characterized by motor and/or vocal ... more Tic disorders are childhood onset neuropsychiatric disorders characterized by motor and/or vocal tics. Research has demonstrated that children with chronic tics (including Tourette syndrome and Chronic Tic Disorder: TS/CTD) can suppress tics, particularly when an immediate, contingent reward is given for successful tic suppression. As a diagnosis of TS/CTD requires tics to be present for at least one year, children in these tic suppression studies had been living with tics for quite some time. Thus, it is unclear whether the ability to inhibit tics is learned over time or present at tic onset. Resolving that issue would inform theories of how tics develop and how behavior therapy for tics works. We investigated tic suppression in school-age children as close to the time of tic onset as possible, and no later than six months after onset. Children were asked to suppress their tics both in the presence and absence of a contingent reward. Results demonstrated that these children, like children with TS/CTD, have some capacity to suppress tics, and that immediate reward enhances that capacity. These findings demonstrate that the modulating effect of reward on inhibitory control of tics is present within months of tic onset, before tics have become chronic.
Objective: Estimates of tic prevalence in community samples of children vary significantly. Under... more Objective: Estimates of tic prevalence in community samples of children vary significantly. Understanding the true prevalence of tics improves clinicians’ ability to counsel patients and families on their typical course. In this study, we directly observe elementary school children in the classroom setting to determine the prevalence of tics in the general school population. Method: Participants were 215 children in kindergarten through fifth grade (5 first grade classrooms and 1 classroom from each of the other grades). Trained raters observed each child for three minutes, once monthly, for three consecutive months. Raters recorded whether tics were present, and if so, their type and frequency.Results: Prevalence over the 3 visits was 47%. Peak point prevalence was 35.1% for motor tics and 4.9% for phonic tics. Simple tics were more common than complex tics. Tic frequency was similar across grades. Tics seen at all 3 visits were uncommon and largely occurred in older children. The ...
A prior study showed that rhythmic, but not arrhythmic, 12 Hz stimulation of the median nerve (MN... more A prior study showed that rhythmic, but not arrhythmic, 12 Hz stimulation of the median nerve (MNS) entrained sensorimotor cortex EEG signal, and found that 10 Hz MNS improved tics in Tourette syndrome (TS). However, no control condition was tested and stimulation blocks lasted only 1 minute. We set out to replicate the TS results and to test whether tic improvement occurs by the proposed cortical entrainment mechanism. Thirty-two people with TS, age 15-64, completed two study visits with repeated MNS on and off blocks in random order, one visit for rhythmic and one for arrhythmic MNS. Subjects and staff were blind to order; a video rater was additionally blind to stimulation and to order of visits and blocks. Rhythmic MNS at 10 Hz improved tics. Both rhythmic and arrhythmic 12 Hz MNS improved tic frequency, intensity and urges without significant difference. Participant masking was effective and there was no carryover effect. Several participants described dramatic benefit. Discomf...
Objective: Recent years have seen a dramatic increase in new “tic” cases in teens and young adult... more Objective: Recent years have seen a dramatic increase in new “tic” cases in teens and young adults. These individuals often present with fulminant onset of symptoms not commonly seen in Tourette syndrome (TS), and are often diagnosed with Functional Neurological Symptom Disorder (FND-tic). However, some authors have questioned whether this illness truly differs from typical Provisional Tic Disorder (PTD) and TS. We sought to test whether the presenting symptoms of FND-tic differ substantially from those in patients later diagnosed with TS. Method: We compared retrospective comparison of data from a longitudinal study of PTD to data summarized from published reports of FND-tic. The longitudinal study of PTD included 89 children with tics beginning less than 9 months ago (median 3.6 months), nearly all of whom were diagnosed with TS at follow-up. We discuss clinical features thought to support a diagnosis of FND-tic, including symptom characteristics, course, severity and comorbidity....
Median nerve stimulation (MNS) at 10-12 Hz was recently proposed as a potential treatment for tic... more Median nerve stimulation (MNS) at 10-12 Hz was recently proposed as a potential treatment for tics in Tourette syndrome and other chronic tic disorders (TS/CTD). Here we report on 31 people ages 15-64 with TS/CTD who participated in a 4-week open label study of MNS. We provide individual participant data. Participants were recruited from participants in a randomized controlled trial of MNS and were given a transcutaneous electrical nerve stimulation (TENS) unit to use for MNS for 4 weeks. They were instructed to use the device as desired. Participants were instructed to complete surveys each time they began or ended stimulation, as well as twice daily at random times when prompted by a text message. These surveys contained information on tic frequency, tic intensity, and stimulation discomfort, when applicable. Participants also completed a more extensive final survey at the conclusion of the 4 weeks. 27 participants completed the study. Median device use was 1.5 days per week (inte...
