School of Biomedical Engineering, Center for Big Data and Population Health of IHM, Anhui Medical University, Hefei, China.
School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.
Transl Psychiatry. 2024 Aug 6;14(1):321. doi: 10.1038/s41398-024-03041-4.
Obsessive-compulsive disorder (OCD) is a clinically challenging and refractory psychiatric disorder characterized by pathologically hyperactivated brain activity. Continuous theta burst stimulation (cTBS) is considered a potentially non-invasive treatment for inducing inhibitory effects on the underlying cortex. Numerous studies showed an unsatisfactory efficacy of cTBS for OCD. Accordingly, it seems that cTBS is ineffective for OCD. However, the neglect of varying OCD severities, modest sample size, absence of a multicenter design incorporating inpatients and outpatients, and lack of personalized imaging-guided targeting may constrain the conclusive findings of cTBS efficacy for OCD. In the preliminary experiment, 50 inpatients with OCD were enrolled to receive cTBS (10 sessions/day for five continuous days) or sham over the personalized right pre-supplementary motor area determined by the highest functional connectivity with the subthalamic nucleus according to our prior study. In the extension experiment, 32 outpatients with OCD received cTBS to generalize the treatment effects. The Yale-Brown Obsessive-Compulsive Scale (YBOCS) was assessed before and after treatment. In the preliminary experiment, the response rates in the cTBS group were 56.52%, respectively, significantly higher than those in the sham group. Further analysis revealed significant YBOCS improvement in patients with moderate OCD symptoms than those with severe OCD symptoms. In the extension experiment, the response rates were 50.00%. Additionally, a significant decrease in YBOCS scores was only found in patients with moderate OCD symptoms. This is the first study with an external validation design across two centers to identify OCD symptoms as playing an important role in cTBS treatment effects, especially in patients with moderate OCD symptoms.
强迫症（OCD）是一种具有挑战性且难治的精神疾病，其特征为病理性大脑活动过度活跃。连续 theta 爆发刺激（cTBS）被认为是一种潜在的非侵入性治疗方法，可对底层皮质产生抑制作用。大量研究表明 cTBS 对 OCD 的疗效不尽如人意。因此，cTBS 似乎对 OCD 无效。然而，忽视 OCD 严重程度的差异、样本量较小、缺乏纳入住院和门诊患者的多中心设计以及缺乏个性化的影像引导靶向治疗可能限制了 cTBS 治疗 OCD 疗效的确定结论。在初步实验中，我们招募了 50 名 OCD 住院患者，根据我们之前的研究，根据与丘脑底核的最高功能连接，使用个性化右辅助运动区接受 cTBS（每天 10 次，连续 5 天）或假刺激。在扩展实验中，32 名 OCD 门诊患者接受 cTBS 以推广治疗效果。治疗前后使用耶鲁-布朗强迫症量表（YBOCS）进行评估。在初步实验中，cTBS 组的反应率分别为 56.52%，明显高于假刺激组。进一步分析显示，中重度 OCD 症状患者的 YBOCS 改善显著高于重度 OCD 症状患者。在扩展实验中，反应率为 50.00%。此外，仅在中重度 OCD 症状患者中发现 YBOCS 评分显著降低。这是首个采用跨两个中心外部验证设计的研究，确定 OCD 症状在 cTBS 治疗效果中发挥重要作用，尤其是在中重度 OCD 症状患者中。
