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TITLE
Clinical and Electrophysiological Outcomes of Deep TMS Over the Medial Prefrontal and Anterior Cingulate Cortices in OCD Patients
AUTHORS
Carmi L; Alyagon U; Barnea-Ygael N; Zohar J; Dar R; Zangen A. Institution Carmi, Lior. School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel. Alyagon, Uri. Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel. Barnea-Ygael, Noam. Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel. Zohar, Joseph. Tel Aviv University, Sackler Faculty of Medicine, Tel- Aviv, Israel. Dar, Reuven. School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel. Zangen, Abraham. Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
ELECTRONIC ADDRESSES
azangen@bgu.ac.il.
SOURCE
Brain Stimulation. 11(1):158-165, 2018 Jan – Feb.
BACKGROUND
Obsessive Compulsive Disorder (OCD) is a chronic and disabling disorder with poor response to pharmacological treatments. Converging evidences suggest that OCD patients suffer from dysfunction of the cortico-striato-thalamo-cortical (CSTC) circuit, including in the medial prefrontal cortex (mPFC) and the anterior cingulate cortex (ACC). OBJECTIVE: To examine whether modulation of mPFC-ACC activity by deep transcranial magnetic stimulation (DTMS) affects OCD symptoms.
METHODS
Treatment resistant OCD participants were treated with either high-frequency (HF; 20 Hz), low-frequency (LF; 1 Hz), or sham DTMS of the mPFC and ACC for five weeks, in a double-blinded manner. All treatments were administered following symptoms provocation, and EEG measurements during a Stroop task were acquired to examine changes in error-related activity. Clinical response to treatment was determined using the Yale-Brown-Obsessive-Compulsive Scale (YBOCS).
RESULTS
Interim analysis revealed that YBOCS scores were significantly improved following HF (n = 7), but not LF stimulation (n = 8), compared to sham (n = 8), and thus recruitment for the LF group was terminated. Following completion of the study, the response rate in the HF group (n = 18) was significantly higher than that of the sham group (n = 15) for at least one month following the end of the treatment. Notably, the clinical response in the HF group correlated with increased Error Related Negativity (ERN) in the Stroop task, an electrophysiological component that is attributed to ACC activity.
CONCLUSION
HF DTMS over the mPFC-ACC alleviates OCD symptoms and may be used as a novel therapeutic intervention. Notwithstanding alternative explanations, this may stem from DTMS ability to directly modify ACC activity.
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