Here we propose (a) to determine the real-world usage and apparent utility of stimulation in peop... more Here we propose (a) to determine the real-world usage and apparent utility of stimulation in people with chronic tics, and (b) to determine momentary self-rated efficacy and side effects of stimulation. In addition, we will compare results from this study to those from the "Peripheral induction of inhibitory brain circuits to treat Tourette's: pilot" study, from which participants will be drawn, in order to compare laboratory and real-world efficacy.
Supplementary_data_20190419 for Tic Suppression in Children With Recent-Onset Tics Predicts 1-Yea... more Supplementary_data_20190419 for Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome by Soyoung Kim, Deanna J. Greene, Amy Robichaux-Viehoever, Emily C. Bihun, Jonathan M. Koller, Haley Acevedo, Bradley L. Schlaggar and Kevin J. Black in Journal of Child Neurology
Supplemental Material, Supplementary_data_20190419 for Tic Suppression in Children With Recent-On... more Supplemental Material, Supplementary_data_20190419 for Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome by Soyoung Kim, Deanna J. Greene, Amy Robichaux-Viehoever, Emily C. Bihun, Jonathan M. Koller, Haley Acevedo, Bradley L. Schlaggar and Kevin J. Black in Journal of Child Neurology
Supplemental Material, Supplemental_File for Tic Suppression in Children With Recent-Onset Tics P... more Supplemental Material, Supplemental_File for Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome by Soyoung Kim, Deanna J. Greene, Amy Robichaux-Viehoever, Emily C. Bihun, Jonathan M. Koller, Haley Acevedo, Bradley L. Schlaggar and Kevin J. Black in Journal of Child Neurology
<strong>VISIT-TS</strong> (<strong>V</strong>ideo-<strong>I</str... more <strong>VISIT-TS</strong> (<strong>V</strong>ideo-<strong>I</strong>ntegrated <strong>S</strong>creening <strong>I</strong>nstrument for <strong>T</strong>ics and <strong>T</strong>ourette <strong>S</strong>yndrome) is a multimedia tool intended to demonstrate tics to a lay audience, to discuss their defining and common attributes, and to address features that differentiate tics from other movements and vocalizations. The video includes a teaching section (5 minutes) followed by questions (5 minutes). The original intended use of VISIT-TS is for epidemiological research. Vachon MJ, Striley CW, Gordon MR, Schroeder ML, Bihun EC, Koller JM, Black KJ: VISIT-TS: A multimedia tool for population studies on tic disorders [<em>version 2; referees: 3 approved</em>]. F1000Res 2016; 5:1518. DOI: 10.12688/f1000research.7196.2.
BackgroundPrevious studies have investigated differences in the volumes of subcortical structures... more BackgroundPrevious studies have investigated differences in the volumes of subcortical structures (e.g., caudate nucleus, putamen, thalamus, amygdala, hippocampus) between individuals with and without Tourette syndrome (TS), as well as the relationships between these volumes and tic symptom severity. These volumes may also predict clinical outcome in Provisional Tic Disorder (PTD), but that hypothesis has never been tested.ObjectiveThis study aimed to examine whether the volumes of subcortical structures measured shortly after tic onset can predict tic symptom severity at one year post tic onset, when TS can first be diagnosed.MethodsWe obtained T1-weighted structural MRI scans from 41 children with PTD (25 with prospective motion correction [vNavs]) whose tics had begun less than 9 months (median 3.7 months) prior to the first study visit (baseline). We re-examined them at the 12-month anniversary of their first tic (follow-up), assessing tic severity using the Yale Global Tic Seve...
