BACKGROUND Intermittent explosive outbursts (IEO), manifesting as sudden episodes of verbal or physical aggression, are frequently present in patients with Tourette disorder (TD) and considered as one of the most disabling symptoms by patients and families. The neuronal correlates of these behaviours are poorly understood, and this was the primary objective of the present study. METHODS We assessed the presence of IEO in 55 patients with TD and then compared the subgroup of the patients with IEO to those without these manifestations using a multimodal neuroimaging approach. RESULTS 47% of TD patients presented IEO, which was frequently associated with attention deficit hyperactivity disorder (ADHD). TD patients (without ADHD) with IEO compared to TD without IEO, showed structural changes in the right supplementary motor area as well as in the right hippocampus (increased fractional anisotropy), and in the left orbitofrontal cortex (decreased mean diffusivity). Using these three nodes as seeds for resting state functional connectivity, we showed a lower connectivity within the sensori-motor cortico-basal ganglia network, and an altered connectivity pattern among the orbito-frontal cortex, amygdala and hippocampus. CONCLUSIONS Overall, our results indicate that TD with IEO is associated with brain dysfunction related to a less efficient top-down control on action selection, and impairments related to emotional regulation, impulse control and aggressive behaviours.

中文翻译：

---

抽动性抽动症的间歇性爆炸症状是感觉运动和边缘网络内部结构和功能异常的基础。

背景技术间歇性爆发性爆发（IEO）表现为口头或身体攻击的突然发作，经常在图雷特病（TD）患者中出现，并且被患者和家庭认为是最致残的症状之一。这些行为的神经元相关性了解甚少，这是本研究的主要目标。方法我们评估了55例TD患者中IEO的存在，然后使用多模式神经影像学方法将IEO患者的亚组与无这些表现的患者进行了比较。结果47％的TD患者出现IEO，这通常与注意力缺陷多动障碍（ADHD）相关。与没有IEO的TD相比，有IEO的TD患者（无ADHD），显示右辅助运动区以及右海马区（分数各向异性增加）和左眶额皮质（平均扩散度降低）中的结构变化。使用这三个节点作为静止状态功能连通性的种子，我们显示出感觉运动皮质-基底神经节网络内的连通性较低，以及眶额皮质，杏仁核和海马之间的连通性模式发生了改变。结论总体而言，我们的结果表明，伴有IEO的TD与大脑功能障碍有关，后者与行动选择的自顶向下控制效率较低有关，与情绪调节，冲动控制和攻击性行为有关。使用这三个节点作为静止状态功能连通性的种子，我们显示出感觉运动皮质-基底神经节网络内的连通性较低，以及眶额皮质，杏仁核和海马之间的连通性模式发生了改变。结论总体而言，我们的结果表明，伴有IEO的TD与大脑功能障碍有关，后者与行动选择的自顶向下控制效率较低有关，与情绪调节，冲动控制和攻击性行为有关。使用这三个节点作为静止状态功能连通性的种子，我们显示出感觉运动皮质-基底神经节网络内的连通性较低，以及眶额皮质，杏仁核和海马之间的连通性模式发生了改变。结论总体而言，我们的结果表明，伴有IEO的TD与大脑功能障碍有关，后者与行动选择的自上而下控制不力有关，与情绪调节，冲动控制和攻击性行为有关。