D'Urso Giordano, Brunoni Andre Russowsky, Anastasia Annalisa, Micillo Marco, de Bartolomeis Andrea, Mantovani Antonio
a Department of Clinical Neurosciences, Anesthesiology and Pharmachoutilization , University Hospital of Naples Federico II , Naples , Italy.
b Interdisciplinary Center for Applied Neuromodulation (CINA) , University Hospital, University of São Paulo , São Paulo , Brazil.
Neurocase. 2016;22(1):60-4. doi: 10.1080/13554794.2015.1045522. Epub 2015 May 14.
About one third of patients with obsessive-compulsive disorder (OCD) fail to experience significant clinical benefit from currently available treatments. Hyperactivity of the presupplementary motor area (pre-SMA) has been detected in OCD patients, but it is not clear whether it is the primary cause or a secondary compensatory mechanism in OCD pathophysiology. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique with polarity-dependent effects on motor cortical excitability. A 33-year-old woman with treatment-resistant OCD received 20 daily consecutive 2 mA/20 min tDCS sessions with the active electrode placed on the pre-SMA, according to the 10-20 EEG system, and the reference electrode on the right deltoid. The first 10 sessions were anodal, while the last 10 were cathodal. Symptoms severity was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) severity score. In the end of anodal stimulation, OCD symptoms had worsened. Subsequent cathodal stimulation induced a dramatic clinical improvement, which led to an overall 30% reduction in baseline symptoms severity score on the Y-BOCS. Our study supports the hypothesis that pre-SMA hyperfunction might be responsible for OCD symptoms and shows that cathodal inhibitory tDCS over this area might be an option when dealing with treatment-resistant OCD.
约三分之一的强迫症（OCD）患者未能从目前可用的治疗中获得显著的临床益处。在强迫症患者中已检测到补充运动前区（pre-SMA）的活动亢进，但尚不清楚它是强迫症病理生理学中的主要原因还是次要的代偿机制。经颅直流电刺激（tDCS）是一种非侵入性脑刺激技术，对运动皮质兴奋性有极性依赖性影响。一名33岁的难治性强迫症女性患者，根据10-20脑电图系统，将有源电极置于补充运动前区，参考电极置于右侧三角肌，连续20天每天接受2毫安/20分钟的tDCS治疗。前10次治疗为阳极刺激，后10次为阴极刺激。使用耶鲁-布朗强迫症量表（Y-BOCS）严重程度评分评估症状严重程度。在阳极刺激结束时，强迫症症状恶化。随后的阴极刺激带来了显著的临床改善，导致Y-BOCS上的基线症状严重程度评分总体降低了30%。我们的研究支持补充运动前区功能亢进可能是强迫症症状的原因这一假设，并表明对该区域进行阴极抑制性tDCS可能是治疗难治性强迫症的一种选择。
