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Why tics can get worse in stressful social situations.

Posted on 2 November 2018 by Helen Robbins


A Tourettes Action supported research study shows part of the brain is hyperactive (the insula) when people with Tourette Syndrome see faces. This may go some way in explaining why tics can get worse in stressful social situations.

The symptoms experienced by people with Tourette Syndrome (TS) often get worse in social situations. New research at Brighton and Sussex Medical School (BSMS) suggests that the reason may be because the brains of people with TS are hyper-responsive to social cues, including emotional facial expressions.

Research Fellow Dr Charlotte Rae, who conducted the study, said: “People with TS often report that their tics get worse in stressful social situations where they are under public scrutiny. Now for the first time, functional MRI scanning has shown how this is probably occurring – through an increase in activity in the insula, and the signals that this area sends to the regions of the brain that cause tics. This understanding may help us to work on new therapies for people with TS, by developing ways to manage the increase in insula activity in such scenarios.”

The researchers scanned the brains of 21 people with TS and 21 control participants without tics while they watched pictures of faces depicting emotions such as anger. Both groups demonstrated activation within visual brain areas, including the fusiform face area, which shows strong activity when people look at faces. In addition, those with TS also showed extra responses in the insula. This brain region also showed much greater signalling with brain regions that control movement and are implicated in generating tics: the pre-supplementary motor area, premotor cortex, primary motor cortex and the putamen.

The strength of communication between the insula and deep (subcortical) brain areas (thalamus and globus pallidus) predicted the severity of tics and Tourette symptoms, while insular communication to upper (cortical) brain areas (supplementary motor area) varied in proportion to uncomfortable feelings of ‘itch’ or ‘pressure’ that occur just before tics (premonitory sensations).  

According to Chair of Psychiatry at BSMS, Prof Hugo Critchley, the study findings may help develop better ways for people with TS to manage their symptoms: “We are getting a clearer insight into the brain basis of tics that now incorporates the science of emotion and social interaction.  By unpicking these mechanisms, we can fine-tune treatment approaches. Until now, we have tended to rely  on medicines to inhibit movements or decrease compulsions in TS, but these often have unwanted side-effects and may not be particularly effective. This research leads the way toward more individualised approaches that get closer to the psychosocial triggers of tics and the neurology of Tourette symptoms”.


Read the research paper in Neurology journal 'Brain' 


About Brighton and Sussex Medical School

Brighton and Sussex Medical School (BSMS) is partnership between the Universities of Brighton and Sussex and the local NHS health community. At BSMS, we identify research areas in medicine where we believe we can make a rapid and real difference. Our focus is on the continuous improvement of medical treatment to deliver more personalised healthcare for patients, by applying basic science to answer fundamental clinical questions.

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Why tics can get worse in stressful social situations.


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