Clinical and electrophysiological outcomes of deep TMS over the medial prefrontal and anterior cingulate cortices in OCD patients

Carmi, Lior; Alyagon, Uri; Barnea‐Ygael, Noam; Zohar, Joseph; Dar, Reuven; Zangen, Abraham

doi:10.1016/j.brs.2017.09.004

Cited by 182 publications

(156 citation statements)

References 74 publications

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“…Resting-state fMRI can further be used to develop brain-based treatment frameworks targeting this common neural substrate. Furthermore, previous studies have investigated the feasibility of brain stimulation techniques targeting the SN, observing symptom improvement in different psychiatric disorders following the stimulation of the dACC (Carmi et al, 2018;Hayward et al, 2007;Kreuzer et al, 2015;Vanneste, Ost, Langguth, & Ridder, 2014). A common target site for therapeutic repetitive transcranial magnetic stimulation (rTMS) is the prefrontal cortex (Fitzgerald, Maller, Hoy, Thomson, & Daskalakis, 2009).…”

Section: Bnmentioning

confidence: 99%

Altered functional connectivity in binge eating disorder and bulimia nervosa: A resting‐state fMRI study

et al. 2019

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Introduction The etiology of bulimic‐type eating (BTE) disorders such as binge eating disorder (BED) and bulimia nervosa (BN) is still largely unknown. Brain networks subserving the processing of rewards, emotions, and cognitive control seem to play a crucial role in the development and maintenance of eating disorders. Therefore, further investigations into the neurobiological underpinnings are needed to discern abnormal connectivity patterns in BTE disorders. Methods The present study aimed to investigate functional as well as seed‐based connectivity within well‐defined brain networks. Twenty‐seven individuals with BED, 29 individuals with BN, 28 overweight, and 30 normal‐weight control participants matched by age, gender, and education underwent resting‐state functional magnetic resonance imaging. Functional connectivity was assessed by spatial group independent component analysis and a seed‐based correlation approach by examining the default mode network (DMN), salience network (SN), and executive network (EN). Results Group comparisons revealed that BTE disorder patients exhibit aberrant functional connectivity in the dorsal anterior cingulate cortex (dACC) within the SN, as well as in the medial prefrontal cortex within the DMN. Furthermore, BED and BN groups differed from each other in functional connectivity within each network. Seed‐based correlational analysis revealed stronger synchronous dACC‐retrosplenial cortex activity in the BN group. Conclusion Our findings demonstrate abnormalities in brain networks involved in salience attribution, self‐referential processing, and cognitive control in bulimic‐type eating disorders. Together with our observation of functional connectivity differences between BED and BN, this study offers a differentiated account of both similarities and differences regarding brain connectivity in BED and BN.

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Section: Bnmentioning

confidence: 99%

Altered functional connectivity in binge eating disorder and bulimia nervosa: A resting‐state fMRI study

et al. 2019

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“…Because the interim analysis showed no difference between the sham and 1 Hz arms, the study was continued with just high frequency and sham. At the end of the study, the response rate in the 20 Hz arm was much greater than in the sham group and the improvements were still present a month after treatments ended [25,26].…”

Section: Detailed Review Of Sham-controlled Trials Using Tms For Treamentioning

confidence: 87%

TMS for OCD

Tendler¹,

Sisko²

2018

Transcranial Magnetic Stimulation in Neuropsychiatry

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Introduction:Obsessive compulsive disorder (OCD) is a common disabling condition, which greater than 40% of patients do not respond to the available treatment options. Imbalances in the cortical-striatal-thalamic-cortical circuits have proven to be useful psychosurgical treatment targets making this circuit disorder an optimal target for intervention with TMS.Methods: PubMed and clinicaltrials.gov were reviewed for sham-controlled therapeutic rTMS studies for OCD. Results:Eighteen relevant studies are presented in a narrative fashion along with relevant methodological details, and distinctions. Conclusions:High and low frequency stimulation to lateral prefrontal cortices does not appear to have consistent efficacy in the small studies done to date. Several small studies with non-blinded operators suggest that low frequency high intensity rTMS to the supplementary motor area with a figure-8 coil reduces OCD symptoms. A fully blinded multicenter center study is warranted to confirm this finding. A promising pilot study and a subsequent multicenter study of high frequency high intensity deep rTMS with the HAC/H7 coil to the bilateral prefrontal orbitofrontal and anterior cingulate cortices were completed with positive results. Many areas of uncertainty remain, such as the optimal state of the circuitry during stimulation and identifying a priori biomarkers for responders and non-responders to specific protocols.

