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Chu L, Wu Y, Yin J, Zhang K, Zhong Y, Fan X, Wang G. Neurotransmitter system gene variants as biomarkers for the therapeutic efficacy of rTMS and SSRIs in obsessive-compulsive disorder. Front Psychiatry 2024; 15:1350978. [PMID: 38840948 PMCID: PMC11150660 DOI: 10.3389/fpsyt.2024.1350978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Purpose This study aims to examine the potential influence of RS4680 (COMT), RS16965628 (SLC6A4), and RS1019385 (GRIN2B) polymorphisms on the therapeutic response to repetitive transcranial magnetic stimulation (rTMS) and selective serotonin reuptake inhibitors (SSRIs) in individuals with obsessive-compulsive disorder (OCD). Patients and methods Thirty-six untreated outpatients diagnosed with OCD were recruited and allocated to active or sham rTMS groups for two weeks. The mean age of the participants was 31.61, with 17 males (47.22%) and 19 females (52.78%). Peripheral blood samples (5 mL) were collected from each participant using ethylenediaminetetraacetic acid (EDTA) vacuum tubes for genotyping purposes, clinical evaluation was taken place at baseline and second week. Results The A allele of RS4680, C allele of RS16965628, and GG allele of RS1019385 were identified as potential bio-markers for predicting treatment response to OCD treatments (rTMS & SSRIs). Conclusion Those genes may serve as bio-markers for the combined treatment of rTMS and SSRIs in OCD. The finding hold promise for further research and the potential implementation of precision treatment of OCD. Clinical trial registration https://www.chictr.org.cn, identifier ChiCTR1900023641.
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Affiliation(s)
- Lingjun Chu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Yidan Wu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Jiajun Yin
- Brain Science Basic Laboratory, The Affiliated Wuxi Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Kai Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, Anhui, China
| | - Yiwen Zhong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Xiwang Fan
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Guoqiang Wang
- Brain Science Basic Laboratory, The Affiliated Wuxi Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
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Hussain S, Chamoli S, Fitzgerald P, Gandhi A, Gill S, Sarma S, Loo C. Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of repetitive transcranial magnetic stimulation. Aust N Z J Psychiatry 2024:48674241249846. [PMID: 38706202 DOI: 10.1177/00048674241249846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVES To provide guidance for the optimal administration of repetitive transcranial magnetic stimulation, based on scientific evidence and supplemented by expert clinical consensus. METHODS Articles and information were sourced from existing guidelines and published literature. The findings were then formulated into consensus-based recommendations and guidance by the authors. The guidelines were subjected to rigorous successive consultation within the RANZCP, involving the Section of ECT and Neurostimulation (SEN) Committee, its broader membership and expert committees. RESULTS The RANZCP professional practice guidelines (PPG) for the administration of rTMS provide up-to-date advice regarding the use of rTMS in clinical practice. The guidelines are intended for use by psychiatrists and non-psychiatrists engaged in the administration of rTMS to facilitate best practice to optimise outcomes for patients. The guidelines strive to find the appropriate balance between promoting best evidence-based practice and acknowledging that evidence for rTMS use is a continually evolving. CONCLUSION The guidelines provide up-to-date advice for psychiatrists and non-psychiatrists to promote optimal standards of rTMS practice.
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Affiliation(s)
- Salam Hussain
- Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Consultation Liaison Psychiatry and Neuromodulation, Sir Charles Gairdner Hospital Mental Health Service, Perth, WA, Australia
- Binational Committee, Section of Electroconvulsive Therapy and Neurostimulation, The Royal Australian & New Zealand College of Psychiatrists, Melbourne, VIC, Australia
| | - Suneel Chamoli
- Binational Committee, Section of Electroconvulsive Therapy and Neurostimulation, The Royal Australian & New Zealand College of Psychiatrists, Melbourne, VIC, Australia
- TMS Specialists Clinics, Neuropsytech Pty Ltd, Canberra, ACT, Australia
| | - Paul Fitzgerald
- School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | - Ashu Gandhi
- Department of Psychiatry, Monash Health, Melbourne, VIC, Australia
- Rehabilitation, Mental Health and Chronic Pain Clinical Institute, Epworth Clinic, Melbourne, VIC, Australia
| | - Shane Gill
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
- South Australian Psychiatry Training Committee, The Royal Australian & New Zealand College of Psychiatrists, Adelaide, SA, Australia
- The Adelaide Clinic, Ramsay Mental Health Care, Adelaide, SA, Australia
| | - Shanthi Sarma
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
- Medicine Department, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Colleen Loo
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- The Black Dog Institute, Randwick, NSW, Australia
- The George Institute for Global Health, Barangaroo, NSW, Australia
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Ramakrishnan D, Farhat LC, Vattimo EFQ, Levine JLS, Johnson JA, Artukoglu BB, Landeros-Weisenberger A, Zangen A, Pelissolo A, de B Pereira CA, Rück C, Costa DLC, Mataix-Cols D, Shannahoff-Khalsa D, Tolin DF, Zarean E, Meyer E, Hawken ER, Storch EA, Andersson E, Miguel EC, Maina G, Leckman JF, Sarris J, March JS, Diniz JB, Kobak K, Mallet L, Vulink NCC, Amiaz R, Fernandes RY, Shavitt RG, Wilhelm S, Golshan S, Tezenas du Montcel S, Erzegovesi S, Baruah U, Greenberg WM, Kobayashi Y, Bloch MH. An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis. J Psychiatr Res 2024; 173:387-397. [PMID: 38598877 DOI: 10.1016/j.jpsychires.2024.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Expert consensus operationalized treatment response and remission in obsessive-compulsive disorder (OCD) as a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) reduction ≥35% and score ≤12 with ≤2 on Clinical Global Impressions Improvement (CGI-I) and Severity (CGI-S) scales, respectively. However, there has been scant empirical evidence supporting these definitions. METHODS We conducted a systematic review and an individual participant data meta-analysis of randomized-controlled trials (RCTs) in adults with OCD to determine optimal Y-BOCS thresholds for response and remission. We estimated pooled sensitivity/specificity for each percent reduction threshold (response) or posttreatment score (remission) to determine response and remission defined by a CGI-I and CGI-S ≤ 2, respectively. RESULTS Individual participant data from 25 of 94 eligible RCTs (1235 participants) were included. The optimal threshold for response was ≥30% Y-BOCS reduction and for remission was ≤15 posttreatment Y-BOCS. However, differences in sensitivity and specificity between the optimal and nearby thresholds for response and remission were small with some uncertainty demonstrated by the confidence ellipses. CONCLUSION While the empirically derived Y-BOCS thresholds in our meta-analysis differ from expert consensus, given the predominance of data from more recent trials of OCD, which involved more refractory participants and novel treatment modalities as opposed to first-line therapies, we recommend the continued use of the consensus definitions.
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Affiliation(s)
| | - Luis C Farhat
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Edoardo F Q Vattimo
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Jessica A Johnson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Bekir B Artukoglu
- Department of Child and Adolescent Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | | | - Abraham Zangen
- Department of Life Sciences and the Zelman Center for Neuroscience, Ben Gurion University, Be'er Sheva, Israel
| | - Antoine Pelissolo
- Psychiatry Department, Henri-Mondor University Hospitals, Faculty of Medicine, Créteil, France
| | - Carlos A de B Pereira
- Mathematics and Statistics Institute, Statistics Department, University of São Paulo, São Paulo, Brazil
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Daniel L C Costa
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - David Shannahoff-Khalsa
- The Research Group for Mind-Body Dynamics, BioCircuits Institute and Center for Integrative Medicine, University of California San Diego, CA, USA; The Khalsa Foundation for Medical Science, Del Mar, CA, USA
| | - David F Tolin
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; The Institute of Living, Hartford, CT, USA
| | - Elham Zarean
- Department of Psychiatry, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Elisabeth Meyer
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily R Hawken
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Eric A Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Euripedes C Miguel
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - James F Leckman
- Child Study Center, Department of Pediatrics and Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jerome Sarris
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia; NICM Health Research Institute, Western Sydney University, NSW, Australia
| | - John S March
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Durham, NC, USA
| | - Juliana B Diniz
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Luc Mallet
- Medical-University Department of Psychiatry and Addictology, Henri Mondor - Albert Chenevier University Hospitals, Créteil, France
| | - Nienke C C Vulink
- The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | | | - Rodrigo Yacubian Fernandes
- The National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Roseli G Shavitt
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Sabine Wilhelm
- OCD and Related Disorders Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahrokh Golshan
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Sophie Tezenas du Montcel
- Sorbonne Universite, Institut du Cerveau Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Inria Aramis project-team, Paris, France
| | - Stefano Erzegovesi
- Department of Neurosciences, Eating Disorders Unit, IRCCS San Raffaele, Milano, Italy
| | - Upasana Baruah
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | - Yuki Kobayashi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Michael H Bloch
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
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Galanis C, Neuhaus L, Hananeia N, Turi Z, Jedlicka P, Vlachos A. Axon morphology and intrinsic cellular properties determine repetitive transcranial magnetic stimulation threshold for plasticity. Front Cell Neurosci 2024; 18:1374555. [PMID: 38638302 PMCID: PMC11025360 DOI: 10.3389/fncel.2024.1374555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/13/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Repetitive transcranial magnetic stimulation (rTMS) is a widely used therapeutic tool in neurology and psychiatry, but its cellular and molecular mechanisms are not fully understood. Standardizing stimulus parameters, specifically electric field strength, is crucial in experimental and clinical settings. It enables meaningful comparisons across studies and facilitates the translation of findings into clinical practice. However, the impact of biophysical properties inherent to the stimulated neurons and networks on the outcome of rTMS protocols remains not well understood. Consequently, achieving standardization of biological effects across different brain regions and subjects poses a significant challenge. Methods This study compared the effects of 10 Hz repetitive magnetic stimulation (rMS) in entorhino-hippocampal tissue cultures from mice and rats, providing insights into the impact of the same stimulation protocol on similar neuronal networks under standardized conditions. Results We observed the previously described plastic changes in excitatory and inhibitory synaptic strength of CA1 pyramidal neurons in both mouse and rat tissue cultures, but a higher stimulation intensity was required for the induction of rMS-induced synaptic plasticity in rat tissue cultures. Through systematic comparison of neuronal structural and functional properties and computational modeling, we found that morphological parameters of CA1 pyramidal neurons alone are insufficient to explain the observed differences between the groups. Although morphologies of mouse and rat CA1 neurons showed no significant differences, simulations confirmed that axon morphologies significantly influence individual cell activation thresholds. Notably, differences in intrinsic cellular properties were sufficient to account for the 10% higher intensity required for the induction of synaptic plasticity in the rat tissue cultures. Conclusion These findings demonstrate the critical importance of axon morphology and intrinsic cellular properties in predicting the plasticity effects of rTMS, carrying valuable implications for the development of computer models aimed at predicting and standardizing the biological effects of rTMS.
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Affiliation(s)
- Christos Galanis
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lena Neuhaus
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicholas Hananeia
- 3R-Zentrum Gießen, Justus-Liebig-Universitat Giessen, Giessen, Germany
| | - Zsolt Turi
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Jedlicka
- 3R-Zentrum Gießen, Justus-Liebig-Universitat Giessen, Giessen, Germany
| | - Andreas Vlachos
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Vinod P, Thatikonda NS, Malo PK, Bhaskarapillai B, Arumugham SS, Janardhan Reddy YC. Comparative efficacy of repetitive transcranial magnetic stimulation protocols for obsessive-compulsive disorder: A network meta-analysis. Asian J Psychiatr 2024; 94:103962. [PMID: 38377642 DOI: 10.1016/j.ajp.2024.103962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has been found to be helpful for the treatment of obsessive-compulsive disorder (OCD). However, the relative efficacy of different rTMS protocols is unclear. OBJECTIVE To conduct a systematic review and network meta-analysis (NMA) of published literature to compare the relative efficacy of different rTMS protocols for decreasing Yale-Brown Obsessive Compulsive Severity (Y-BOCS) scores in patients with OCD. METHOD Relevant articles published between 1985 to September 2023 were searched from the Cochrane Central Register of Controlled Trials, PubMed and PsycInfo. Double or single-blinded randomized controlled studies conducted on patients with OCD comparing an active rTMS protocol with either another active or sham rTMS protocol were included. Network meta-analysis (NMA) was conducted using a frequentist approach. Standardized mean difference (SMD) of change in Y-BOCS scores was calculated employing Hedge's g. Pairwise meta-analysis using random effects model was conducted which was extended to the NMA using restricted maximum likelihood estimation procedure. Surface under the cumulative ranking (SUCRA) probabilities were used to rank the interventions. RESULTS Excitatory rTMS of the bilateral dorsolateral prefrontal cortex (DLPFC), inhibitory rTMS of right DLPFC, inhibitory as well as excitatory rTMS of bilateral medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC) and inhibitory rTMS of bilateral supplementary motor area (SMA) were superior to sham stimulation. The DLPFC and mPFC/ACC protocols had a higher probability of being among the top-ranked interventions. The majority of studies had a modest sample size and at least some concerns in the risk of bias assessment. CONCLUSION rTMS targeting either the medial or lateral prefrontal cortices is a promising intervention for resistant OCD. There is a need to confirm these findings in large systematic studies.
