Department of Molecular, Cellular and Biomedical Sciences, CUNY, School of Medicine, New York, USA.
Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy.
J Psychiatr Res. 2021 Apr;136:560-570. doi: 10.1016/j.jpsychires.2020.10.030. Epub 2020 Oct 29.
intrusive thoughts and compulsive behaviors that characterize obsessive compulsive disorder (OCD) are associated to aberrant resting state functional connectivity (rsFC) patterns within the cortico-striatal-thalamo-cortical (CSTC) circuits. A high percentage of OCD patients do not respond to conventional pharmacological treatments or psychotherapy. In these patients, inhibitory repetitive transcranial magnetic stimulation (rTMS) of the Supplementary Motor Area (SMA) resulted in a significant clinical benefit.
In the current study, we applied a novel protocol of 1-week MRI-guided individualized double-daily sessions of rTMS treatment (1-Hz; 110% of resting Motor Threshold/7200 pulses/day), to bilateral SMA in 9 OCD patients. We tested its (i) feasibility-safety, (ii) clinical efficacy and (iii) rsFC related changes.
Patients reported no side effects during and after rTMS. Personalized rTMS treatment led to a significant improvement of OCD symptoms (average 25%; p = .005) and persistence of benefit up to 3-month follow-up. rsFC analysis revealed a significant reduction of connectivity patterns between bilateral SMA and subcortical regions, specifically in the basal ganglia and thalamus. Additional analysis showed that OCD symptoms severity correlates with a higher connectivity pattern between bilateral SMA and subcortical regions.
rTMS double-daily sessions are safe, feasible and effective in OCD. The clinical outcomes, that are consistent with those found in our previous RCT, are linked to a decreased connectivity between SMA and subcortical brain areas implicated in control over obsessions and maladaptive compulsive behavior.
强迫症（OCD）的特征是侵入性思维和强迫行为，与皮质-纹状体-丘脑-皮质（CSTC）回路中的异常静息状态功能连接（rsFC）模式有关。很大一部分 OCD 患者对传统的药物治疗或心理治疗没有反应。在这些患者中，抑制性重复经颅磁刺激（rTMS）对补充运动区（SMA）的刺激导致了显著的临床获益。
在目前的研究中，我们应用了一种新的方案，对 9 名 OCD 患者进行了为期 1 周的 MRI 引导的个体化双侧每日 rTMS 治疗（1Hz；110%静息运动阈值/7200 脉冲/天）。我们测试了它的（i）可行性-安全性，（ii）临床疗效和（iii）rsFC 相关变化。
患者在 rTMS 治疗过程中和治疗后均未报告任何副作用。个性化 rTMS 治疗导致 OCD 症状显著改善（平均 25%；p=0.005），并在 3 个月的随访中持续获益。rsFC 分析显示，双侧 SMA 与皮质下区域之间的连接模式显著减少，特别是在基底节和丘脑。进一步的分析表明，OCD 症状的严重程度与双侧 SMA 与皮质下区域之间的连接模式更高有关。
rTMS 每日两次治疗在 OCD 中是安全、可行和有效的。临床结果与我们之前的 RCT 一致，与 SMA 和涉及控制强迫观念和适应不良强迫行为的皮质下脑区之间的连接减少有关。