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“…Baseline symptom severity for inclusion was de ned as a score of 16 or higher on the Y-BOCS (Mean = 22.20, SD = 7.01), which is the cut-off criterion for moderate OCD (8-15 mild, 16-23 moderate, 24-31 severe, 32-40 extreme). Treatment response was de ned as a reduction of at least 30% in the Y-BOCS total score, based on some previous studies [32,46] and is suggested to represent a relevant clinical improvement (i.e., improvement of Clinical Global Impression (CGI)). Although 35% of symptom reduction is taken as "response" criterion in other studies [47], we chose a more liberal criterion to achieve a more balanced response distribution for the binary regression analysis.…”

Section: Clinical Proceduresmentioning

confidence: 99%

“…In this line, recent reviews of rTMS studies show that brain state-dependent modulatory effects of rTMS are an additional parameter that may potentially affect rTMS effects [29], and taking this factor into account might improve treatment outcomes in patients who usually develop treatment-resistant illness subtypes. Moreover, different cortical regions have been targeted in previous studies with mixed results [30][31][32][33][34], leaving the question of which cortical regions to stimulate unanswered.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and clinical predictors of response to rTMS treatment in pharmacoresistant obsessive-compulsive disorder (OCD): A retrospective study

Rostami¹,

Kazemi

Jabbari³

et al. 2020

Preprint

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Background: Application of repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been promising and approved by the Food and Drug Administration in 2018, but effects differ between patients. Knowledge about clinical predictors of rTMS response may help to increase clinical efficacy but is not available so far. Methods: In a retrospective study, we investigated the efficacy of rTMS over the dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA) in 65 pharmaco-resistant OCD outpatients recruited for rTMS treatment from July 2015 to May 2017. Patients received either SMA rTMS (n = 38) or bilateral DLPFC rTMS (n = 27) in case of reporting higher affective and depressive symptoms in addition to the primary OCD symptoms. OCD symptoms and depression/anxiety states were measured at baseline (before the 1st session) and after the 20th session of rTMS. Additionally, we performed a binary logistic regression analysis on the demographic and clinical variables based on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) 3-factor and 2-factor models and individual items to investigate potential predictors of rTMS response. Results: Patients’ scores in Y-BOCS and Beck anxiety/depression inventories were significantly decreased following rTMS treatment. 46.2% of all patients responded to rTMS, based on the criterion of at least a 30% reduction in Y-BOCS scores. There was no significant difference between response rates of patients in DLPFC and SMA groups. No significant demographic predictors of rTMS efficacy were identified. The factors “Obsession severity”, “resistance” and “disturbance” and the “Interference due to obsessions” and “resistance against compulsions” items of the Y-BOCS significantly predicted response to rTMS. Conclusions: In patients with less intrusive/interfering thoughts, and low scores in the “obsession severity”, “disturbance”, and “resistance factors, rTMS might have superior effects. Identification of clinical and non-clinical predictors of response is relevant to personalize and adapt rTMS protocols in pharmaco-resistant OCD patients. Interpretation of rTMS efficacy should be done with caution due to the lack of a sham intervention condition.

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Clinical and electrophysiological outcomes of deep TMS over the medial prefrontal and anterior cingulate cortices in OCD patients

Abstract: HF DTMS over the mPFC-ACC alleviates OCD symptoms and may be used as a novel therapeutic intervention. Notwithstanding alternative explanations, this may stem from DTMS ability to directly modify ACC activity.

Cited by 182 publications

References 74 publications

Altered functional connectivity in binge eating disorder and bulimia nervosa: A resting‐state fMRI study

Altered functional connectivity in binge eating disorder and bulimia nervosa: A resting‐state fMRI study

TMS for OCD

Efficacy and clinical predictors of response to rTMS treatment in pharmacoresistant obsessive-compulsive disorder (OCD): A retrospective study

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