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Affiliation(s)
- Pratibha Vinod
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Navya Spurthi Thatikonda
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Palash Kumar Malo
- Centre for Brain Research, Indian Institute of Science, Bengaluru 560012, India
| | | | - Shyam Sundar Arumugham
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), India.
| | - Y C Janardhan Reddy
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), India
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Kar SK, Agrawal A, Silva-Dos-Santos A, Gupta Y, Deng ZD. The Efficacy of Transcranial Magnetic Stimulation in the Treatment of Obsessive-Compulsive Disorder: An Umbrella Review of Meta-Analyses. CNS Spectr 2024; 29:109-118. [PMID: 38053347 DOI: 10.1017/s1092852923006387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has been increasingly used for treating obsessive-compulsive disorder (OCD). Although several meta-analyses have explored its effectiveness and safety, there is no umbrella review specifically focused on rTMS for OCD. This umbrella review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and analyzed relevant meta-analyses on rTMS for OCD. METHODS Twenty-three articles were identified from PubMed, and after screening, 12 meta-analyses were included in the review. The studies analyzed in the meta-analyses ranged from 10 to 27, with total participants ranging from 282 to 791. The most commonly studied regions were the dorsolateral prefrontal cortex (DLPFC), supplementary motor area (SMA), and orbito-frontal cortex (OFC). RESULT The majority of the meta-analyses consistently supported the effectiveness of rTMS in reducing OCD symptoms when applied to the DLPFC and SMA. Encouraging results were also observed when targeting the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC) through deep transcranial magnetic stimulation (dTMS). However, there was a high level of heterogeneity in the findings of nine out of 12 meta-analyses. CONCLUSION In conclusion, existing evidence suggests that rTMS targeting the DLPFC and SMA consistently reduces OCD symptoms, but targeting the mPFC and ACC through dTMS shows variable results. However, the high heterogeneity in the study findings indicates a need for further research and standardization in the field.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Aditya Agrawal
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Amílcar Silva-Dos-Santos
- Neuroscience Unit, CUF Tejo Hospital, Lisbon, Portugal
- Mental Health Department, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Department of Psychiatry, Universidade do Mindelo, Mindelo, Cape Verde
- Psychiatry Unit, Hospital de Cascais, Cascais, Portugal
| | - Yogesh Gupta
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Zhi-De Deng
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Baldi S, Schuhmann T, Goossens L, Schruers KRJ. Individualized, connectome-based, non-invasive stimulation of OCD deep-brain targets: A proof-of-concept. Neuroimage 2024; 288:120527. [PMID: 38286272 DOI: 10.1016/j.neuroimage.2024.120527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/09/2023] [Accepted: 01/26/2024] [Indexed: 01/31/2024] Open
Abstract
Treatment-resistant obsessive-compulsive disorder (OCD) generally improves with deep-brain stimulation (DBS), thought to modulate neural activity at both the implantation site and in connected brain regions. However, its invasive nature, side-effects, and lack of customization, make non-invasive treatments preferable. Harnessing the established remote effects of cortical transcranial magnetic stimulation (TMS), connectivity-based approaches have emerged for depression that aim at influencing distant regions connected to the stimulation site. We here investigated whether effective OCD DBS targets (here subthalamic nucleus [STN] and nucleus accumbens [NAc]) could be modulated non-invasively with TMS. In a proof-of-concept study with nine healthy individuals, we used 7T magnetic resonance imaging (MRI) and probabilistic tractography to reconstruct the fiber tracts traversing manually segmented STN/NAc. Two TMS targets were individually selected based on the strength of their structural connectivity to either the STN, or both the STN and NAc. In a sham-controlled, within-subject cross-over design, TMS was administered over the personalized targets, located around the precentral and middle frontal gyrus. Resting-state functional 3T MRI was acquired before, and at 5 and 25 min after stimulation to investigate TMS-induced changes in the functional connectivity of the STN and NAc with other regions of the brain. Static and dynamic seed-to-voxel correlation analyses were conducted. TMS over both targets was able to modulate the functional connectivity of the STN and NAc, engaging both overlapping and distinct regions, and unfolding following different temporal dynamics. Given the relevance of the engaged connected regions to OCD pathology, we argue that a personalized, connectivity-based procedure is worth investigating as potential treatment for refractory OCD.
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Affiliation(s)
- Samantha Baldi
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Teresa Schuhmann
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Maastricht Brain Imaging Centre, Maastricht, the Netherlands
| | - Liesbet Goossens
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Koen R J Schruers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Alizadehgoradel J, Molaei B, Barzegar Jalali K, Pouresmali A, Sharifi K, Hallajian AH, Nejati V, Glinski B, Vicario CM, Nitsche MA, Salehinejad MA. Targeting the prefrontal-supplementary motor network in obsessive-compulsive disorder with intensified electrical stimulation in two dosages: a randomized, controlled trial. Transl Psychiatry 2024; 14:78. [PMID: 38316750 PMCID: PMC10844238 DOI: 10.1038/s41398-024-02736-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Obsessive-compulsive disorder (OCD) is associated with a high disease burden, and treatment options are limited. We used intensified electrical stimulation in two dosages to target a main circuitry associated with the pathophysiology of OCD, left dorsolateral prefrontal cortex (l-DLPFC), and pre-supplementary motor area (pre-SMA) and assessed clinical outcomes, neuropsychological performance, and brain physiology. In a double-blind, randomized controlled trial, thirty-nine patients with OCD were randomly assigned to three groups of sham, 2-mA, or 1-mA transcranial direct current stimulation (tDCS) targeting the l-DLPFC (F3) and pre-SMA (FC2) with anodal and cathodal stimulation respectively. The treatment included 10 sessions of 20-minute stimulation delivered twice per day with 20-min between-session intervals. Outcome measures were reduction in OCD symptoms, anxiety, and depressive states, performance on a neuropsychological test battery (response inhibition, working memory, attention), oscillatory brain activities, and functional connectivity. All outcome measures except EEG were examined at pre-intervention, post-intervention, and 1-month follow-up times. The 2-mA protocol significantly reduced OCD symptoms, anxiety, and depression states and improved quality of life after the intervention up to 1-month follow-up compared to the sham group, while the 1-mA protocol reduced OCD symptoms only in the follow-up and depressive state immediately after and 1-month following the intervention. Both protocols partially improved response inhibition, and the 2-mA protocol reduced attention bias to OCD-related stimuli and improved reaction time in working memory performance. Both protocols increased alpha oscillatory power, and the 2-mA protocol decreased delta power as well. Both protocols increased connectivity in higher frequency bands at frontal-central areas compared to the sham. Modulation of the prefrontal-supplementary motor network with intensified tDCS ameliorates OCD clinical symptoms and results in beneficial cognitive effects. The 2-mA intensified stimulation resulted in larger symptom reduction and improved more converging outcome variables related to therapeutic efficacy. These results support applying the intensified prefrontal-SMA tDCS in larger trials.
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Affiliation(s)
| | - Behnam Molaei
- Department of Psychiatry and Psychology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
| | | | - Asghar Pouresmali
- Department of Family Health, Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Kiomars Sharifi
- Sharif Brain Center, Department of Electrical Engineering, Sharif University of Technology, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences, Tehran, Iran
| | | | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Benedikt Glinski
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Carmelo M Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Università di Messina, Messina, Italy
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Bielefeld, Germany
- German Centre for Mental Health (DZPG), Bochum, Germany
| | - Mohammad Ali Salehinejad
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences, Tehran, Iran.
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
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Thirioux B, Langbour N, Bokam P, Wassouf I, Guillard-Bouhet N, Wangermez C, Leblanc PM, Doolub D, Harika-Germaneau G, Jaafari N. EEG microstate co-specificity in schizophrenia and obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:207-225. [PMID: 37421444 DOI: 10.1007/s00406-023-01642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023]
Abstract
The past 20 years of research on EEG microstates has yielded the hypothesis that the imbalance pattern in the temporal dynamics of microstates C (increased) and D (decreased) is specific to schizophrenia. A similar microstate imbalance has been recently found in obsessive-compulsive disorder (OCD). The aim of the present high-density EEG study was to examine whether this pathological microstate pattern is co-specific to schizophrenia and OCD. We compared microstate temporal dynamics using Bayesian analyses, transition probabilities analyses and the Topographic Electrophysiological State Source-Imaging method for source reconstruction in 24 OCD patients and 28 schizophrenia patients, respectively, free of comorbid psychotic and OCD symptoms, and 27 healthy controls. OCD and schizophrenia patients exhibited the same increased contribution of microstate C, decreased duration and contribution of microstate D and greater D → C transition probabilities, compared with controls. A Bayes factor of 4.424 for the contribution of microstate C, 4.600 and 3.824, respectively, for the duration and contribution of microstate D demonstrated that there was no difference in microstate patterns between the two disorders. Source reconstruction further showed undistinguishable dysregulations between the Salience Network (SN), associated with microstate C, and the Executive Control Network (ECN), associated with microstate D, and between the ECN and cognitive cortico-striato-thalamo-cortical (CSTC) loop in the two disorders. The ECN/CSTC loop dysconnectivity was slightly worsened in schizophrenia. Our findings provide substantial evidence for a common aetiological pathway in schizophrenia and OCD, i.e. microstate co-specificity, and same anomalies in salience and external attention processing, leading to co-expression of symptoms.
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Affiliation(s)
- Bérangère Thirioux
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, 370 Avenue Jacques Coeur, 86021, Poitiers, France.
- Centre de Recherches sur la Cognition et l'Apprentissage, Université de Poitiers, CNRS 7295, 86021, Poitiers, France.
| | - Nicolas Langbour
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, 370 Avenue Jacques Coeur, 86021, Poitiers, France
- Centre de Recherches sur la Cognition et l'Apprentissage, Université de Poitiers, CNRS 7295, 86021, Poitiers, France
| | - Prasanth Bokam
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, 370 Avenue Jacques Coeur, 86021, Poitiers, France
| | - Issa Wassouf
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, 370 Avenue Jacques Coeur, 86021, Poitiers, France
- Centre Hospitalier Nord Deux-Sèvres, Parthenay, France
| | - Nathalie Guillard-Bouhet
- Centre de Réhabilitation et d'Activités Thérapeutiques Intersectorial de la Vienne, Centre Hospitalier Henri Laborit, 86021, Poitiers, France
- Centre Médico-Psychologique, Centre Hospitalier Henri Laborit, 86021, Poitiers, France
| | - Carole Wangermez
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, 370 Avenue Jacques Coeur, 86021, Poitiers, France
- Centre de Réhabilitation et d'Activités Thérapeutiques Intersectorial de la Vienne, Centre Hospitalier Henri Laborit, 86021, Poitiers, France
| | - Pierre-Marie Leblanc
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, 370 Avenue Jacques Coeur, 86021, Poitiers, France
| | - Damien Doolub
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, 370 Avenue Jacques Coeur, 86021, Poitiers, France
- Centre de Recherches sur la Cognition et l'Apprentissage, Université de Poitiers, CNRS 7295, 86021, Poitiers, France
| | - Ghina Harika-Germaneau
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, 370 Avenue Jacques Coeur, 86021, Poitiers, France
- Centre de Recherches sur la Cognition et l'Apprentissage, Université de Poitiers, CNRS 7295, 86021, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, 86021, Poitiers, France
| | - Nematollah Jaafari
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, 370 Avenue Jacques Coeur, 86021, Poitiers, France
- Centre de Recherches sur la Cognition et l'Apprentissage, Université de Poitiers, CNRS 7295, 86021, Poitiers, France
- Centre Médico-Psychologique, Centre Hospitalier Henri Laborit, 86021, Poitiers, France
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10
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Jiang J, Wan K, Liu Y, Tang Y, Tang W, Liu J, Ma J, Xue C, Chen L, Qian H, Liu D, Shen X, Fan R, Wang Y, Wang K, Ji G, Zhu C. A Controlled Clinical Study of Accelerated High-Dose Theta Burst Stimulation in Patients with Obsessive-Compulsive Disorder. Neural Plast 2023; 2023:2741287. [PMID: 38099081 PMCID: PMC10721349 DOI: 10.1155/2023/2741287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/20/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is frequently treated using a combination of counseling, drugs, and, more recently various transcranial stimulation protocols, but all require several weeks to months for clinically significant improvement, so there is a need for treatments with faster onset. This study investigated whether an accelerated high-dose theta burst stimulation (ahTBS) protocol significantly improves the efficacy of OCD compared to traditional 1-Hz repetitive transcranial magnetic stimulation (rTMS) in the routine clinical setting. Method Forty-five patients with OCD were randomized into two groups and treated with ahTBS or 1-Hz rTMS for 5 days. Patients were assessed at baseline at the end of treatment using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Results After 5 days of treatment, there was a significant decrease in Y-BOCS scores in both groups (p < 0.001), and the difference between the two groups was not statistically significant (group × time interaction, F = 1.90, p=0.18). There was also no statistically significant difference in other secondary outcome indicators, including depression, anxiety symptoms, and response rate. However, the ahTBS group had a greater trend in response rate. Neuropsychological testing showed no negative cognitive side effects of either treatment. Conclusion Accelerated high-dose TBS is as safe and has comparable short-term efficacy to traditional 1-Hz rTMS for the clinical treatment of OCD. Further research is needed to explore optimal ahTBS parameters, validate the utility of this treatment modality, and identify factors predictive of rapid clinical response to guide clinical decision-making. This trial is registered with NCT05221632.
