Bation Remy, Poulet Emmanuel, Haesebaert Frederic, Saoud Mohamed, Brunelin Jerome
Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France.
Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France; CHU de Lyon - Groupement Hospitalier Edouard Herriot - Service de Psychiatrie des Urgences, France.
Prog Neuropsychopharmacol Biol Psychiatry. 2016 Feb 4;65:153-7. doi: 10.1016/j.pnpbp.2015.10.001. Epub 2015 Oct 9.
Obsessive-compulsive disorder (OCD) is a severe mental illness. OCD symptoms are often resistant to available treatments. Abnormalities within the orbitofronto-striato-pallido-thalamic circuitry, especially orbitofrontal cortex (OFC) hyperactivity and cerebellar hypoactivity have been observed in patients. Non-invasive brain stimulation studies have indicated that transcranial direct current stimulation (tDCS) may be a useful alternative to alleviate treatment-resistant symptoms in various neuropsychiatric conditions.
In an open-label pilot study, 8 patients with treatment-resistant OCD received 10 sessions (twice a day) of 2mA tDCS applied with the cathode over the left OFC and the anode over the right cerebellum. OCD (Y-BOCS and OCD-VAS) as well as depressive (MADRS) symptoms were measured 4 times: one time before tDCS and 3 times after (immediately after, 1 and 3months after the 10th tDCS session).
We reported a significant 26.4% (±15.8) decrease of Y-BOCS score (p=0.002). The beneficial effect lasted during the 3month follow-up. No effect of tDCS was observed on depressive symptoms. At end point, 5 out of 8 patients had a decrease of ≥25%; and 3 out of 8 patients had a decrease of ≥35% in Y-BOCS score. tDCS was well tolerated.
tDCS with the cathode placed over the left OFC combined with the anode placed over the right cerebellum is a suitable and safe approach to decrease OCD symptoms in patients with treatment-resistant OCD. Large scale randomized controlled studies are needed to confirm this promising result.
强迫症（OCD）是一种严重的精神疾病。强迫症症状通常对现有治疗有抵抗性。在患者中已观察到眶额-纹状体-苍白球-丘脑神经回路异常，尤其是眶额皮质（OFC）活动亢进和小脑活动减退。非侵入性脑刺激研究表明，经颅直流电刺激（tDCS）可能是缓解各种神经精神疾病中难治性症状的一种有效替代方法。
在一项开放标签的试点研究中，8名难治性强迫症患者接受了10次（每天两次）2mA的tDCS治疗，阴极置于左侧OFC上方，阳极置于右侧小脑上方。对强迫症（Y-BOCS和OCD-VAS）以及抑郁（MADRS）症状进行了4次测量：tDCS治疗前一次，治疗后3次（第10次tDCS治疗后立即测量、1个月后和3个月后测量）。
我们报告Y-BOCS评分显著降低了26.4%（±15.8）（p=0.002）。这种有益效果在3个月的随访期内持续存在。未观察到tDCS对抑郁症状有影响。在研究终点，8名患者中有5名Y-BOCS评分降低≥25%；8名患者中有3名Y-BOCS评分降低≥35%。tDCS耐受性良好。
阴极置于左侧OFC上方、阳极置于右侧小脑上方的tDCS是降低难治性强迫症患者强迫症症状的一种合适且安全的方法。需要大规模随机对照研究来证实这一有前景的结果。
