Pre‐supplementary motor network connectivity and clinical outcome of magnetic stimulation in obsessive–compulsive disorder

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 presupplementary 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 (F 1,35 = 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, Gong-Jun Ji and Wen Xie contributed equally to this work.

Assessing the Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Obsessive- Compulsive Disorder

“…Thus in many cases similar to our study, low frequency excitation over SMA and the time between 2 Up to 12 weeks of treatment have been effective in treating obsessive-compulsive disorder. 9‐13,21‐24…”

“…6 it is not known whether this hyperactivity represents part of OCD pathophysiology, or whether as a compensatory mechanism. 12 So the mechanism by which neuromodulation of the SMA through rTMS acts on SMA is unclear. Therefore, further studies may be needed to investigate neuronal actions of low frequency rTMS over the SMA.…”

“…Thus in many cases similar to our study, low frequency excitation over SMA and the time between 2 Up to 12 weeks of treatment have been effective in treating obsessive-compulsive disorder. [9][10][11][12][13][21][22][23][24] In a meta-analysis that included twenty studies on 781 patients, it had reviewed the preference for SMA stimulation, low-frequency treatment, and more than 12 weeks duration and recommended that more future studies be performed over the SMA for more than 12 weeks duration. 14 In one study, it was reported that the presence of 5-HTTLPR (L/S) in SLC6A4 may have been associated with greater effectiveness of rTMS in adjuvant therapy with SSRIs.…”

“…In a study of 37 OCD patients to examine the effect of rTMS (1-Hz, 14 days, 30 min/day) over the right pre supplementary motor area (preSMA), patients in the target group had a greater improvement in Yale–Brown OCD score than in the sham group (F1,35 = 6.0, p = .019). 12…”

“…11 In a study of 37 OCD patients to examine the effect of rTMS (1-Hz, 14 days, 30 min/day) over the right pre supplementary motor area (preSMA), patients in the target group had a greater improvement in Yale-Brown OCD score than in the sham group (F1,35 = 6.0, p = .019). 12 Another study was performed on 57 OCD patients treated with SSRIs to show whether the SLC6A4 impacts on therapeutic effects of rTMS. In this study, the effects of rTMS over the supplementary motor area (1-Hz, once per day, for 5 days a week, for 4 weeks) were evaluated in a double-blind study and showed that the score of (Y-BOCS) in the target group at the end of treatment was significantly lower than the sham group.…”