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Affiliation(s)
- Jin Jiang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Ke Wan
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Yueling Liu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Yan Tang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Wenxin Tang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Jian Liu
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Jiehua Ma
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Chuang Xue
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Lu Chen
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Huichang Qian
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dandan Liu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Xinxin Shen
- Department of Psychology, Zhejiang Sci-Tech University, Hangzhou, China
| | - Ruijuan Fan
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Yongguang Wang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Kai Wang
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
| | - Gongjun Ji
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
| | - Chunyan Zhu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
- Department of Psychology, The Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
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11
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Galanis C, Neuhaus L, Hananeia N, Turi Z, Jedlicka P, Vlachos A. Axon morphology and intrinsic cellular properties determine repetitive transcranial magnetic stimulation threshold for plasticity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.25.559399. [PMID: 37808716 PMCID: PMC10557586 DOI: 10.1101/2023.09.25.559399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a widely used therapeutic tool in neurology and psychiatry, but its cellular and molecular mechanisms are not fully understood. Standardizing stimulus parameters, specifically electric field strength and direction, is crucial in experimental and clinical settings. It enables meaningful comparisons across studies and facilitating the translation of findings into clinical practice. However, the impact of biophysical properties inherent to the stimulated neurons and networks on the outcome of rTMS protocols remains not well understood. Consequently, achieving standardization of biological effects across different brain regions and subjects poses a significant challenge. This study compared the effects of 10 Hz repetitive magnetic stimulation (rMS) in entorhino-hippocampal tissue cultures from mice and rats, providing insights into the impact of the same stimulation protocol on similar neuronal networks under standardized conditions. We observed the previously described plastic changes in excitatory and inhibitory synaptic strength of CA1 pyramidal neurons in both mouse and rat tissue cultures, but a higher stimulation intensity was required for the induction of rMS-induced synaptic plasticity in rat tissue cultures. Through systematic comparison of neuronal structural and functional properties and computational modeling, we found that morphological parameters of CA1 pyramidal neurons alone are insufficient to explain the observed differences between the groups. However, axon morphologies of individual cells played a significant role in determining activation thresholds. Notably, differences in intrinsic cellular properties were sufficient to account for the 10 % higher intensity required for the induction of synaptic plasticity in the rat tissue cultures. These findings demonstrate the critical importance of axon morphology and intrinsic cellular properties in predicting the plasticity effects of rTMS, carrying valuable implications for the development of computer models aimed at predicting and standardizing the biological effects of rTMS.
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12
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Kamamuta A, Takagi Y, Takahashi M, Kurihara K, Shibata H, Tanaka K, Hata K. Fatigue Potentially Reduces the Effect of Transcranial Magnetic Stimulation on Depression Following COVID-19 and Its Vaccination. Vaccines (Basel) 2023; 11:1151. [PMID: 37514967 PMCID: PMC10383898 DOI: 10.3390/vaccines11071151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
COVID-19's long-term effects, known as Long-COVID, present psychiatric and physical challenges in recovered patients. Similarly, rare long-term post-vaccination side effects, resembling Long-COVID, are emerging (called Post-Vaccine). However, effective treatments for both conditions are scarce. Our clinical experience suggests that transcranial magnetic stimulation (TMS) often aids recovery in Long-COVID and Post-Vaccine patients. However, its effectiveness is reduced in patients with severe fatigue. Therefore, we retrospectively analysed Tokyo TMS Clinic's outpatient records (60 in total; mean age, 38 years) to compare Long-COVID and post-vaccine patients' characteristics and symptoms, assess the impact of TMS on their symptoms, and investigate the role of fatigue in depression recovery with TMS. The primary outcome was the regression coefficient of the initial fatigue score on depression score improvement using TMS. Secondary outcomes included psychiatric/physical scores before and after TMS and their improvement rates. We found no differences in the initial symptoms and background factors between Long-COVID and Post-Vaccine patients. After ten TMS sessions, all psychiatric and physical symptom scores improved significantly. TMS improves depression, insomnia, anxiety, and related neuropsychiatric symptoms, which were the primary complaints in this study. Thus, we conclude that TMS improves depression and anxiety. The effectiveness of TMS in treating depression in Long-COVID and Post-Vaccine patients decreased as fatigue severity increased. In conclusion, TMS relieved depressive symptoms following COVID-19 and vaccination; however, fatigue may hinder its effectiveness.
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Affiliation(s)
| | | | | | | | | | | | - Katsuhiko Hata
- Tokyo TMS Clinic, Tokyo 150-0021, Japan
- Department of Physics, Tokyo University of Science, Tokyo 162-8601, Japan
- Department of Neuroscience, Research Center for Mathematical Medicine, Tokyo 183-0014, Japan
- Department of Sports and Medical Science, Graduate School of Emergency Medical System, Kokushikan University, Tokyo 206-8515, Japan
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13
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Noda Y, Fujii K, Tokura F, Nakajima S, Kitahata R. A Case Series of Continuous Theta Burst Stimulation Treatment for the Supplementary Motor Area Twice a Day in Patients with Obsessive-Compulsive Disorder: A Real World TMS Registry Study in Japan. J Pers Med 2023; 13:jpm13050875. [PMID: 37241045 DOI: 10.3390/jpm13050875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/10/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by patterns in which unwanted thoughts and fears are evoked as obsessions and furthermore, compulsive behaviors are provoked repeatedly, with a prevalence rate of 2% of the population. These obsessive-compulsive symptoms disrupt daily life and cause great distress to the individual. At present, OCD is treated with antidepressants, mainly selective serotonin reuptake inhibitors, and psychotherapy, including the exposure and response prevention method. However, these approaches may only show a certain level of efficacy, and approximately 50% of patients with OCD show treatment resistance. This situation has led to the research and development of neuromodulation therapies, including transcranial magnetic stimulation treatment, for OCD worldwide in recent years. In this case series, we retrospectively analyzed the TMS registry data of continuous theta burst stimulation (cTBS) therapy targeting the bilateral supplementary motor cortex for six patients with OCD whose obsessive-compulsive symptoms had not improved with pharmacotherapy. The results suggest that treatment with cTBS for the bilateral supplementary motor area may reduce obsessive-compulsive symptoms in patients with OCD, despite the limitations of an open-label preliminary case series. The present findings warrant further validation with a randomized, sham-controlled trial with a larger sample size in the future.
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Affiliation(s)
- Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo 151-0051, Japan
| | - Kyoshiro Fujii
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo 151-0051, Japan
| | - Fumi Tokura
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo 151-0051, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo 151-0051, Japan
| | - Ryosuke Kitahata
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
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14
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Zhang S, Zou H, Zou X, Ke J, Zheng B, Chen X, Zhou X, Wei J. Transcriptome Sequencing of CeRNA Network Constructing in Status Epilepticus Mice Treated by Low-Frequency Repetitive Transcranial Magnetic Stimulation. J Mol Neurosci 2023; 73:316-326. [PMID: 37133759 DOI: 10.1007/s12031-023-02108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/20/2023] [Indexed: 05/04/2023]
Abstract
It is shown that great progress was recently made in the treatment of repetitive transcranial magnetic stimulation (rTMS) for neurological and psychiatric diseases. This study aimed to address how rTMS exerted it therapeutic effects by regulating competitive endogenous RNAs (ceRNAs) of lncRNA-miRNA-mRNA. The distinction of lncRNA, miRNA and mRNA expression in male status epilepticus (SE) mice treated by two different ways, low-frequency rTMS (LF-rTMS) vs. sham rTMS, was analyzed by high-throughput sequencing. The Gene Ontology (GO) functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were carried out. Gene-Gene Cross Linkage Network was established; pivotal genes were screened out. qRT-PCR was used to verify gene-gene interactions. Our results showed that there were 1615 lncRNAs, 510 mRNAs, and 17 miRNAs differentially which were expressed between the LF-rTMS group and the sham rTMS group. The expression difference of these lncRNAs, mRNAs, and miRNAs by microarray detection were consistent with the results by qPCR. GO functional enrichment showed that immune-associated molecular mechanisms, biological processes, and GABA-A receptor activity played a role in SE mice treated with LF-rTMS. KEGG pathway enrichment analysis revealed that differentially expressed genes were correlated to T cell receptor signaling pathway, primary immune deficiency and Th17 cell differentiation signaling pathway. Gene-gene cross linkage network was established on the basis of Pearson's correlation coefficient and miRNA. In conclusion, LF-rTMS alleviates SE through regulating the GABA-A receptor activity transmission, improving immune functions, and biological processes, suggesting the underlying ceRNA molecular mechanisms of LF-rTMS treatment for epilepsy.
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Affiliation(s)
- Shaotian Zhang
- Department of Neurology, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, No.13 Shi Liu Gang Rd, Haizhu District, Guangzhou, Guangdong, 510315, China
| | - Huihui Zou
- Special Medical Service Center, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, No.13 Shi Liu Gang Rd, Haizhu District, Guangzhou, Guangdong, China
| | - Xiaopei Zou
- Special Medical Service Center, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, No.13 Shi Liu Gang Rd, Haizhu District, Guangzhou, Guangdong, China
| | - Jiaqia Ke
- Special Medical Service Center, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, No.13 Shi Liu Gang Rd, Haizhu District, Guangzhou, Guangdong, China
| | - Bofang Zheng
- Special Medical Service Center, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, No.13 Shi Liu Gang Rd, Haizhu District, Guangzhou, Guangdong, China
| | - Xinrun Chen
- Department of Clinical Medicine, The First Clinical College of Guangzhou Medical University, Guangzhou, Guangdong, 510315, China
| | - Xianju Zhou
- Special Medical Service Center, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, No.13 Shi Liu Gang Rd, Haizhu District, Guangzhou, Guangdong, China
| | - Jiana Wei
- Department of Neurology, Second Affiliated Hospital, Guangzhou Medical University, No.250 East Changgang Rd, Guangzhou, 510260, China.
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15
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Ziesel D, Nowakowska M, Scheruebel S, Kornmueller K, Schäfer U, Schindl R, Baumgartner C, Üçal M, Rienmüller T. Electrical stimulation methods and protocols for the treatment of traumatic brain injury: a critical review of preclinical research. J Neuroeng Rehabil 2023; 20:51. [PMID: 37098582 PMCID: PMC10131365 DOI: 10.1186/s12984-023-01159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/13/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of disabilities resulting from cognitive and neurological deficits, as well as psychological disorders. Only recently, preclinical research on electrical stimulation methods as a potential treatment of TBI sequelae has gained more traction. However, the underlying mechanisms of the anticipated improvements induced by these methods are still not fully understood. It remains unclear in which stage after TBI they are best applied to optimize the therapeutic outcome, preferably with persisting effects. Studies with animal models address these questions and investigate beneficial long- and short-term changes mediated by these novel modalities. METHODS In this review, we present the state-of-the-art in preclinical research on electrical stimulation methods used to treat TBI sequelae. We analyze publications on the most commonly used electrical stimulation methods, namely transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS) and vagus nerve stimulation (VNS), that aim to treat disabilities caused by TBI. We discuss applied stimulation parameters, such as the amplitude, frequency, and length of stimulation, as well as stimulation time frames, specifically the onset of stimulation, how often stimulation sessions were repeated and the total length of the treatment. These parameters are then analyzed in the context of injury severity, the disability under investigation and the stimulated location, and the resulting therapeutic effects are compared. We provide a comprehensive and critical review and discuss directions for future research. RESULTS AND CONCLUSION: We find that the parameters used in studies on each of these stimulation methods vary widely, making it difficult to draw direct comparisons between stimulation protocols and therapeutic outcome. Persisting beneficial effects and adverse consequences of electrical simulation are rarely investigated, leaving many questions about their suitability for clinical applications. Nevertheless, we conclude that the stimulation methods discussed here show promising results that could be further supported by additional research in this field.
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Affiliation(s)
- D Ziesel
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, Austria
| | - M Nowakowska
- Research Unit of Experimental Neurotraumatology, Department of Neurosurgery, Medical University of Graz, Graz, Austria
| | - S Scheruebel
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Biophysics Division, Medical University of Graz, Graz, Austria
| | - K Kornmueller
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Biophysics Division, Medical University of Graz, Graz, Austria
| | - U Schäfer
- Research Unit of Experimental Neurotraumatology, Department of Neurosurgery, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - R Schindl
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Biophysics Division, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - C Baumgartner
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - M Üçal
- Research Unit of Experimental Neurotraumatology, Department of Neurosurgery, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - T Rienmüller
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, Austria.
- BioTechMed-Graz, Graz, Austria.
