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Abstract Details

Biofeedback-based Video Game Device to Treat Rage Attacks in Youth with Tourette Syndrome
Child Neurology and Developmental Neurology
P5 - Poster Session 5 (11:45 AM-12:45 PM)
4-008
Approximately 20-40% of individuals with Tourette Syndrome (TS) have rage attacks, which are recurrent, explosive behavioral outbursts that can cause significant functional impairment. Despite the impact of rage attacks in TS, there has been limited research on treatment, and most studies have focused on pharmacologic interventions. Non-pharmacologic interventions have the potential to improve symptoms with fewer side effects. Mightier, a biofeedback-based video game device, may help teach emotional regulation through heart rate control and has the potential to improve rage attacks in youth with TS.
To evaluate the feasibility and acceptability of Mightier as a therapeutic intervention for rage attacks in youth with TS.
Feasibility was assessed by recruitment number and retention rate. Subjects aged 6-12 years old with a diagnosis of TS and rage attacks were enrolled between October 2021 and May 2022 into a 20-week, single-arm trial. We also evaluated efficacy by assessing rage severity (Clinical Global Impressions of Rage (CGI-Rage), Rage Outbursts and Anger Rating Scale (ROARS)) and overall aggression severity (Modified Overt Aggression Scale) pre- and post-intervention. CGI-Improvement was completed post-intervention.

Recruitment rate was 1.1 subjects per month. Of the 8 enrolled subjects, 4 have completed the study and 1 has withdrawn due to medication changes during the study period. Retention rate was 87.5% (n=7). No screening failures occurred. Post-intervention, rage attack severity on CGI-Rage and ROARS improved in 75% (n=3) of subjects and did not change in 1 subject. Aggression did not significantly change (improved by a mean 0.5 points). CGI-I was rated as much improved or very much improved across all subjects.

Based on our recruitment rate and retention, Mightier may be feasible for use in youth with rage attacks and TS. Preliminary efficacy outcomes are promising.
Authors/Disclosures
Matthew Tae
PRESENTER
Mr. Tae has nothing to disclose.
Samantha Paige Myers Ms. Myers has nothing to disclose.
Jason Kahn, PhD (Mightier) Dr. Kahn has received personal compensation for serving as an employee of Neuromotion Labs. Dr. Kahn has stock in Neuromotion Labs. The institution of Dr. Kahn has received research support from NIMH. Dr. Kahn has received intellectual property interests from a discovery or technology relating to health care.
Nicole Walsh, NP (University of Rochester Medical Center) Mrs. Walsh has nothing to disclose.
Emily Ann Stone, Other (Mightier) Miss Stone has received personal compensation for serving as an employee of Mightier. Miss Stone has stock in Mightier.
Alyssa L. Peechatka, PhD (Mightier) Dr. Peechatka has received personal compensation for serving as an employee of Mightier. Dr. Peechatka has stock in Mightier. The institution of Dr. Peechatka has received research support from National Institutes of Mental Health .
Jessica Ragnio, Other (Mightier) Ms. Ragnio has received personal compensation for serving as an employee of Mightier. Ms. Ragnio has stock in Mightier.
Jonathan W. Mink, MD, PhD, FAAN The institution of Dr. Mink has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amicus. The institution of Dr. Mink has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurogene. Dr. Mink has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TEVA. Dr. Mink has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PTC Therapeutics. Dr. Mink has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Applied Therapeutics. Dr. Mink has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. The institution of Dr. Mink has received research support from Neurogene. The institution of Dr. Mink has received research support from NIH. Dr. Mink has received publishing royalties from a publication relating to health care. Dr. Mink has received personal compensation in the range of $500-$4,999 for serving as a Member, Study Section with NINDS.
Jennifer Anne Vermilion, MD (University of Rochester) The institution of Dr. Vermilion has received research support from Tourette Association of America, American Academy of Neurology and American Brain Foundation. The institution of Dr. Vermilion has received research support from Centers for Disease Control.