Deep Transcranial Magnetic Stimulation Effects on the Electrophysiological Parameters in Obsessive-Compulsive Disorder

Backgrounds. Deep Transcranial Magnetic Stimulation (dTMS) is a non-invasive treatment cleared by FDA as a safe and efficient intervention for the treatment of depression and obsessive-compulsive disorder (OCD). Objectives. In this retrospective single-center study, the effects of dTMS on the electrophysiological parameters and the clinical outcomes of patients with OCD were tested. Methods. Thirty sessions of dTMS were administered to 29 OCD patients (15 female and 14 male). Quantitative electroencephalography (QEEG) recordings and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) were measured at baseline and endpoint. Paired sample t-test was used to measure the change in Y-BOCS scores and QEEG activity after dTMS practice. Results. All 29 patients responded to the dTMS intervention by indicating at least 35% reduction in Y-BOCS scores. QEEG recordings revealed a significant decrease in theta, alpha and the beta rhythms. The decrease in the severity of OCD symptoms correlated with the decrease in beta activity at left central region. Conclusions. Historically, excess fast oscillations in OCD are correlated with the unresponsiveness to selective serotonin reuptake inhibitor (SSRI) treatment. We hypothesize that the decrease in the power of beta bands by deep TMS is related to the mechanism of the therapeutic response.

Repetitive Transcranial Magnetic Stimulation in Alcohol Dependence: A Randomized, Double-Blind, Sham-Controlled Proof-of-Concept Trial Targeting the Medial Prefrontal and Anterior Cingulate Cortices

BACKGROUND

Alcohol addiction is associated with a high disease burden, and treatment options are limited. In a proof-of-concept study, we used deep repetitive transcranial magnetic stimulation (dTMS) to target circuitry associated with the pathophysiology of alcohol addiction. We evaluated clinical outcomes and explored associated neural signatures using functional magnetic resonance imaging.

METHODS

This was a double-blind, randomized, sham-controlled trial. A total of 51 recently abstinent treatment-seeking patients with alcohol use disorder (moderate to severe) were randomized to sham or active dTMS, using an H7 coil targeting midline frontocortical areas, including the medial prefrontal and anterior cingulate cortices. Treatment included 15 sessions over 3 weeks, followed by five sessions over 3 months of follow-up. Each session delivered 100 trains of 30 pulses at 10 Hz. The primary predefined outcome was reduction in percentage of heavy drinking days, obtained using timeline follow-back interviews. Secondary analyses included self-reports of craving, ethyl glucuronide in urine, and brain imaging measures.

RESULTS

Both craving after treatment and percentage of heavy drinking days during follow-up were significantly lower in the active versus sham control group (percentage of heavy drinking days = 2.9 ± 0.8% vs. 10.6 ± 1.9%, p = .037). Active dTMS was associated with decreased resting-state functional connectivity of the dorsal anterior cingulate cortex with the caudate nucleus and decreased connectivity of the medial prefrontal cortex to the subgenual anterior cingulate cortex.

CONCLUSIONS

We provide initial proof-of-concept for dTMS targeting midline frontocortical structures as a treatment for alcohol addiction. These data strongly support a rationale for a full-scale confirmatory multicenter trial. Therapeutic benefits of dTMS appear to be associated with persistent changes in brain network activity.

Brain activation alterations with adjunctive deep transcranial magnetic stimulation in obsessive-compulsive disorder: an fMRI study

BACKGROUND

Obsessive-compulsive disorder (OCD) is one of the most common neuropsychiatric disorders with lifetime prevalence higher than that of schizophrenia and bipolar disorders. Inadequate response to available pharmacological and psychotherapeutic interventions is common in OCD. Adjunctive brain stimulation methods to address the inadequate treatment response in OCD have found a special interest in research. This study aimed to examine the efficacy of adjunctive deep transcranial magnetic stimulation (dTMS) in ameliorating the symptoms of OCD and the effect of dTMS on activation of brain regions while performing the Stroop task using functional magnetic resonance imaging (fMRI).

METHODS

A total of 41 patients were assessed for the study out of which 15 OCD patients received 10 sessions of high-frequency dTMS using the H7 coil to target the anterior cingulate cortex and the medial prefrontal cortex over a period of 2 weeks. The Yale-Brown Obsessive-Compulsive Scale, the Hamilton Anxiety Rating Scale, and the Hamilton Depression Rating Scale were used for the pre- and post-stimulation clinical assessment. fMRI was used to measure the activation of brain regions while performing the Stroop task.

RESULTS

There was a significant improvement in the obsessive-compulsive, anxiety, and depressive symptoms after the 2 weeks of the dTMS treatment. A significant decrease in the activation of left caudate nucleus and adjacent white matter was noted while performing the Stroop task after the dTMS treatment.

CONCLUSION

The study provides preliminary evidence for functional correlates of effectiveness of dTMS as an adjunctive treatment modality for OCD.