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16
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Luo G, Wang S, Yao S, Quan D, Guo G, Gao J, Zheng H. Direct changes of neurometabolic concentrations in the pregenual anterior cingulate cortex among obsessive-compulsive patients after repetitive transcranial magnetic stimulation treatment. J Affect Disord 2023; 333:79-85. [PMID: 37080494 DOI: 10.1016/j.jad.2023.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/01/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND AIM Although Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising new noninvasive brain stimulation therapy, its underlying mechanisms of action remain unknown. OCD patients exhibit impaired response control and attention shifting, which is linked to some brain areas such as anterior cingulate cortex and basal ganglia. OCD patients also display altered neurometabolic concentrations in cortical cortical-striatal-thalamic-cortical (CSTC). In this study, we aimed to elucidate efficacy of rTMS treatment in alleviating related symptoms and pregenual anterior cingulate cortex (pACC) neurometabolites. METHODS OCD patients were randomly divided into either drug (n = 23) or drug + rTMS (n = 29) groups, and those in the latter group subjected to 4-week rTMS treatment. All participants were visited twice, at baseline and follow-up after four weeks. During both visits, all patients were subjected to 1H-MRS, then Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Global Assessment Function (GAF) used to assess severity of obsessive-compulsive symptoms. We also evaluated synchronous anxiety and depression by Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D). RESULTS After 4 weeks of treatment, patients in the Drug + rTMS group displayed significantly lower Y-BOCS (p = 0.038), BDI (p = 0.009), HAM-D (p = 0.013), HAM-A (p = 0.012) scores than their counterparts in the Drug group. Conversely, patients in the Drug + rTMS group had significantly higher tNAA concentrations (p = 0.030) than those in the Drug group. Notably, the Drug + rTMS group exhibited higher, but insignificant Glu (p = 0.055) and Glx (p = 0.068) concentrations compared to the Drug group. Partial correlation analysis revealed a significant negative correlation between post HAM-A scores and 4-week change of pACC glutamate levels in the Drug + rTMS group (r = -0.434, p = 0.02). CONCLUSION rTMS treatment is an efficacious treatment therapy for OCD, mainly by inducing changes in neurometabolites.
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Affiliation(s)
- Guowei Luo
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Shantou University Medical College, Shantou, China
| | - Shibin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Siyu Yao
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Dongming Quan
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guangquan Guo
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Junling Gao
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Huirong Zheng
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; South China University of Technology School of Medicine, Guangzhou, China; Shantou University Medical College, Shantou, China.
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Sá KN, Baptista RF, Shirahige L, Razza LB, Nogueira M, Coura MHF, Afonso-Santos L, Tanaka C, Baptista AF, Monte-Silva K, Brunoni AR. Evidence-based umbrella review of non-invasive brain stimulation in anxiety disorders. THE EUROPEAN JOURNAL OF PSYCHIATRY 2023. [DOI: 10.1016/j.ejpsy.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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18
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Bandelow B, Allgulander C, Baldwin DS, Costa DLDC, Denys D, Dilbaz N, Domschke K, Hollander E, Kasper S, Möller HJ, Eriksson E, Fineberg NA, Hättenschwiler J, Kaiya H, Karavaeva T, Katzman MA, Kim YK, Inoue T, Lim L, Masdrakis V, Menchón JM, Miguel EC, Nardi AE, Pallanti S, Perna G, Rujescu D, Starcevic V, Stein DJ, Tsai SJ, Van Ameringen M, Vasileva A, Wang Z, Zohar J. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - Version 3. Part II: OCD and PTSD. World J Biol Psychiatry 2023; 24:118-134. [PMID: 35900217 DOI: 10.1080/15622975.2022.2086296] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders which was published in 2002 and revised in 2008. METHOD A consensus panel of 34 international experts representing 22 countries developed recommendations based on efficacy and acceptability of the treatments. In this version, not only medications but also psychotherapies and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medication treatments. RESULT The present paper (Part II) contains recommendations based on published randomised controlled trials (RCTs) for the treatment of OCD (n = 291) and PTSD (n = 234) in children, adolescents, and adults. The accompanying paper (Part I) contains the recommendations for the treatment of anxiety disorders.For OCD, first-line treatments are selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT). Internet-CBT was also superior to active controls. Several second-line medications are available, including clomipramine. For treatment-resistant cases, several options are available, including augmentation of SSRI treatment with antipsychotics and other drugs.Other non-pharmacological treatments, including repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and others were also evaluated.For PTSD, SSRIs and the SNRI venlafaxine are first-line treatments. CBT is the psychotherapy modality with the best body of evidence. For treatment-unresponsive patients, augmentation of SSRI treatment with antipsychotics may be an option. CONCLUSION OCD and PTSD can be effectively treated with CBT and medications.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany
| | | | - David S Baldwin
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Daniel Lucas da Conceição Costa
- Department and Institute of Psychiatry, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Damiaan Denys
- Afdeling Psychiatrie, Universitair Medische Centra, Amsterdam, The Netherlands
| | - Nesrin Dilbaz
- Psikiyatri Uzmanı, Üsküdar Üniversitesi Tıp Fakültesi Psikiyatri ABD İstanbul, Istanbul, Turkey
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Siegfried Kasper
- Clinical Division of General Psychiatry Medical, University of Vienna, Vienna, Austria
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, University of München, München, Germany
| | - Elias Eriksson
- Department of Pharmacology, University of Gothenburg, Gothenburg, Sweden
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, United Kingdom
| | | | - Hisanobu Kaiya
- Department of Psychiatry, Kyoto Prefactual Medical College, Kyoto, Japan
| | - Tatiana Karavaeva
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Ministry of Health, Federal State Budgetary Institution of Higher Education, St. Petersburg State University, St. Petersburg, Russia.,Federal State Budgetary Institution of Higher Education St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - Martin A Katzman
- S.T.A.R.T. CLINIC, Toronto, Ontario, Canada.,Adler Graduate Professional School Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Northern Ontario School of Medicine Thunder Bay, Thunder Bay, Ontario, Canada.,Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Leslie Lim
- Department of Psychiatry, Singapore General Hospital, Singapore, Singapore
| | - Vasilios Masdrakis
- First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Cibersam, University of Barcelona, Barcelona, Spain
| | - Euripedes C Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antônio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Giampaolo Perna
- Department of Biological Sciences, Humanitas University Pieve Emanuele, Milano, Italy
| | - Dan Rujescu
- Clinical Division of General Psychiatry Medical, University of Vienna, Austria
| | - Vladan Starcevic
- Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, University of Sydney, Sydney, Australia
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department Psychiatry and Neuroscience Institute, University of Cape Town, South Africa
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Anna Vasileva
- V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Ministry of Health, I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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19
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Khedr EM, Elbeh K, Saber M, Abdelrady Z, Abdelwarith A. A double blind randomized clinical trial of the effectiveness of low frequency rTMS over right DLPFC or OFC for treatment of obsessive-compulsive disorder. J Psychiatr Res 2022; 156:122-131. [PMID: 36244200 DOI: 10.1016/j.jpsychires.2022.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
We compared the effectiveness of low frequency repetitive transcranial magnetic stimulation over right dorsolateral prefrontal cortex (DLPFC), right orbitofrontal cortex (OFC) and sham for treatment of obsessive-compulsive disorder (OCD) and sought to determine possible predictors of effective treatment. Sixty OCD patients participated and were randomly allocated to one of the 3 treatment groups. Treatment was administered daily for 10 days. Assessments were made at the beginning and end of therapy as well as three months later using the Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory (BDI), and Clinical Global Impression - Severity scale (CGI-S). There were no significant demographic or clinical differences between the groups at baseline. One-way repeated measures ANOVA showed that participants in all 3 groups improved their scores on all rating scales following treatment. A two-way repeated measures ANOVA revealed a significant time and group interaction due to the fact that both active treatment groups outperformed the sham group, although there was no significant difference between the two. Percent improvement had significant negative correlations with the following factors: duration of illness, baseline Y-BOCS, HAM-A, and BDI. We conclude that rTMS over either right DLPFC or OFC has a therapeutic effect on OCD symptoms. Patients with lower Y-BOCS and fewer comorbidities responded best to rTMS.
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Affiliation(s)
- Eman M Khedr
- Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt; Department of Neuropsychiatry, Aswan University, Aswan, Egypt.
| | - Khaled Elbeh
- Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt
| | - Mostafa Saber
- Department of Neuropsychiatry, Aswan University, Aswan, Egypt
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20
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Chou PH, Sack AT, Su KP. Targeting Three Brain Regions (Bilateral SMA, Left and Right DLPFC) Sequentially in One Session Using Combined Repetitive Transcranial Magnetic Stimulation and Intermittent Theta-burst Stimulation in Treatment-refractory Obsessive-compulsive Disorder: A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2022; 20:773-776. [PMID: 36263652 PMCID: PMC9606437 DOI: 10.9758/cpn.2022.20.4.773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 01/18/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been widely used as a therapy for refractory obsessive-compulsive disorder (OCD). However, it remains unclear which exact target and stimulation sequence of rTMS is most effective for OCD. Here, we report the case of an 18-year-old female with treatment-refractory OCD whose symptoms markedly improved after combined rTMS and intermittent theta-burst stimulation over the bilateral dorsolateral prefrontal cortex and supplementary motor area. Our report indicates that combining treatment sequences that stimulate different brain regions sequentially is feasible and may clinically benefit patients suffering from OCD.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan,Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Alexander T. Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherland
| | - Kuan-Pin Su
- College of Medicine, China Medical University, Taichung, Taiwan,Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan,An-Nan Hospital, China Medical University, Tainan, Taiwan,Address for correspondence: Kuan-Pin Su Department of Psychiatry, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan, E-mail: , ORCID: https://orcid.org/0000-0002-4501-2502
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21
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Hashempour S, Ansari S, Arbabi M, Etesam F, Sharafi SE, Khaje Vand M, Noorbala AA. Assessing the Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Obsessive- Compulsive Disorder. Clin EEG Neurosci 2022; 53:491-498. [PMID: 35275000 DOI: 10.1177/15500594221076596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Obsessive-compulsive disorder (OCD) is a frequent and disabling neuropsychiatric disorder with a lifetime prevalence of 3%. About 40% to 60% of patients show no or just partial symptom improvement to treatment with a first-line drug and cognitive behavior therapy. Ten percent of patients remain treatment refractory despite several treatments. For these patients, repetitive Transcranial Magnetic Stimulation (rTMS) has been suggested as a treatment option. Method. We investigated the efficacy of rTMS on the Supplementary Motor Area (SMA) in 16 right handed pharmaco-resistant OCD patients in an outpatient setting. The patients have been diagnosed with OCD by two psychiatrists and referred for rTMS intervention. Patients received 16 sessions of low frequency (0.5 HZ) rTMS on SMA,100% motor threshold, 1200 stimuli/day for 40 minutes every other day. OCD, depression, and anxiety symptoms were measured at baseline, 2, 6, and 12 weeks by Yale-Brown Obsessive Compulsive Scale(Y-BOCS) and Hamilton Depressive and Anxiety rating scales (HAM-D and HAM-A). We assessed the side effects of rTMS by a self-administrative questionnaire. Results. Patients' scores in Y-BOCS, HAM-D, and HAM-A were significantly decreased following rTMS treatment. The baseline and 12 weeks scores of Y-BOCS were 28.94 and 18.31 (P-value < 0.01), HAM-D were 14.69 and 7.94 (P-value <0.01) and HAM-A were 16.38 and 6.94 (P- value < 0.01), respectively. The patients reported no serious side effects of rTMS except two case that reported light headach. Conclusion. This study showed that low-frequency rTMS on SMA improved OCD, anxiety, and depression symptoms after 16 sessions.
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Affiliation(s)
- Sara Hashempour
- 48439Psychosomatic Medicine Research Center, Imam Khomeini Hospital, 48504Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Ansari
- 48439Psychosomatic Medicine Research Center, Imam Khomeini Hospital, 48504Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Arbabi
- 48439Psychosomatic Medicine Research Center, Imam Khomeini Hospital, 48504Tehran University of Medical Sciences, Tehran, Iran
| | - Farnaz Etesam
- 48439Psychosomatic Medicine Research Center, Imam Khomeini Hospital, 48504Tehran University of Medical Sciences, Tehran, Iran
| | - Sayedeh Elham Sharafi
- 48439Psychosomatic Medicine Research Center, Imam Khomeini Hospital, 48504Tehran University of Medical Sciences, Tehran, Iran
| | - Mansooreh Khaje Vand
- 48439Psychosomatic Medicine Research Center, Imam Khomeini Hospital, 48504Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ali Noorbala
- 48439Psychosomatic Medicine Research Center, Imam Khomeini Hospital, 48504Tehran University of Medical Sciences, Tehran, Iran
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22
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Guo Q, Wang K, Han H, Li P, Cheng J, Zhu J, Wang Z, Fan Q. Continuous theta burst stimulation over the bilateral supplementary motor area in obsessive-compulsive disorder treatment: A clinical randomized single-blind sham-controlled trial. Eur Psychiatry 2022; 65:e64. [PMID: 36203323 PMCID: PMC9641651 DOI: 10.1192/j.eurpsy.2022.2323] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) can cause substantial damage to quality of life. Continuous theta burst stimulation (cTBS) is a promising treatment for OCD patients with the advantages of safety and noninvasiveness. OBJECTIVE The present study aimed to evaluate the treatment efficacy of cTBS over the bilateral supplementary motor area (SMA) for OCD patients with a single-blind, sham-controlled design. METHODS Fifty-four OCD patients were randomized to receive active or sham cTBS treatment over the bilateral SMA for 4 weeks (five sessions per week, 20 sessions in total). Patients were assessed at baseline (week 0), the end of treatment (week 4), and follow-up (week 8). Clinical scales included the YBOCS, HAMD24, HAMA14, and OBQ44. Three behavioral tests were also conducted to explore the effect of cTBS on response inhibition and decision-making in OCD patients. RESULTS The treatment response rates were not significantly different between the two groups at week 4 (active: 23.1% vs. sham: 16.7%, p = 0.571) and week 8 (active: 26.9% vs. sham: 16.7%, p = 0.382). Depression and anxiety improvements were significantly different between the two groups at week 4 (HAMD24: F = 4.644, p = 0.037; HAMA14: F = 5.219, p = 0.028). There was no significant difference between the two groups in the performance of three behavioral tests. The treatment satisfaction and dropout rates were not significantly different between the two groups. CONCLUSIONS The treatment of cTBS over the bilateral SMA was safe and tolerable, and it could significantly improve the depression and anxiety of OCD patients but was not enough to improve OCD symptoms in this study.
