Eng Goi Khia, Tambini Arielle, Hermiller Molly S, Recchia Nicolette, Harvey Jeanmarie R, Iosifescu Dan V, Tobe Russell H, Stern Emily R
Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, United States.
Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States.
Front Hum Neurosci. 2025 Jun 24;19:1587644. doi: 10.3389/fnhum.2025.1587644. eCollection 2025.
Obsessive-compulsive disorder (OCD) is chronic and impairing. While OCD often involves fear of harm or bad events, many patients experience "sensory phenomena," which are aversive sensory experiences that drive repetitive behaviors regardless of specific fears. Standard treatments do not effectively address sensory phenomena, and novel approaches are needed. Transcranial magnetic stimulation (TMS) is a safe and non-invasive neuromodulation technique increasingly used in psychiatric disorders, including OCD. This work presents a data-driven approach to identifying TMS brain targets for modulating sensory urges in OCD incorporating both behavioral and clinical criteria (Study 1) for a proof-of-concept investigation (Study 2). Study 1 included 69 individuals with OCD and 23 controls who completed an urges-for-action fMRI task involving instructed eyeblink suppression as an experimental model for sensory-based urges. Data-driven conjunction analysis revealed several brain regions, including the right postcentral gyrus, that were associated with more blink suppression failure (behavioral), more severe sensory phenomena (clinical), and were hyperactivated in OCD patients compared to controls. Study 2 administered single-session inhibitory TMS on 4 returning OCD patients using individualized targets within the postcentral gyrus identified from Study 1. Compared to sham, inhibitory TMS delivered to individualized postcentral gyrus targets resulted in fewer blink suppression failures, reduced activation in the target (postcentral gyrus) and key urge-related areas (insula, mid-cingulate), and greater reduction in self-reported urge to engage in OCD-related compulsions, with medium to large effect sizes. These findings demonstrate the potential of utilizing data-driven approaches incorporating behavioral and clinical criteria to target hard-to-treat sensory phenomena in OCD.
强迫症（OCD）是一种慢性且会造成损害的疾病。虽然强迫症通常涉及对伤害或不良事件的恐惧，但许多患者会经历“感觉现象”，即一些厌恶的感觉体验，这些体验会驱使重复行为，而与特定恐惧无关。标准治疗方法无法有效解决感觉现象，因此需要新的方法。经颅磁刺激（TMS）是一种安全且非侵入性的神经调节技术，越来越多地用于包括强迫症在内的精神疾病。这项研究提出了一种数据驱动的方法，用于确定经颅磁刺激治疗强迫症中调节感觉冲动的脑靶点，该方法结合了行为和临床标准（研究1）进行概念验证研究（研究2）。研究1纳入了69名强迫症患者和23名对照者，他们完成了一项行动冲动功能磁共振成像任务，该任务涉及指令性眨眼抑制，作为基于感觉的冲动的实验模型。数据驱动的联合分析揭示了几个脑区，包括右侧中央后回，这些脑区与更多的眨眼抑制失败（行为方面）、更严重的感觉现象（临床方面）相关，并且与对照组相比，在强迫症患者中表现为过度激活。研究2对4名回访的强迫症患者在中央后回内使用从研究1中确定的个体化靶点进行了单节段抑制性经颅磁刺激。与假刺激相比，给予个体化中央后回靶点的抑制性经颅磁刺激导致眨眼抑制失败减少，靶点（中央后回）和关键冲动相关区域（岛叶、扣带回中部）的激活减少，以及自我报告的参与强迫症相关强迫行为的冲动有更大程度的降低，效应大小为中等至大。这些发现证明了利用结合行为和临床标准的数据驱动方法来针对强迫症中难以治疗的感觉现象的潜力。