Background: Successful voluntary tic suppression is a key component of the behavioral interventio... more Background: Successful voluntary tic suppression is a key component of the behavioral interventions that are used to treat tic disorders. Objective: This study aimed to examine tic suppression in children with recent-onset tics and determine whether the capacity to suppress tics predicts futures tic severity. Methods: We tested 45 children (30 male, mean age 7.74 years) with recent-onset tics (mean 3.47 months prior to the first study visit; baseline) and re-examined each child at the 12-month anniversary of the first recognized tic (follow-up). At the baseline visit, children performed a tic suppression task with several conditions: tic freely, inhibit tics given a verbal request, and inhibit tics in the presence of a reward. Results: At the baseline visit, children with tics for only a few months could suppress their tics, and tic suppression was especially successful when they received immediate and contingent reward. Additionally, the ability to suppress tics in the presence of ...
Motor and vocal tics are common in childhood. The received wisdom among clinicians is that for mo... more Motor and vocal tics are common in childhood. The received wisdom among clinicians is that for most children the tics are temporary, disappearing within a few months. However, that common clinical teaching is based largely on biased and incomplete data. The present study was designed to prospectively assess outcome of children with what the current nomenclature calls Provisional Tic Disorder. We identified 43 children with recent onset tics (mean 3.3 months since tic onset) and re-examined 39 of them on the 12-month anniversary of their first tic. Tic symptoms improved on a group level at the 12-month follow-up, and only two children had more than minimal impairment due to tics. Remarkably, however, tics were present in all children at follow-up, although in several cases tics were apparent only when the child was observed remotely by video. Our results suggest that remission of Provisional Tic Disorder is the exception rather than the rule. We also identified several clinical featu...
Motor and vocal tics are common in childhood. The received wisdom among clinicians is that for mo... more Motor and vocal tics are common in childhood. The received wisdom among clinicians is that for most children the tics are temporary, disappearing within a few months. However, that common clinical teaching is based largely on biased and incomplete data. The present study was designed to prospectively assess outcome of children with what the current nomenclature calls Provisional Tic Disorder. We identified 43 children with recent onset tics (mean 3.3 months since tic onset) and re-examined 39 of them on the 12-month anniversary of their first tic. Tic symptoms improved on a group level at the 12-month follow-up, and only two children had more than minimal impairment due to tics. Remarkably, however, tics were present in all children at follow-up, although in several cases tics were apparent only when the child was observed remotely by video. Our results suggest that remission of Provisional Tic Disorder is the exception rather than the rule. We also identified several clinical featu...
Tic disorders are childhood onset neuropsychiatric disorders characterized by motor and/or vocal ... more Tic disorders are childhood onset neuropsychiatric disorders characterized by motor and/or vocal tics. Research has demonstrated that children with chronic tics (including Tourette syndrome and Chronic Tic Disorder: TS/CTD) can suppress tics, particularly when an immediate, contingent reward is given for successful tic suppression. As a diagnosis of TS/CTD requires tics to be present for at least one year, children in these tic suppression studies had been living with tics for quite some time. Thus, it is unclear whether the ability to inhibit tics is learned over time or present at tic onset. Resolving that issue would inform theories of how tics develop and how behavior therapy for tics works. We investigated tic suppression in school-age children as close to the time of tic onset as possible, and no later than six months after onset. Children were asked to suppress their tics both in the presence and absence of a contingent reward. Results demonstrated that these children, like children with TS/CTD, have some capacity to suppress tics, and that immediate reward enhances that capacity. These findings demonstrate that the modulating effect of reward on inhibitory control of tics is present within months of tic onset, before tics have become chronic.
Objective: Estimates of tic prevalence in community samples of children vary significantly. Under... more Objective: Estimates of tic prevalence in community samples of children vary significantly. Understanding the true prevalence of tics improves clinicians’ ability to counsel patients and families on their typical course. In this study, we directly observe elementary school children in the classroom setting to determine the prevalence of tics in the general school population. Method: Participants were 215 children in kindergarten through fifth grade (5 first grade classrooms and 1 classroom from each of the other grades). Trained raters observed each child for three minutes, once monthly, for three consecutive months. Raters recorded whether tics were present, and if so, their type and frequency.Results: Prevalence over the 3 visits was 47%. Peak point prevalence was 35.1% for motor tics and 4.9% for phonic tics. Simple tics were more common than complex tics. Tic frequency was similar across grades. Tics seen at all 3 visits were uncommon and largely occurred in older children. The ...