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Affiliation(s)
- Qihui Guo
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaifeng Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiqin Han
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Puyu Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayue Cheng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjuan Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China,Authors for correspondence: Zhen Wang and Qing Fan, E-mails: ;
| | - Qing Fan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China,Authors for correspondence: Zhen Wang and Qing Fan, E-mails: ;
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23
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Pellegrini L, Garg K, Enara A, Gottlieb DS, Wellsted D, Albert U, Laws KR, Fineberg NA. Repetitive transcranial magnetic stimulation (r-TMS) and selective serotonin reuptake inhibitor-resistance in obsessive-compulsive disorder: A meta-analysis and clinical implications. Compr Psychiatry 2022; 118:152339. [PMID: 35917621 DOI: 10.1016/j.comppsych.2022.152339] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Despite promising results from several randomized controlled trials (RCTs) and meta-analyses, the efficacy of r-TMS as a treatment for OCD remains controversial, at least in part owing to inconsistency in the trial methodologies and heterogeneity in the trial outcomes. This meta-analysis attempts to explain some of this heterogeneity by comparing the efficacy of r-TMS in patients with or without resistance to treatment with selective serotonin reuptake inhibitors (SSRI), defined using standardized criteria. METHODS We conducted a pre-registered (PROSPERO ID: 241381) systematic review and meta-analysis. English language articles reporting blinded RCTs were retrieved from searches using MEDLINE, PsycINFO, and Cochrane Library databases. Studies were subjected to subgroup analysis based on four stages of treatment resistance, defined using an adaptation of published criteria (1 = not treatment resistant, 2 = one SSRI trial failed, 3 = two SSRI trials failed, 4 = two SSRI trials failed plus one or more CBT trial failed). Meta-regression analyses investigated patient and methodological factors (age, duration of OCD, illness severity, stage of treatment-resistance, or researcher allegiance) as possible moderators of effect size. RESULTS Twenty-five independent comparisons (23 studies) were included. Overall, r-TMS showed a medium-sized reduction of Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores (Hedge's g: -0.47; 95%CI: - 0.67 to -0.27) with moderate heterogeneity (I2 = 39.8%). Assessment of publication bias using Trim and Fill analysis suggested a reduced effect size that remained significant (g: -0.29; 95%CI: -0.51 to -0.07). Subgroup analysis found that those studies including patients non-resistant to SSRI (stage 1) (g: -0.65; 95%CI: -1.05 to -0.25, k = 7) or with low SSRI-resistance (stage 2) (g:-0.47; 95%CI: -0.86 to -0.09, k = 6) produced statistically significant results with low heterogeneity, while studies including more highly resistant patients at stage 3 (g: -0.39; 95%CI: -0.90 to 0.11, k = 4) and stage 4 (g: -0.36; 95%CI: -0.75 to 0.03, k = 8) did not. Intriguingly, the only significant moderator of the effect size found by meta-regression was the severity of baseline depressive symptoms. All trials showed evidence of researcher allegiance in favour of the intervention and therefore caution is required in interpreting the reported effect sizes. CONCLUSION This meta-analysis shows that r-TMS is an effective treatment for OCD, but largely for those not resistant to SSRI or failing to respond to only one SSRI trial. As a consequence, r-TMS may be best implemented earlier in the care pathway. These findings would have major implications for clinical service development, but further well-powered RCTs, which eliminate bias from researcher allegiance, are needed before definitive conclusions can be drawn.
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Affiliation(s)
- Luca Pellegrini
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Centre for Psychedelic Research, Imperial College London, London, UK.
| | - Kabir Garg
- South London and Maudsley NHS Foundation Trust, UK
| | - Arun Enara
- Camden and Islington NHS Foundation Trust, UK
| | - David Shimon Gottlieb
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK; Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - David Wellsted
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
| | - Keith R Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; University of Cambridge School of Clinical Medicine, Cambridge, USA
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24
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Boosting psychological change: Combining non-invasive brain stimulation with psychotherapy. Neurosci Biobehav Rev 2022; 142:104867. [PMID: 36122739 DOI: 10.1016/j.neubiorev.2022.104867] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022]
Abstract
Mental health disorders and substance use disorders are a leading cause of morbidity and mortality worldwide, and one of the most important challenges for public health systems. While evidence-based psychotherapy is generally pursued to address mental health challenges, psychological change is often hampered by non-adherence to treatments, relapses, and practical barriers (e.g., time, cost). In recent decades, Non-invasive brain stimulation (NIBS) techniques have emerged as promising tools to directly target dysfunctional neural circuitry and promote long-lasting plastic changes. While the therapeutic efficacy of NIBS protocols for mental illnesses has been established, neuromodulatory interventions might also be employed to support the processes activated by psychotherapy. Indeed, combining psychotherapy with NIBS might help tailor the treatment to the patient's unique characteristics and therapeutic goal, and would allow more direct control of the neuronal changes induced by therapy. Herein, we overview emerging evidence on the use of NIBS to enhance the psychotherapeutic effect, while highlighting the next steps in advancing clinical and research methods toward personalized intervention approaches.
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25
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Mukherjee A, Kumre PK, Goyal N, Khanra S. Adjunctive neuronavigated accelerated continuous theta-burst stimulation in obsessive-compulsive disorder: a randomized sham-controlled study. CNS Spectr 2022; 28:1-10. [PMID: 36059099 DOI: 10.1017/s1092852922000980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Approximately 40% of patients treated for obsessive-compulsive disorder (OCD) do not respond to standard and second-line augmentation treatments leading to the exploration of alternate biological treatments. Continuous theta burst stimulation (cTBS) is a form of repetitive transcranial magnetic stimulation inducing more rapid and longer-lasting effects on synaptic plasticity than the latter. To the best of our knowledge, only one recent study and a case report investigated the effect of cTBS at the supplementary motor area (SMA) in OCD. OBJECTIVE This study aimed to examine the effect of accelerated robotized neuronavigated cTBS over SMA in patients with OCD. METHODS A total of 32 patients with OCD were enrolled and randomized into active and sham cTBS groups. For active cTBS stimulation, an accelerated protocol was used. Bursts of three stimuli at 50 Hz, at 80% of MT, repeated at 5 Hz were used. Daily 2 sessions of 900 pulses each, for a total of 30 sessions over 3 wk (weekly 10 sessions), were given. Yale-Brown Obsessive-Compulsive Rating Scale (YBOCS), Clinical Global Impressions scale (CGI), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were administered at baseline and at end of weeks 3 and 8. RESULTS A total of 26 patients completed the study. Active cTBS group showed significant group × time effect in YBOCS obsession (P < .001, η2 = 0.288), compulsion (P = .004, η2 = 0.207), YBOCS total (P < .001, η2 = 0.288), CGI-S (P = .010, η2 = 0.248), CGI-C (P = .010, η2 = 0.248), HAM-D (P = .014, η2 = 0.224) than sham cTBS group. CONCLUSIONS Findings from our study suggest that adjunctive accelerated cTBS significantly improves psychopathology, severity of illness, and depression among patients with OCD. Future studies with larger sample sizes will add to our knowledge.
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Affiliation(s)
- Aniruddha Mukherjee
- Centre for Cognitive Neuroscience, Central Institute of Psychiatry, Ranchi, India
| | - Pramod Kumar Kumre
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India
| | - Nishant Goyal
- Centre for Cognitive Neuroscience, Central Institute of Psychiatry, Ranchi, India
| | - Sourav Khanra
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India
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26
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Li P, Cheng J, Fan Q, Lin L, Zhou S, Gao J, Tang Y, Yuan T, Wang Z. The functional connectivity predictor of therapeutic effect of continuous theta burst stimulation on obsessive-compulsive disorder: A preliminary study. J Affect Disord 2022; 311:231-238. [PMID: 35605703 DOI: 10.1016/j.jad.2022.05.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the efficacy of continuous theta burst stimulation (cTBS) on the bilateral supplementary motor area (SMA) among patients with obsessive-compulsive disorder (OCD) and to explore the potential predictors of cTBS outcome based on neuroimaging. METHODS 29 OCD patients and 29 healthy controls (HCs) were enrolled in this pilot study. Twenty consecutive cTBS intervention targeting at bilateral SMA was applied. MRI scan was carried out before cTBS and 15 regions in the executive control and sensorimotor network were chosen and analyzed using MATLAB, DPABI, and SPM12. RESULTS 11 out of 29 patients responded to cTBS (37.93%), and the clinical symptom of OCD patients was significantly relieved after receiving regular cTBS. Also, the FC between Cerebelum_Crus2_L and Frontal_Inf_Tri_L of OCD patients showed positive prognosis for the efficacy of cTBS, with the area under the curve (AUC) of 0.85 (95% confidence interval: 0.718-0.989, p = 0.002). None of the patients had any serious adverse event. CONCLUSION cTBS intervention on bilateral SMA can significantly improve the symptoms of medicated OCD patients with moderate severity. And the pretherapy FC could be a valuable potential predictor of the cTBS treatment outcome among OCD patients.
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Affiliation(s)
- Puyu Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jiayue Cheng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Qing Fan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Liangjun Lin
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Shuangyi Zhou
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jian Gao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yingying Tang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Tifei Yuan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), Shanghai, PR China.
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Kammen A, Cavaleri J, Lam J, Frank AC, Mason X, Choi W, Penn M, Brasfield K, Van Noppen B, Murray SB, Lee DJ. Neuromodulation of OCD: A review of invasive and non-invasive methods. Front Neurol 2022; 13:909264. [PMID: 36016538 PMCID: PMC9397524 DOI: 10.3389/fneur.2022.909264] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/19/2022] [Indexed: 12/27/2022] Open
Abstract
Early research into neural correlates of obsessive compulsive disorder (OCD) has focused on individual components, several network-based models have emerged from more recent data on dysfunction within brain networks, including the the lateral orbitofrontal cortex (lOFC)-ventromedial caudate, limbic, salience, and default mode networks. Moreover, the interplay between multiple brain networks has been increasingly recognized. As the understanding of the neural circuitry underlying the pathophysiology of OCD continues to evolve, so will too our ability to specifically target these networks using invasive and noninvasive methods. This review discusses the rationale for and theory behind neuromodulation in the treatment of OCD.
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Affiliation(s)
- Alexandra Kammen
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jonathon Cavaleri
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jordan Lam
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - Adam C. Frank
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Xenos Mason
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Wooseong Choi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Marisa Penn
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Kaevon Brasfield
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Barbara Van Noppen
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Stuart B. Murray
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Darrin Jason Lee
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Passera B, Chauvin A, Raffin E, Bougerol T, David O, Harquel S. Exploring the spatial resolution of TMS-EEG coupling on the sensorimotor region. Neuroimage 2022; 259:119419. [PMID: 35777633 DOI: 10.1016/j.neuroimage.2022.119419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/12/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
The use of TMS-EEG coupling as a neuroimaging tool for the functional exploration of the human brain recently gained strong interest. If this tool directly inherits the fine temporal resolution from EEG, its spatial counterpart remains unknown. In this study, we explored the spatial resolution of TMS-EEG coupling by evaluating the minimal distance between two stimulated cortical sites that would significantly evoke different response dynamics. TMS evoked responses were mapped on the sensorimotor region in twenty participants. The stimulation grid was composed of nine targets separated between 10 and 15 mm on average. The dynamical signatures of TMS evoked activity were extracted and compared between sites using both local and remote linear regression scores and spatial generalized mixed models. We found a significant effect of the distance between stimulated sites on their dynamical signatures, neighboring sites showing differentiable response dynamics. Besides, common dynamical signatures were also found between sites up to 25-30 mm from each other. This overlap in dynamical properties decreased with distance and was stronger between sites within the same Brodmann area. Our results suggest that the spatial resolution of TMS-EEG coupling might be at least as high as 10 mm. Furthermore, our results reveal an anisotropic spatial resolution that was higher across than within the same Brodmann areas, in accordance with the TMS induced E-field modeling. Common cytoarchitectonic leading to shared dynamical properties within the same Brodmann area could also explain this anisotropy. Overall, these findings suggest that TMS-EEG benefits from the spatial resolution of TMS, which makes it an accurate technique for meso-scale brain mapping.
