Ruffini Chiara, Locatelli Marco, Lucca Adelio, Benedetti Francesco, Insacco Chiara, Smeraldi Enrico
Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy.
Prim Care Companion J Clin Psychiatry. 2009;11(5):226-30. doi: 10.4088/PCC.08m00663.
The orbitofrontal cortex (OFC) plays a major role in the pathophysiology of obsessive-compulsive disorder (OCD); functional neuroimaging studies indicate that OCD symptoms are associated with increased activity in the OFC, caudate nucleus, thalamus, and anterior cingulate gyrus. The goal of our single-blind study was to assess whether repetitive transcranial magnetic stimulation (rTMS) over the left OFC would influence OCD symptoms in drug-resistant patients.
Twenty-three consecutively admitted right-handed inpatients with DSM-IV-TR-diagnosed drug-resistant OCD were given rTMS (80% motor threshold, 1 Hz seconds per minute for 10 minutes every day for 15 days) to the left OFC parallel (active: n = 16) or perpendicular (sham: n = 7) to the scalp. The patients' OCD symptoms, mood, and anxiety were rated at baseline, at the end of treatment, and once every 2 weeks for 3 months after treatment. Data were gathered from June 2006 to November 2007.
Considering changes in Yale-Brown Obsessive Compulsive Scale (YBOCS) scores with 2-way analysis of variance for repeated measures for a total of 8 observations (before rTMS, after treatment, and every 2 weeks for 12 weeks' follow-up), we found significant reduction of YBOCS scores comparing active versus sham treatment for 10 weeks after the end of rTMS (P < .02), with loss of significance after 12 weeks (P < .06). We also found a reduction of anxiety and depression symptoms but not a significant difference in the 2 groups.
Low-frequency rTMS of the left OFC produced significant but time-limited improvement in OCD patients compared to sham treatment.
眶额皮质（OFC）在强迫症（OCD）的病理生理学中起主要作用；功能神经影像学研究表明，OCD症状与眶额皮质、尾状核、丘脑及前扣带回的活动增加有关。我们单盲研究的目的是评估对左侧眶额皮质进行重复经颅磁刺激（rTMS）是否会影响耐药患者的OCD症状。
23例连续入院的、经DSM-IV-TR诊断为耐药OCD的右利手患者，接受了针对左侧眶额皮质的rTMS治疗（80%运动阈值，每分钟1次，每次10分钟，共15天），刺激方向与头皮平行（治疗组：n = 16）或垂直（假刺激组：n = 7）。在基线、治疗结束时以及治疗后3个月内每2周对患者的OCD症状、情绪和焦虑进行评分。数据收集时间为2006年6月至2007年11月。
采用重复测量的双向方差分析对总共8次观察（rTMS前、治疗后以及随访12周内每2周一次）的耶鲁-布朗强迫症量表（YBOCS）评分变化进行分析，我们发现rTMS结束后10周，治疗组与假刺激组相比YBOCS评分显著降低（P < .02），12周后差异不再显著（P < .06）。我们还发现两组的焦虑和抑郁症状均有减轻，但差异无统计学意义。
与假刺激治疗相比，对左侧眶额皮质进行低频rTMS治疗可使OCD患者症状得到显著但有时间限制的改善。