A prior study showed that rhythmic, but not arrhythmic, 12 Hz stimulation of the median nerve (MN... more A prior study showed that rhythmic, but not arrhythmic, 12 Hz stimulation of the median nerve (MNS) entrained sensorimotor cortex EEG signal, and found that 10 Hz MNS improved tics in Tourette syndrome (TS). However, no control condition was tested and stimulation blocks lasted only 1 minute. We set out to replicate the TS results and to test whether tic improvement occurs by the proposed cortical entrainment mechanism. Thirty-two people with TS, age 15-64, completed two study visits with repeated MNS on and off blocks in random order, one visit for rhythmic and one for arrhythmic MNS. Subjects and staff were blind to order; a video rater was additionally blind to stimulation and to order of visits and blocks. Rhythmic MNS at 10 Hz improved tics. Both rhythmic and arrhythmic 12 Hz MNS improved tic frequency, intensity and urges without significant difference. Participant masking was effective and there was no carryover effect. Several participants described dramatic benefit. Discomf...
Objective: Recent years have seen a dramatic increase in new “tic” cases in teens and young adult... more Objective: Recent years have seen a dramatic increase in new “tic” cases in teens and young adults. These individuals often present with fulminant onset of symptoms not commonly seen in Tourette syndrome (TS), and are often diagnosed with Functional Neurological Symptom Disorder (FND-tic). However, some authors have questioned whether this illness truly differs from typical Provisional Tic Disorder (PTD) and TS. We sought to test whether the presenting symptoms of FND-tic differ substantially from those in patients later diagnosed with TS. Method: We compared retrospective comparison of data from a longitudinal study of PTD to data summarized from published reports of FND-tic. The longitudinal study of PTD included 89 children with tics beginning less than 9 months ago (median 3.6 months), nearly all of whom were diagnosed with TS at follow-up. We discuss clinical features thought to support a diagnosis of FND-tic, including symptom characteristics, course, severity and comorbidity....
Median nerve stimulation (MNS) at 10-12 Hz was recently proposed as a potential treatment for tic... more Median nerve stimulation (MNS) at 10-12 Hz was recently proposed as a potential treatment for tics in Tourette syndrome and other chronic tic disorders (TS/CTD). Here we report on 31 people ages 15-64 with TS/CTD who participated in a 4-week open label study of MNS. We provide individual participant data. Participants were recruited from participants in a randomized controlled trial of MNS and were given a transcutaneous electrical nerve stimulation (TENS) unit to use for MNS for 4 weeks. They were instructed to use the device as desired. Participants were instructed to complete surveys each time they began or ended stimulation, as well as twice daily at random times when prompted by a text message. These surveys contained information on tic frequency, tic intensity, and stimulation discomfort, when applicable. Participants also completed a more extensive final survey at the conclusion of the 4 weeks. 27 participants completed the study. Median device use was 1.5 days per week (inte...
Here we propose (a) to determine the real-world usage and apparent utility of stimulation in peop... more Here we propose (a) to determine the real-world usage and apparent utility of stimulation in people with chronic tics, and (b) to determine momentary self-rated efficacy and side effects of stimulation. In addition, we will compare results from this study to those from the "Peripheral induction of inhibitory brain circuits to treat Tourette's: pilot" study, from which participants will be drawn, in order to compare laboratory and real-world efficacy.
Supplementary_data_20190419 for Tic Suppression in Children With Recent-Onset Tics Predicts 1-Yea... more Supplementary_data_20190419 for Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome by Soyoung Kim, Deanna J. Greene, Amy Robichaux-Viehoever, Emily C. Bihun, Jonathan M. Koller, Haley Acevedo, Bradley L. Schlaggar and Kevin J. Black in Journal of Child Neurology
Supplemental Material, Supplementary_data_20190419 for Tic Suppression in Children With Recent-On... more Supplemental Material, Supplementary_data_20190419 for Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome by Soyoung Kim, Deanna J. Greene, Amy Robichaux-Viehoever, Emily C. Bihun, Jonathan M. Koller, Haley Acevedo, Bradley L. Schlaggar and Kevin J. Black in Journal of Child Neurology
Supplemental Material, Supplemental_File for Tic Suppression in Children With Recent-Onset Tics P... more Supplemental Material, Supplemental_File for Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome by Soyoung Kim, Deanna J. Greene, Amy Robichaux-Viehoever, Emily C. Bihun, Jonathan M. Koller, Haley Acevedo, Bradley L. Schlaggar and Kevin J. Black in Journal of Child Neurology
<strong>VISIT-TS</strong> (<strong>V</strong>ideo-<strong>I</str... more <strong>VISIT-TS</strong> (<strong>V</strong>ideo-<strong>I</strong>ntegrated <strong>S</strong>creening <strong>I</strong>nstrument for <strong>T</strong>ics and <strong>T</strong>ourette <strong>S</strong>yndrome) is a multimedia tool intended to demonstrate tics to a lay audience, to discuss their defining and common attributes, and to address features that differentiate tics from other movements and vocalizations. The video includes a teaching section (5 minutes) followed by questions (5 minutes). The original intended use of VISIT-TS is for epidemiological research. Vachon MJ, Striley CW, Gordon MR, Schroeder ML, Bihun EC, Koller JM, Black KJ: VISIT-TS: A multimedia tool for population studies on tic disorders [<em>version 2; referees: 3 approved</em>]. F1000Res 2016; 5:1518. DOI: 10.12688/f1000research.7196.2.