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Affiliation(s)
- Brice Passera
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; Univ. Grenoble Alpes, CNRS, UMR5105, Laboratoire Psychologie et NeuroCognition, LPNC, F-38000 Grenoble, France; Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alan Chauvin
- Univ. Grenoble Alpes, CNRS, UMR5105, Laboratoire Psychologie et NeuroCognition, LPNC, F-38000 Grenoble, France
| | - Estelle Raffin
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Thierry Bougerol
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; Centre Hospitalier Univ. Grenoble Alpes, Service de Psychiatrie, F-38000 Grenoble, France
| | - Olivier David
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France; Aix Marseille Univ, Inserm, U1106, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Sylvain Harquel
- Univ. Grenoble Alpes, CNRS, UMR5105, Laboratoire Psychologie et NeuroCognition, LPNC, F-38000 Grenoble, France; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland.
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Somaa FA, de Graaf TA, Sack AT. Transcranial Magnetic Stimulation in the Treatment of Neurological Diseases. Front Neurol 2022; 13:793253. [PMID: 35669870 PMCID: PMC9163300 DOI: 10.3389/fneur.2022.793253] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
Transcranial Magnetic Stimulation (TMS) has widespread use in research and clinical application. For psychiatric applications, such as depression or OCD, repetitive TMS protocols (rTMS) are an established and globally applied treatment option. While promising, rTMS is not yet as common in treating neurological diseases, except for neurorehabilitation after (motor) stroke and neuropathic pain treatment. This may soon change. New clinical studies testing the potential of rTMS in various other neurological conditions appear at a rapid pace. This can prove challenging for both practitioners and clinical researchers. Although most of these neurological applications have not yet received the same level of scientific/empirical scrutiny as motor stroke and neuropathic pain, the results are encouraging, opening new doors for TMS in neurology. We here review the latest clinical evidence for rTMS in pioneering neurological applications including movement disorders, Alzheimer's disease/mild cognitive impairment, epilepsy, multiple sclerosis, and disorders of consciousness.
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Affiliation(s)
- Fahad A. Somaa
- Department of Occupational Therapy, Faculty of Medical Rehabilitation, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tom A. de Graaf
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Center of Integrative Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alexander T. Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Center of Integrative Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Brain + Nerve Centre, Maastricht University Medical Centre+, Maastricht, Netherlands
- *Correspondence: Alexander T. Sack
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Continuous but not intermittent theta burst stimulation decreases striatal dopamine release and cortical excitability. Exp Neurol 2022; 354:114106. [DOI: 10.1016/j.expneurol.2022.114106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/12/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022]
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Fremont R, Dworkin J, Manoochehri M, Krueger F, Huey E, Grafman J. Damage to the dorsolateral prefrontal cortex is associated with repetitive compulsive behaviors in patients with penetrating brain injury. BMJ Neurol Open 2022; 4:e000229. [PMID: 35519903 PMCID: PMC9020295 DOI: 10.1136/bmjno-2021-000229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/18/2022] [Indexed: 11/03/2022] Open
Abstract
Background Damage to cortico-striato-thalamo-cortical (CSTC) circuits is associated with the development of repetitive behaviours in animals and humans. However, the types of repetitive behaviours that are developed after injury to these structures are poorly defined. This study examines the effect of damage to separate elements of CSTC circuits sustained by veterans of the Vietnam War on obsessions, compulsions, and tics. Methods We performed partial correlations (correcting for cognition, age, education, and global brain damage) between volume loss from traumatic brain injury in specific elements of CSTC circuits (lateral and medial orbitofrontal and dorsolateral prefrontal cortices, anterior cingulate cortex, thalamus, and basal ganglia) and scores on a modified version of the Yale-Brown Obsessive Compulsive Scale Symptom Checklist and the Yale Global Tic Severity Scale in 83 Vietnam war veterans with penetrating brain injuries at different sites throughout the brain. Results We found that volume loss in the left dorsolateral prefrontal cortex was associated with the development of compulsive behaviours (r=0.32, padj<0.05) whereas volume loss in the basal ganglia was associated with the development of tics (r=0.33, padj<0.05). Conclusion Our findings indicate that damage to specific CSTC elements can be associated with the development of compulsive behaviours and tics that are not necessarily accompanied by obsessions.
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Affiliation(s)
- Rachel Fremont
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Jordan Dworkin
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Masood Manoochehri
- Taub Insitute, Columbia University Medical Center, New York, New York, USA
| | - Frank Krueger
- Molecular Neuroscience Department, George Mason University, Fairfax, Virginia, USA
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Edward Huey
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
- Department of Neurology, Columbia University, New York, New York, USA
| | - Jordan Grafman
- Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, Illinois, USA
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32
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Wang YN, Pan YC, Shu HY, Zhang LJ, Li QY, Ge QM, Liang RB, Shao Y. Altered Spontaneous Brain Activity Patterns in Children With Strabismic Amblyopia After Low-Frequency Repetitive Transcranial Magnetic Stimulation: A Resting-State Functional Magnetic Resonance Imaging Study. Front Hum Neurosci 2022; 16:790678. [PMID: 35463933 PMCID: PMC9027809 DOI: 10.3389/fnhum.2022.790678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivePrevious studies have demonstrated altered brain activity in strabismic amblyopia (SA). In this study, low-frequency repetitive transcranial magnetic stimulation (rTMS) was applied in children with strabismic amblyopia after they had undergone strabismus surgery. The effect of rTMS was investigated by measuring the changes of brain features using the amplitude of low-frequency fluctuation (ALFF).Materials and MethodsIn this study, 21 SA patients (12 males and 9 females) were recruited based on their age (7–13 years old), weight, and sex. They all had SA in their left eyes and they received rTMS treatment one month after strabismus surgery. Their vision before and after surgery were categorized as pre-rTMS (PRT) and post-rTMS (POT). All participants received rTMS treatment, underwent magnetic resonance imaging (MRI), and their data were analyzed using the repeated measures t-test. The team used correlation analysis to explore the relationship between logMAR visual acuity and ALFF.ResultsPre- versus post-rTMS values of ALFF were significantly different within individuals. In the POT group, ALFF values were significantly decreased in the Angular_R (AR), Parietal_Inf_L (PIL), and Cingulum_Mid_R (CMR) while ALFF values were significantly increased in the Fusiform_R (FR) and Frontal_Inf_Orb_L(FIL) compared to the PRT stage.ConclusionOur data showed that ALFF recorded from some brain regions was changed significantly after rTMS in strabismic amblyopes. The results may infer the pathological basis of SA and demonstrate that visual function may be improved using rTMS in strabismic amblyopic patients.
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Fitzsimmons SMDD, van der Werf YD, van Campen AD, Arns M, Sack AT, Hoogendoorn AW, van den Heuvel OA. Repetitive transcranial magnetic stimulation for obsessive-compulsive disorder: A systematic review and pairwise/network meta-analysis. J Affect Disord 2022; 302:302-312. [PMID: 35041869 DOI: 10.1016/j.jad.2022.01.048] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
Background We evaluated the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD), and ranked the relative efficacy of different stimulation protocols. Methods We performed a search for randomised, sham-controlled trials of rTMS for OCD. The primary analysis included both a pairwise meta-analysis and a series of frequentist network meta-analyses (NMA) of OCD symptom severity. Secondary analyses were carried out on relevant clinical factors and safety. Results 21 studies involving 662 patients were included. The pairwise meta-analysis showed that rTMS for OCD is efficacious across all protocols (Hedges' g=-0.502 [95%CI= -0.708, -0.296]). The first NMA, with stimulation protocols clustered only by anatomical location, showed that both dorsolateral prefrontal cortex (dlPFC) stimulation and medial frontal cortex stimulation were efficacious. In the second NMA, considering each unique combination of frequency and location separately, low frequency (LF) pre-supplementary motor area (preSMA) stimulation, high frequency (HF) bilateral dlPFC stimulation, and LF right dlPFC stimulation were all efficacious . LF right dlPFC was ranked highest in terms of efficacy, although the corresponding confidence intervals overlapped with the other two protocols. Limitations Evidence base included mostly small studies, with only a few studies using similar protocols, giving a sparse network. Studies were heterogeneous, and a risk of publication bias was found. Conclusions rTMS for OCD was efficacious compared with sham stimulation. LF right dlPFC, HF bilateral dlPFC and LF preSMA stimulation were all efficacious protocols with significant and comparable clinical improvements. Future studies should further investigate the relative merits of these three protocols.
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Affiliation(s)
- Sophie M D D Fitzsimmons
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Ysbrand D van der Werf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - A Dilene van Campen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Martijn Arns
- Brainclinics Foundation, Research Institute Brainclinics, Nijmegen, the Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Alexander T Sack
- Brain Stimulation and Cognition Lab, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands; Department of Psychiatry and Neuropsychology, Brain+Nerve Centre, Maastricht University Medical Centre+ (MUMC+), the Netherlands
| | - Adriaan W Hoogendoorn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health, De Boelelaan 1117, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
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- Transcranial magnetic stimulation for Exposure Therapy Resistant Obsessive-compulsive disorder (TETRO)
| | - Odile A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
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34
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Joshi M, Kar SK, Dalal PK. Safety and efficacy of early augmentation with repetitive transcranial magnetic stimulation in the treatment of drug-free patients with obsessive-compulsive disorder. CNS Spectr 2022; 28:1-7. [PMID: 35082003 DOI: 10.1017/s1092852922000013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder that results in significant disability and substantial compromise in the quality of life. Until now, the role of repetitive transcranial magnetic stimulation (rTMS) has been primarily explored in individuals with treatment-resistant OCD. In this study, we investigated the safety and efficacy of rTMS as an early augmentation strategy in drug-free patients with OCD. METHODS This is a randomized double-blind, placebo-controlled study that involved the administration of a total of 20 sessions of rTMS (active/sham) to drug-naïve OCD patients using a standard protocol (1-Hz; 20 trains [80 pulses/train]; 1600 pulses per session at 100% resting motor threshold) at supplementary motor area. All patients (active and sham) were started on escitalopram 10 mg/d, which was subsequently increased to 20 mg/d after 10 days. RESULTS Out of the 24 patients, 13 received active and 11 received sham rTMS. At the end of rTMS therapy, there was a substantial reduction (P = .001) in total Yale-Brown Obsessive-Compulsive Scale, obsessions (P = .030) and compulsions (P = .001) between the groups. Only few patients (N = 8) reported mild side effect with rTMS, local pain, and headache being the commonest. The study revealed large effect size (Cohen's d = 1.6) of rTMS as an early augmentation strategy in drug-free patients of OCD. CONCLUSIONS rTMS is a safe and effective early augmentation strategy in the management of OCD. Larger randomized controlled trials are required to establish the therapeutic role of rTMS as early augmentation in OCD.
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Affiliation(s)
- Mohita Joshi
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Pronob K Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, India
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Marder KG, Barbour T, Ferber S, Idowu O, Itzkoff A. Psychiatric Applications of Repetitive Transcranial Magnetic Stimulation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:8-18. [PMID: 35746935 PMCID: PMC9063593 DOI: 10.1176/appi.focus.20210021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Transcranial magnetic stimulation (TMS) is an increasingly popular noninvasive brain stimulation modality. In TMS, a pulsed magnetic field is used to noninvasively stimulate a targeted brain region. Repeated stimulation produces lasting changes in brain activity via mechanisms of synaptic plasticity similar to long-term potentiation. Local application of TMS alters activity in distant, functionally connected brain regions, indicating that TMS modulates activity of cortical networks. TMS has been approved by the U.S. Food and Drug Administration for the treatment of major depressive disorder, obsessive-compulsive disorder, and smoking cessation, and a growing evidence base supports its efficacy in the treatment of other neuropsychiatric conditions. TMS is rapidly becoming part of the standard of care for treatment-resistant depression, where it yields response rates of 40%-60%. TMS is generally safe and well tolerated; its most serious risk is seizure, which occurs very rarely. This review aims to familiarize practicing psychiatrists with basic principles of TMS, including target localization, commonly used treatment protocols and their outcomes, and safety and tolerability. Practical considerations, including evaluation and monitoring of patients undergoing TMS, device selection, treatment setting, and insurance reimbursement, are also reviewed.
