Di Ponzio Michele, Makris Nikos, Tenerini Carlotta, Grassi Eleonora, Ragone Samuele, Pallanti Stefano
Institute for Neuroscience, Florence, Italy.
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Front Psychiatry. 2023 Feb 3;13:1035469. doi: 10.3389/fpsyt.2022.1035469. eCollection 2022.
Repetitive Transcranial Magnetic Stimulation (rTMS) is not only a therapeutic option but also an investigational tool to explore circuits and subjective dimensions in pathological conditions. Obsessive-Compulsive Related Disorders (OCRDs) shared similarities with Substance Use Disorder (SUD), suggesting the involvement of the reward system. This study aimed to verify the efficacy of targeting the reward system with rTMS in OCRDs.
Patients with trichotillomania, hoarding disorder and skin picking disorder were treated with rTMS over the left DorsoLateral PreFrontal Cortex (DLPFC) at 15 Hz, targeting the reward system via the connection with the nucleus accumbens and the ventral tegmental area. All patients were administered with psychometric scales assessing depression symptoms and severity of OCRDs symptoms at the baseline, at the end of the treatment and a 1-month follow-up.
Analysis of the results showed a reduction in symptom severity at the end of the treatment in all three groups ( < 0.0001) as well as a reduction in depression symptoms ( < 0.01). Improvements at 1-month follow-up were maintained only in younger patients. Indeed, when changes in scores at the follow-up were analyzed separately for younger (<30 years) and older patients (>60 years), the elderly showed again an increase in symptoms severity, suggesting that the stability of TMS effects over time reduces with age, possibly as an effect of age-related reduction in brain plasticity.
This study adopted with promising results a protocol (15 Hz over the left DLPFC) targeting the reward system, typically employed in addictions. These results can be in line with the view of OCRDs as behavioral addictions, suggesting the implication of common circuits, such as the reward system, in the mechanisms at the basis of these disorders.
重复经颅磁刺激（rTMS）不仅是一种治疗选择，也是探索病理状态下神经回路和主观维度的研究工具。强迫相关障碍（OCRDs）与物质使用障碍（SUD）有相似之处，提示奖赏系统参与其中。本研究旨在验证rTMS靶向奖赏系统治疗OCRDs的疗效。
拔毛癖、囤积障碍和皮肤搔抓障碍患者接受15赫兹的rTMS刺激左侧背外侧前额叶皮质（DLPFC），通过与伏隔核和腹侧被盖区的连接靶向奖赏系统。所有患者在基线、治疗结束时和1个月随访时均接受心理测量量表评估抑郁症状和OCRDs症状的严重程度。
结果分析显示，所有三组患者在治疗结束时症状严重程度均降低（<0.0001），抑郁症状也有所减轻（<0.01）。仅年轻患者在1个月随访时维持了改善。实际上，当分别分析年轻患者（<30岁）和老年患者（>60岁）随访时得分的变化时，老年患者的症状严重程度再次增加，这表明TMS效应随时间的稳定性随年龄降低，可能是由于与年龄相关的脑可塑性降低所致。
本研究采用了一种针对奖赏系统的方案（左侧DLPFC，15赫兹），该方案常用于成瘾治疗，取得了有前景的结果。这些结果与将OCRDs视为行为成瘾的观点一致，提示常见神经回路（如奖赏系统）参与了这些障碍的发病机制。