BackgroundPrevious studies have investigated differences in the volumes of subcortical structures... more BackgroundPrevious studies have investigated differences in the volumes of subcortical structures (e.g., caudate nucleus, putamen, thalamus, amygdala, hippocampus) between individuals with and without Tourette syndrome (TS), as well as the relationships between these volumes and tic symptom severity. These volumes may also predict clinical outcome in Provisional Tic Disorder (PTD), but that hypothesis has never been tested.ObjectiveThis study aimed to examine whether the volumes of subcortical structures measured shortly after tic onset can predict tic symptom severity at one year post tic onset, when TS can first be diagnosed.MethodsWe obtained T1-weighted structural MRI scans from 41 children with PTD (25 with prospective motion correction [vNavs]) whose tics had begun less than 9 months (median 3.7 months) prior to the first study visit (baseline). We re-examined them at the 12-month anniversary of their first tic (follow-up), assessing tic severity using the Yale Global Tic Seve...
Background: Successful voluntary tic suppression is a key component of the behavioral interventio... more Background: Successful voluntary tic suppression is a key component of the behavioral interventions that are used to treat tic disorders. Objective: This study aimed to examine tic suppression in children with recent-onset tics and determine whether the capacity to suppress tics predicts futures tic severity. Methods: We tested 45 children (30 male, mean age 7.74 years) with recent-onset tics (mean 3.47 months prior to the first study visit; baseline) and re-examined each child at the 12-month anniversary of the first recognized tic (follow-up). At the baseline visit, children performed a tic suppression task with several conditions: tic freely, inhibit tics given a verbal request, and inhibit tics in the presence of a reward. Results: At the baseline visit, children with tics for only a few months could suppress their tics, and tic suppression was especially successful when they received immediate and contingent reward. Additionally, the ability to suppress tics in the presence of ...
Motor and vocal tics are common in childhood. The received wisdom among clinicians is that for mo... more Motor and vocal tics are common in childhood. The received wisdom among clinicians is that for most children the tics are temporary, disappearing within a few months. However, that common clinical teaching is based largely on biased and incomplete data. The present study was designed to prospectively assess outcome of children with what the current nomenclature calls Provisional Tic Disorder. We identified 43 children with recent onset tics (mean 3.3 months since tic onset) and re-examined 39 of them on the 12-month anniversary of their first tic. Tic symptoms improved on a group level at the 12-month follow-up, and only two children had more than minimal impairment due to tics. Remarkably, however, tics were present in all children at follow-up, although in several cases tics were apparent only when the child was observed remotely by video. Our results suggest that remission of Provisional Tic Disorder is the exception rather than the rule. We also identified several clinical featu...
Motor and vocal tics are common in childhood. The received wisdom among clinicians is that for mo... more Motor and vocal tics are common in childhood. The received wisdom among clinicians is that for most children the tics are temporary, disappearing within a few months. However, that common clinical teaching is based largely on biased and incomplete data. The present study was designed to prospectively assess outcome of children with what the current nomenclature calls Provisional Tic Disorder. We identified 43 children with recent onset tics (mean 3.3 months since tic onset) and re-examined 39 of them on the 12-month anniversary of their first tic. Tic symptoms improved on a group level at the 12-month follow-up, and only two children had more than minimal impairment due to tics. Remarkably, however, tics were present in all children at follow-up, although in several cases tics were apparent only when the child was observed remotely by video. Our results suggest that remission of Provisional Tic Disorder is the exception rather than the rule. We also identified several clinical featu...
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Papers by Emily Bihun