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36
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Rodrigues da Silva D, Maia A, Cotovio G, Oliveira J, Oliveira-Maia AJ, Barahona-Corrêa JB. Motor cortical inhibitory deficits in patients with obsessive-compulsive disorder-A systematic review and meta-analysis of transcranial magnetic stimulation literature. Front Psychiatry 2022; 13:1050480. [PMID: 36569621 PMCID: PMC9770010 DOI: 10.3389/fpsyt.2022.1050480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a highly prevalent chronic disorder, often refractory to treatment. While remaining elusive, a full understanding of the pathophysiology of OCD is crucial to optimize treatment. Transcranial magnetic stimulation (TMS) is a non-invasive technique that, paired with other neurophysiological techniques, such as electromyography, allows for in vivo assessment of human corticospinal neurophysiology. It has been used in clinical populations, including comparisons of patients with OCD and control volunteers. Results are often contradictory, and it is unclear if such measures change after treatment. Here we summarize research comparing corticospinal excitability between patients with OCD and control volunteers, and explore the effects of treatment with repetitive TMS (rTMS) on these excitability measures. METHODS We conducted a systematic review and meta-analysis of case-control studies comparing various motor cortical excitability measures in patients with OCD and control volunteers. Whenever possible, we meta-analyzed motor cortical excitability changes after rTMS treatment. RESULTS From 1,282 articles, 17 reporting motor cortex excitability measures were included in quantitative analyses. Meta-analysis regarding cortical silent period shows inhibitory deficits in patients with OCD, when compared to control volunteers. We found no statistically significant differences in the remaining meta-analyses, and no evidence, in patients with OCD, of pre- to post-rTMS changes in resting motor threshold, the only excitability measure for which longitudinal data were reported. DISCUSSION Our work suggests an inhibitory deficit of motor cortex excitability in patients with OCD when compared to control volunteers. Cortical silent period is believed to reflect activity of GABAB receptors, which is in line with neuroimaging research, showing GABAergic deficits in patients with OCD. Regardless of its effect on OCD symptoms, rTMS apparently does not modify Resting Motor Threshold, possibly because this measure reflects glutamatergic synaptic transmission, while rTMS is believed to mainly influence GABAergic function. Our meta-analyses are limited by the small number of studies included, and their methodological heterogeneity. Nonetheless, cortical silent period is a reliable and easily implementable measurement to assess neurophysiology in humans, in vivo. The present review illustrates the importance of pursuing the study of OCD pathophysiology using cortical silent period and other easily accessible, non-invasive measures of cortical excitability. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020201764], identifier [CRD42020201764].
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Affiliation(s)
| | - Ana Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Gonçalo Cotovio
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - José Oliveira
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - J Bernardo Barahona-Corrêa
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
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Chen GW, Hsu TW, Ching PY, Pan CC, Chou PH, Chu CS. Efficacy and Tolerability of Repetitive Transcranial Magnetic Stimulation on Suicidal Ideation: A Systemic Review and Meta-Analysis. Front Psychiatry 2022; 13:884390. [PMID: 35599760 PMCID: PMC9120615 DOI: 10.3389/fpsyt.2022.884390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in treating suicidal ideation in patients with mental illness. METHOD We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Major electronic databases were systematically searched from the time of their inception until July 22, 2021. The primary outcome was the mean change in the scores for suicidal ideation. The secondary outcome was the mean change in depression severity. RESULTS Ten randomized controlled trials were eligible with 415 participants in the active treatment group (mean age = 53.78 years; mean proportion of women = 54.5%) and 387 participants in the control group (mean age = 55.52 years; mean proportion of women = 51.78%). rTMS significantly reduced suicidal ideation (k = 10, n = 802, Hedges' g = -0.390, 95% confidence interval [CI] = -0.193 to -0.588, p <.001) and severity of depressive symptoms (k = 9, n = 761, Hedges' g = -0.698, 95% CI = -1.023 to -0.372, p < 0.001) in patients with major mental disorders. In the subgroup analysis, rTMS reduced suicidal ideation among patients with non-treatment-resistant depression (non-TRD) (-0.208) but not in those with TRD. rTMS as combination therapy had a larger effect than did monotherapy (-0.500 vs. -0.210). Suicidal ideation significantly reduced in patients receiving more than ten treatment sessions (-0.255). Importantly, the rTMS group showed favorable tolerability without major adverse events. CONCLUSION The study showed that rTMS was effective and well-tolerated in reducing suicidal ideation and depression severity in patients with major mental disorders.
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Affiliation(s)
- Guan-Wei Chen
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tien-Wei Hsu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pao-Yuan Ching
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Chuan Pan
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Non-invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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38
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Luo Q, Liu W, Jin L, Chang C, Peng Z. Classification of Obsessive-Compulsive Disorder Using Distance Correlation on Resting-State Functional MRI Images. Front Neuroinform 2021; 15:676491. [PMID: 34744676 PMCID: PMC8564498 DOI: 10.3389/fninf.2021.676491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Both the Pearson correlation and partial correlation methods have been widely used in the resting-state functional MRI (rs-fMRI) studies. However, they can only measure linear relationship, although partial correlation excludes some indirect effects. Recent distance correlation can discover both the linear and non-linear dependencies. Our goal was to use the multivariate pattern analysis to compare the ability of such three correlation methods to distinguish between the patients with obsessive-compulsive disorder (OCD) and healthy control subjects (HCSs), so as to find optimal correlation method. The main process includes four steps. First, the regions of interest are defined by automated anatomical labeling (AAL). Second, functional connectivity (FC) matrices are constructed by the three correlation methods. Third, the best discriminative features are selected by support vector machine recursive feature elimination (SVM-RFE) with a stratified N-fold cross-validation strategy. Finally, these discriminative features are used to train a classifier. We had a total of 128 subjects out of which 61 subjects had OCD and 67 subjects were normal. All the three correlation methods with SVM have achieved good results, among which distance correlation is the best [accuracy = 93.01%, specificity = 89.71%, sensitivity = 95.08%, and area under the receiver-operating characteristic curve (AUC) = 0.94], followed by Pearson correlation and partial correlation is the last. The most discriminative regions of the brain for distance correlation are right dorsolateral superior frontal gyrus, orbital part of left superior frontal gyrus, orbital part of right middle frontal gyrus, right anterior cingulate and paracingulate gyri, left the supplementary motor area, and right precuneus, which are the promising biomarkers of OCD.
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Affiliation(s)
- Qian Luo
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.,Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China.,National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Shenzhen University, Shenzhen, China
| | - Weixiang Liu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.,Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China.,National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Shenzhen University, Shenzhen, China
| | - Lili Jin
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.,Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Chunqi Chang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.,Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China.,National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Shenzhen University, Shenzhen, China.,Peng Cheng Laboratory, Shenzhen, China
| | - Ziwen Peng
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China.,Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen University School of Medicine, Shenzhen, China
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39
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Meek BP, Fotros A, Abo Aoun M, Modirrousta M. Improvements in error-monitoring and symptoms following low-frequency rTMS of dorsal anterior cingulate cortex in obsessive compulsive disorder; a randomized, sham-controlled study. Brain Cogn 2021; 154:105809. [PMID: 34619574 DOI: 10.1016/j.bandc.2021.105809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/13/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022]
Abstract
Action monitoring deficit is a core underlying characteristic and endophenotype of Obsessive Compulsive Disorder (OCD). Dorsal anterior cingulate cortex (dACC) is heavily involved in error monitoring and cognitive control, and the hyperactivity in this region is associated with OCD symptom severity. This study aimed to test whether low frequency (LF) repetitive transcranial magnetic stimulation (rTMS) targeting dACC improves both error-monitoring performance and OCD symptoms in a randomized, sham-controlled, double-blind trial design. 20 OCD patients were randomly assigned to receive 20 sessions of Active (n = 10) or Sham (n = 10) rTMS administered twice-daily. Error-monitoring performance and symptom severity were measured pre- and post-treatment using Erikson Flanker tasks and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), with three month symptom follow-up. Following active-but not sham-rTMS, patients showed improved response time for incongruent stimuli, trials following a correct response, and for reporting and correcting errors. Significant OCD symptom improvement was observed at one-month follow-up for patients who received Active (28.0% reduction) but not Sham (11.7% reduction) stimulation. In OCD patients, LF rTMS of the dACC can simultaneously improve on-line adjustment of behaviour-by enhancing the capacity for rapid error monitoring-and clinical symptoms, suggesting a link between error monitoring impairment and OCD pathophysiology.
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Affiliation(s)
- Benjamin P Meek
- Albrechtsen Research Centre, St. Boniface Hospital, 409 Tache Ave, Winnipeg, MB R2H 2A6, Canada
| | - Aryandokht Fotros
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02912, United States
| | - Mohamed Abo Aoun
- Albrechtsen Research Centre, St. Boniface Hospital, 409 Tache Ave, Winnipeg, MB R2H 2A6, Canada
| | - Mandana Modirrousta
- Albrechtsen Research Centre, St. Boniface Hospital, 409 Tache Ave, Winnipeg, MB R2H 2A6, Canada; Department of Psychiatry, University of Manitoba, 66 Chancellors Circle, Winnipeg, MB R3T 2N2, Canada.
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40
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Efficacy of repetitive transcranial magnetic stimulation in patients with obsessive-compulsive disorder: a pilot study. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2021; 35:192-198. [PMID: 34611847 DOI: 10.1007/s40211-021-00403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a common disabling psychiatric disorder. Considering the lack of an acceptable treatment response in many patients, several efforts have been made to increase the efficacy of therapy. We aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) on the supplementary motor area in the treatment of patients with drug-resistant OCD and examine changes in brain function. METHODS This quasi-experimental study was performed on 12 patients who were referred to outpatient clinics of Ibn-e-Sina psychiatric hospital and were diagnosed with OCD according to the clinical and diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). All patients received 20 rTMS sessions in their right supplementary motor region. Main outcomes were assessed using quantitative electroencephalography (qEEG) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and after the intervention. In addition, Y‑BOCS was completed after 10 rTMS sessions and after the 6‑week follow-up. Data were analyzed with SPSS. RESULTS Ten of 12 patients completed this study, of whom 7 (70%) were female. The mean age was 36.66 ± 10.28 years. Y‑BOCS overall score significantly decreased over time during the course of study compared to baseline (P < 0.05). A significant decrease in beta wave activity of the parietal and occipital regions was seen in posttreatment qEEG, compared with baseline (P < 0.05). CONCLUSIONS rTMS over the supplementary motor area at 20 sessions could effectively improve Y‑BOCS score and decrease beta wave activity in parietal and occipital regions. Further studies are needed to approve these findings in a controlled design.
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41
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Shephard E, Stern ER, van den Heuvel OA, Costa DL, Batistuzzo MC, Godoy PB, Lopes AC, Brunoni AR, Hoexter MQ, Shavitt RG, Reddy JY, Lochner C, Stein DJ, Simpson HB, Miguel EC. Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder. Mol Psychiatry 2021; 26:4583-4604. [PMID: 33414496 PMCID: PMC8260628 DOI: 10.1038/s41380-020-01007-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive-compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.
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Affiliation(s)
- Elizabeth Shephard
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. .,Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
| | - Emily R. Stern
- Department of Psychiatry, The New York University School of Medicine, New York, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Odile A. van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Daniel L.C. Costa
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo C. Batistuzzo
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Priscilla B.G. Godoy
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio C. Lopes
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andre R. Brunoni
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Q. Hoexter
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roseli G. Shavitt
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Janardhan Y.C Reddy
- Department of Psychiatry OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Christine Lochner
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - H. Blair Simpson
- Center for OCD and Related Disorders, New York State Psychiatric Institute and the Department of Psychiatry, Columbia University Irving Medical Center, New York New York
| | - Euripedes C. Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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42
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Acevedo N, Bosanac P, Pikoos T, Rossell S, Castle D. Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review. Brain Sci 2021; 11:brainsci11070948. [PMID: 34356182 PMCID: PMC8307974 DOI: 10.3390/brainsci11070948] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 01/16/2023] Open
Abstract
Invasive and noninvasive neurostimulation therapies for obsessive-compulsive and related disorders (OCRD) were systematically reviewed with the aim of assessing clinical characteristics, methodologies, neuroanatomical substrates, and varied stimulation parameters. Previous reviews have focused on a narrow scope, statistical rather than clinical significance, grouped together heterogenous protocols, and proposed inconclusive outcomes and directions. Herein, a comprehensive and transdiagnostic evaluation of all clinically relevant determinants is presented with translational clinical recommendations and novel response rates. Electroconvulsive therapy (ECT) studies were limited in number and quality but demonstrated greater efficacy than previously identified. Targeting the pre-SMA/SMA is recommended for transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). TMS yielded superior outcomes, although polarity findings were conflicting, and refinement of frontal/cognitive control protocols may optimize outcomes. For both techniques, standardization of polarity, more treatment sessions (>20), and targeting multiple structures are encouraged. A deep brain stimulation (DBS) 'sweet spot' of the striatum for OCD was proposed, and CBT is strongly encouraged. Tourette's patients showed less variance and reliance on treatment optimization. Several DBS targets achieved consistent, rapid, and sustained clinical response. Analysis of fiber connectivity, as opposed to precise neural regions, should be implemented for target selection. Standardization of protocols is necessary to achieve translational outcomes.
