A promising avenue for treating Misophonia
A recent study by Turrini et al [1] used cortico-cortical paired associative stimulation (ccPAS) - an non-invasive brain stimulation technique to manipulate brain connectivity achieved via network-based transcranial magnetic stimulation (TMS) - to alter effective connectivity in action observation network (AON) via Hebbian spike-timing-dependent plasticity (STDP). They showed that enhancing (or weakening) the connectivity between the ventral part of the PreMotor cortical area (PMv) and the primary motor cortex (M1) increases (or decreases) the tendency to automatically imitate the behaviour of others. They also showed that enhancing supplementary motor area’s (SMA) connectivity with M1 actually induces a greater ability to avoid imitation when it is inappropriate to the context. This provides us with a promising avenue to treat disorders of aberrant mirroring.
Misophonia is a condition where people have extreme distress towards everyday bodily sounds like eating, chewing, breathing etc which are called trigger sounds. This causes the sufferers to avoid social situations like social meals at home, eating out or going to movies. Thus they experience significant loneliness and isolation even within their home.
Using functional MRI, we previously [2] reported a differential activation in Misophonia sufferers in response to trigger sounds much more than for other sounds in the motor brain, especially the brain area that is involved in representing lip, tongue, and jaw movement (i.e. chewing). Secondly, we also reported increased functional connectivity between the brain area that represents chewing to the secondary auditory brain in Misophonia sufferers during perception of any sound. Lastly, we also reported an enhanced functional connectivity in resting state fMRI in Misophonia sufferers between the brain area that represents chewing and auditory and visual brain areas.
We proposed [2] a model of Misophonia based on involuntary ‘mirroring’ of action of others, where trigger sounds or images activate the part of the brain in Misophonia sufferers as if they are executing the movements themselves. We suggested that this involuntary overactivation of the 'mirror' system may lead to either a sense of loss of control or interference in current goals and actions of Misophonia sufferers. Thus this results in extreme anger or irritation in Misophonia sufferers.
Given that we have shown Misophonia to be aberrant overactivation of the ‘mirror’ system, we proposed [3] to employ network-based TMS - shown [1] to effectively manipulate brain connectivity - by decreasing effective connectivity between PMv and M1 in Misophonia sufferers to reduce automatic imitative behaviour and enable them to be less sensitive to interference in their everyday tasks.
References:
[1] Turrini, Sonia, Francesca Fiori, Naomi Bevacqua, Chiara Saracini, Boris Lucero, Matteo Candidi, and Alessio Avenanti. "Spike-timing-dependent plasticity induction reveals dissociable supplementary–and premotor–motor pathways to automatic imitation." Proceedings of the National Academy of Sciences 121, no. 27 (2024): e2404925121.
Link: https://www.pnas.org/doi/10.1073/pnas.2404925121
[2] S Kumar, P Dheerendra, M Erfanian, E Benzaquen, W Sedley, M Lad, PE Gander, DE Bamiou, TD Griffiths, "The motor basis for Misophonia", Journal of Neuroscience, vol 41(26), pp. 5762-5770, 2021 Link: https://www.jneurosci.org/content/41/26/5762
Misophonia is a condition where people have extreme distress towards everyday bodily sounds like eating, chewing, breathing etc which are called trigger sounds. This causes the sufferers to avoid social situations like social meals at home, eating out or going to movies. Thus they experience significant loneliness and isolation even within their home.
Using functional MRI, we previously [2] reported a differential activation in Misophonia sufferers in response to trigger sounds much more than for other sounds in the motor brain, especially the brain area that is involved in representing lip, tongue, and jaw movement (i.e. chewing). Secondly, we also reported increased functional connectivity between the brain area that represents chewing to the secondary auditory brain in Misophonia sufferers during perception of any sound. Lastly, we also reported an enhanced functional connectivity in resting state fMRI in Misophonia sufferers between the brain area that represents chewing and auditory and visual brain areas.
We proposed [2] a model of Misophonia based on involuntary ‘mirroring’ of action of others, where trigger sounds or images activate the part of the brain in Misophonia sufferers as if they are executing the movements themselves. We suggested that this involuntary overactivation of the 'mirror' system may lead to either a sense of loss of control or interference in current goals and actions of Misophonia sufferers. Thus this results in extreme anger or irritation in Misophonia sufferers.
Given that we have shown Misophonia to be aberrant overactivation of the ‘mirror’ system, we proposed [3] to employ network-based TMS - shown [1] to effectively manipulate brain connectivity - by decreasing effective connectivity between PMv and M1 in Misophonia sufferers to reduce automatic imitative behaviour and enable them to be less sensitive to interference in their everyday tasks.
References:
[1] Turrini, Sonia, Francesca Fiori, Naomi Bevacqua, Chiara Saracini, Boris Lucero, Matteo Candidi, and Alessio Avenanti. "Spike-timing-dependent plasticity induction reveals dissociable supplementary–and premotor–motor pathways to automatic imitation." Proceedings of the National Academy of Sciences 121, no. 27 (2024): e2404925121.
Link: https://www.pnas.org/doi/10.1073/pnas.2404925121
[2] S Kumar, P Dheerendra, M Erfanian, E Benzaquen, W Sedley, M Lad, PE Gander, DE Bamiou, TD Griffiths, "The motor basis for Misophonia", Journal of Neuroscience, vol 41(26), pp. 5762-5770, 2021 Link: https://www.jneurosci.org/content/41/26/5762
[3] Pradeep D, Sukhbinder Kumar, Phillip E Gander, Joel I Berger, Lars F Muckli, "Reducing hyper mirroring in misophonia: A proposal for cortico-cortical paired associative stimulation (ccPAS) as a potential intervention for treatment", Medical Hypotheses, vol. 206, p. 111840, Jan 2026
Link: https://www.sciencedirect.com/science/article/pii/S0306987725002798
Link: https://www.sciencedirect.com/science/article/pii/S0306987725002798
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