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Affiliation(s)
- Nicola Acevedo
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
- Correspondence:
| | - Peter Bosanac
- St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
- Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Toni Pikoos
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
| | - Susan Rossell
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
- St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
| | - David Castle
- St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
- Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
- Centre for Addiction and Mental Health, 252 College Street, Toronto, ON M5T 1R7, Canada
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43
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Roy C, Goyal N, Shreekantiah U, Ram D. Does single session transcranial magnetic stimulation alter fractional anisotropy in obsessive-compulsive disorder? A preliminary observation. Psychiatry Res 2021; 301:113970. [PMID: 33984823 DOI: 10.1016/j.psychres.2021.113970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 04/21/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Chandramouli Roy
- K.S. Mani Centre for Cognitive Neurosciences and fMRI Centre, Central Institute of Psychiatry, Ranchi 834006, Jharkhand, India
| | - Nishant Goyal
- K.S. Mani Centre for Cognitive Neurosciences and fMRI Centre, Central Institute of Psychiatry, Ranchi 834006, Jharkhand, India
| | - Umesh Shreekantiah
- K.S. Mani Centre for Cognitive Neurosciences and fMRI Centre, Central Institute of Psychiatry, Ranchi 834006, Jharkhand, India.
| | - Daya Ram
- K.S. Mani Centre for Cognitive Neurosciences and fMRI Centre, Central Institute of Psychiatry, Ranchi 834006, Jharkhand, India
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44
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Ji GJ, Xie W, Yang T, Wu Q, Sui P, Bai T, Chen L, Chen L, Chen X, Dong Y, Wang A, Li D, Yang J, Qiu B, Yu F, Zhang L, Luo Y, Wang K, Zhu C. Pre-supplementary motor network connectivity and clinical outcome of magnetic stimulation in obsessive-compulsive disorder. Hum Brain Mapp 2021; 42:3833-3844. [PMID: 34050701 PMCID: PMC8288080 DOI: 10.1002/hbm.25468] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022] Open
Abstract
A large proportion of patients with obsessive–compulsive disorder (OCD) respond unsatisfactorily to pharmacological and psychological treatments. An alternative novel treatment for these patients is repetitive transcranial magnetic stimulation (rTMS). This study aimed to investigate the underlying neural mechanism of rTMS treatment in OCD patients. A total of 37 patients with OCD were randomized to receive real or sham 1‐Hz rTMS (14 days, 30 min/day) over the right pre‐supplementary motor area (preSMA). Resting‐state functional magnetic resonance imaging data were collected before and after rTMS treatment. The individualized target was defined by a personalized functional connectivity map of the subthalamic nucleus. After treatment, patients in the real group showed a better improvement in the Yale–Brown Obsessive Compulsive Scale than the sham group (F1,35 = 6.0, p = .019). To show the neural mechanism involved, we identified an “ideal target connectivity” before treatment. Leave‐one‐out cross‐validation indicated that this connectivity pattern can significantly predict patients' symptom improvements (r = .60, p = .009). After real treatment, the average connectivity strength of the target network significantly decreased in the real but not in the sham group. This network‐level change was cross‐validated in three independent datasets. Altogether, these findings suggest that personalized magnetic stimulation on preSMA may alleviate obsessive–compulsive symptoms by decreasing the connectivity strength of the target network.
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Affiliation(s)
- Gong-Jun Ji
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Wen Xie
- Department of Psychiatry, Anhui Mental Health Center, Hefei, China
| | - Tingting Yang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Qianqian Wu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Pengjiao Sui
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Tongjian Bai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Lu Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Lu Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Xingui Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Yi Dong
- Department of Psychiatry, Anhui Mental Health Center, Hefei, China
| | - Anzhen Wang
- Department of Psychiatry, Anhui Mental Health Center, Hefei, China
| | - Dandan Li
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Jinying Yang
- Laboratory Center for Information Science, University of Science and Technology of China, Hefei, China
| | - Bensheng Qiu
- Hefei National Lab for Physical Sciences at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Fengqiong Yu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Lei Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Yudan Luo
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Chunyan Zhu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
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45
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Liang K, Li H, Bu X, Li X, Cao L, Liu J, Gao Y, Li B, Qiu C, Bao W, Zhang S, Hu X, Xing H, Gong Q, Huang X. Efficacy and tolerability of repetitive transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Transl Psychiatry 2021; 11:332. [PMID: 34050130 PMCID: PMC8163761 DOI: 10.1038/s41398-021-01453-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/30/2021] [Accepted: 05/11/2021] [Indexed: 02/08/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been widely used as an alternative treatment for obsessive-compulsive disorder (OCD). However, the most effective rTMS parameters, such as the targets and stimulation frequencies, remain controversial. Therefore, we aimed to compare and rank the efficacy and tolerability of different rTMS strategies for OCD treatment. We searched five electronic databases from the date of their inception to March 25, 2020. Pairwise meta-analyses and network meta-analyses were performed to synthesize data. We assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Twenty-two eligible randomized controlled trials (RCTs) were included. For efficacy, low-frequency (LF) rTMS over the dorsolateral prefrontal cortex (DLPFC; mean difference (MD) 6.34, 95% credible interval (CrI) 2.12-10.42) and supplementary motor area (MD 4.18, 95% CrI 0.83-7.62), and high-frequency rTMS over the DLPFC (MD 3.75, 95% CrI 1.04-6.81) were more effective than sham rTMS. Regarding tolerability, all rTMS treatment strategies were similar to the sham rTMS. The estimated ranking probabilities of treatments showed that LF-rTMS over the DLPFC might be the most effective intervention among all rTMS strategies. However, the quality of evidence regarding efficacy was evaluated as very low. Current evidence suggested a marginal advantage for LF-rTMS over the DLPFC on OCD treatment. High-quality RCTs with low selection and performance bias are needed to further verify the efficacy of specific rTMS strategies for the OCD treatment.
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Affiliation(s)
- Kaili Liang
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Hailong Li
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Xuan Bu
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Xue Li
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China ,grid.13291.380000 0001 0807 1581School of Physical Science and Technology, Sichuan University, Chengdu, People’s Republic of China
| | - Lingxiao Cao
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Jing Liu
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Yingxue Gao
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Bin Li
- grid.412901.f0000 0004 1770 1022Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Changjian Qiu
- grid.412901.f0000 0004 1770 1022Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Weijie Bao
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Suming Zhang
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Xinyu Hu
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Haoyang Xing
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China ,grid.13291.380000 0001 0807 1581School of Physical Science and Technology, Sichuan University, Chengdu, People’s Republic of China
| | - Qiyong Gong
- grid.412901.f0000 0004 1770 1022Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China ,grid.412901.f0000 0004 1770 1022Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China. .,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
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46
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Peris TS, Salgari G, Perez J, Jurgiel J, Vreeland A, O'Neill J, Chang S, Piacentini J, Loo SK. Shared and unique neural mechanisms underlying pediatric trichotillomania and obsessive compulsive disorder. Psychiatry Res 2021; 298:113653. [PMID: 33621723 DOI: 10.1016/j.psychres.2020.113653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/12/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Little is known about the neural underpinnings of pediatric trichotillomania (TTM). We examined error-related negativity (ERN)-amplitude and theta-EEG power differences among youth with TTM, OCD, and healthy controls (HC). METHODS Forty channel EEG was recorded from 63 pediatric participants (22 with TTM, 22 with OCD, and 19 HC) during the Eriksen Flanker Task. EEG data from inhibitory control were used to derive estimates of ERN amplitude and event-related spectral power associated with motor inhibition. RESULTS TTM and HC were similar in brain activity patterns in frontal and central regions and TTM and OCD were similar in the parietal region. Frontal ERN-amplitude was significantly larger in OCD relative to TTM and HC, who did not differ from each other. The TTM group had higher theta power compared to OCD in frontal and central regions, and higher theta than both comparison groups in right motor cortex and superior parietal regions. Within TTM, flanker task performance was correlated with EEG activity in frontal, central, and motor cortices whereas global functioning and impairment were associated with EEG power in bilateral motor and parietal cortices. CONCLUSIONS Findings are discussed in terms of shared and unique neural mechanisms in TTM and OCD and treatment implications.
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Affiliation(s)
- Tara S Peris
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States.
| | - Giulia Salgari
- Department of Psychology, University of Central Florida, United States
| | - Jocelyn Perez
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
| | - Joseph Jurgiel
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
| | | | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
| | - Susanna Chang
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
| | - John Piacentini
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
| | - Sandra K Loo
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
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47
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Brakoulias V, Nguyen PHD, Lin D, Pham NDK. An international survey of different transcranial magnetic stimulation (TMS) protocols for patients with obsessive-compulsive disorder (OCD). Psychiatry Res 2021; 298:113765. [PMID: 33571799 DOI: 10.1016/j.psychres.2021.113765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
This study aims to evaluate current preferences and trends in the delivery of Transcranial Magnetic Stimulation (TMS) for Obsessive-Compulsive Disorder (OCD). A 10-item online questionnaire was developed and conducted online between April to June 2020, surveying providers of TMS for patients with OCD internationally. A total of 27 valid responses were analysed from 10 countries. The most common target for TMS was the supplementary motor area and stimulation was commonly given bilaterally, but techniques differed between centres. Exposure tasks were not commonly used during TMS. The study calls for more research clarifying the best mode of TMS delivery for OCD.
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Affiliation(s)
- Vlasios Brakoulias
- Department of Psychiatry, Blacktown Hospital, Western Sydney Local Health District - Mental Health Service, Blacktown, NSW, Australia.; Western Sydney University School of Medicine, Campbelltown, NSW, Australia
| | | | - Dongni Lin
- Western Sydney University School of Medicine, Campbelltown, NSW, Australia
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48
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Mantovani A, Neri F, D'Urso G, Mencarelli L, Tatti E, Momi D, Menardi A, Sprugnoli G, Santarnecchi E, Rossi S. Functional connectivity changes and symptoms improvement after personalized, double-daily dosing, repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: A pilot study. J Psychiatr Res 2021; 136:560-570. [PMID: 33158554 DOI: 10.1016/j.jpsychires.2020.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Antonio Mantovani
- Department of Molecular, Cellular and Biomedical Sciences, CUNY, School of Medicine, New York, USA
| | - Francesco Neri
- 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.
| | - Giordano D'Urso
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Lucia Mencarelli
- 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; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elisa Tatti
- Department of Molecular, Cellular and Biomedical Sciences, CUNY, School of Medicine, New York, USA
| | - Davide Momi
- 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; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arianna Menardi
- 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; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giulia Sprugnoli
- 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
| | - Emiliano Santarnecchi
- 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; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Simone Rossi
- 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; Department of Medicine, Surgery and Neuroscience, University of Siena School of Medicine, Siena, Italy
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49
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Repetitive Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Meta-analysis of Randomized, Sham-Controlled Trials. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:947-960. [PMID: 33775927 DOI: 10.1016/j.bpsc.2021.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a chronic, disabling mental health condition with limited treatment options available to date. Numerous randomized controlled trials have explored the efficacy of repetitive transcranial magnetic stimulation (rTMS) in OCD. This meta-analysis synthesized data from selected randomized controlled trials and examined the impact of different treatment parameters to generate hypotheses that would direct future randomized controlled trials. METHODS A database search was performed to identify studies published in English up to October 2020. Randomized, sham-controlled studies that used rTMS to treat OCD were included. Effect sizes were calculated using Hedges' g for pre- to post-treatment Yale-Brown Obsessive Compulsive Scale scores. Subgroup analyses were conducted to assess the effects of variations in rTMS treatment parameters. RESULTS A total of 26 studies with 781 participants were included. Overall, rTMS demonstrated a modest effect on reduction of Yale-Brown Obsessive Compulsive Scale scores (Hedges' g = 0.64, 95% confidence interval = 0.39-0.89; p < .0001). The largest significant effect size was obtained by targeting the bilateral dorsolateral prefrontal cortex. High- and low-frequency rTMS showed comparable effects. Studies with follow-up data suggested that the effects of active rTMS remain significantly superior to those of sham 4 weeks after treatment. CONCLUSIONS The therapeutic effects of rTMS are superior to those of sham in the treatment of OCD. Targeting the bilateral dorsolateral prefrontal cortex was the most favorable approach in administering rTMS. Further research is required to determine the optimal frequency, total pulses per session, and duration of treatment with rTMS for OCD.
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Morand-Beaulieu S, Aardema F, O'Connor KP, Lavoie ME. Lateralized readiness potentials and sensorimotor activity in adults with obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110061. [PMID: 32781016 DOI: 10.1016/j.pnpbp.2020.110061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/13/2020] [Accepted: 08/03/2020] [Indexed: 01/22/2023]
Abstract
Obsessive-compulsive disorder (OCD) patients are known to have various functional abnormalities in prefrontal and motor areas. Given the presence of compulsions in many OCD patients, impaired response preparation processes could be a core feature of OCD. Yet, these processes remain understudied from a neurophysiological standpoint. Nineteen OCD patients were matched on age and sex to 19 healthy controls. Continuous EEG was recorded in all participants during a stimulus-response compatibility task. EEG from electrodes C3 and C4 was then averaged into stimulus- and response-locked LRPs. We compared both groups on various LRP measures, such as the LRP onset, the Gratton dip, and the maximum LRP peak. OCD patients showed significantly larger LRP peak than healthy controls, as well as larger Gratton dip. However, there was no group difference regarding LRP onset. Among OCD patients, it seems that motor regions are overactive during response preparation. Such overactivity was found for both incorrect responses that are aborted before execution and responses that are truly executed. These results suggest that regulation of sensorimotor activity should be addressed in the treatment of OCD.
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Affiliation(s)
- Simon Morand-Beaulieu
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada; Département de neurosciences, Université de Montréal, Montréal, QC, Canada; Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Frederick Aardema
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada; Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, QC, Canada
| | - Kieron P O'Connor
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada; Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, QC, Canada
| | - Marc E Lavoie
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada; Département de neurosciences, Université de Montréal, Montréal, QC, Canada; Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, QC, Canada.
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