Mantovani A, Lisanby SH, Pieraccini F, et al. Repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS)

Department of Neuroscience, Section of Psychiatry, Section of Neurophysiology, Postgraduate School in Applied Neurological Sciences, Siena University, Siena, Italy.
The International Journal of Neuropsychopharmacology (Impact Factor: 4.01). 03/2006; 9(1):95-100. DOI: 10.1017/S1461145705005729
Source: PubMed


There is evidence that motor and premotor cortex are hyperexcitable in obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS). We tested whether low-frequency repetitive transcranial magnetic stimulation (rTMS) could normalize overactive motor cortical regions and thereby improve symptoms. Subjects with OCD or TS were treated with active rTMS to the supplementary motor area (SMA) for 10 daily sessions at 1 Hz, 100% of motor threshold, 1200 stimuli/day. Suggestions of clinical improvement were apparent as early as the first week of rTMS. At the second week of treatment, statistically significant reductions were seen in the YBOCS, YGTSS, CGI, HARS, HDRS, SAD, BDI, SCL-90, and SASS. Symptoms improvement was correlated with a significant increase of the right resting motor threshold and was stable at 3 months follow-up. Slow rTMS to SMA resulted in a significant clinical improvement and a normalization of the right hemisphere hyperexcitability, thereby restoring hemispheric symmetry in motor threshold.

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Available from: Simone Rossi, Feb 17, 2015
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    • "rTMS to the dlPFC, although successful in major depression (O'Reardon et al, 2007; Berlim et al, 2014), has shown minimal clinical benefit over sham in double-blind trials for OCD (Alonso et al, 2001; Sachdev et al, 2007). However, medial prefrontal targets appear more promising: 1 Hz rTMS of the supplementary motor area (SMA) and pre-SMA has achieved substantial symptom improvement in case reports and randomized controlled trials (Mantovani et al, 2006, 2010a, b). Likewise, with transcranial direct current stimulation, cathodal but not anodal stimulation of the SMA has been reported to improve OCD symptoms (D'Urso et al, 2015). "
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    ABSTRACT: Obsessive-compulsive disorder (OCD) is a disabling illness with high rates of non-response to conventional treatments. OCD pathophysiology is believed to involve abnormalities in cortico-striatal-thalamic-cortical circuits through regions such as dorsomedial prefrontal cortex (dmPFC), and ventral striatum. These regions may constitute therapeutic targets for neuromodulation treatments, such as repetitive transcranial magnetic stimulation (rTMS). However, the neurobiological predictors and correlates of successful rTMS treatment for OCD are unclear. Here, we used resting-state functional magnetic resonance imaging (fMRI) to identify neural predictors and correlates of response to 20-30 sessions of bilateral 10 Hz dmPFC-rTMS in 20 treatment-resistant OCD patients, with 40 healthy controls as baseline comparators. A region of interest in the dmPFC was used to generate whole-brain functional connectivity maps pre- and post-treatment. 10 of 20 patients met response criteria (⩾50% improvement on Yale-Brown Obsessive-Compulsive Scale, YBOCS); response to dmPFC-rTMS was sharply bimodal. dmPFC-rTMS responders had higher dmPFC-ventral striatal connectivity at baseline. The degree of reduction in this connectivity, from pre- to post-treatment, correlated to the degree of YBOCS symptomatic improvement. Baseline clinical and psychometric data did not predict treatment response. In summary, reductions in fronto-striatal hyperconnectivity were associated with treatment response to dmPFC-rTMS in OCD. This finding is consistent with previous fMRI studies of deep brain stimulation in OCD, but opposite to previous reports on mechanisms of dmPFC-rTMS in major depression. fMRI could prove useful in predicting response to dmPFC-rTMS in OCD.Neuropsychopharmacology accepted article preview online, 06 October 2015. doi:10.1038/npp.2015.292.
    Brain Stimulation 03/2015; 8(2):323-324. DOI:10.1016/j.brs.2015.01.050 · 4.40 Impact Factor
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    • "Mantovani et al. (2006, 2010) stimulated the supplementary motor area (SMA) with slow rTMS. In a first study the course of treatment consisted of 10 sessions and there was a significant clinical improvement and a normalization of the right hemisphere hyperexcitability (Mantovani et al., 2006). In a second study OCD patients received 1 Hz rTMS over the SMA bilaterally for 4 weeks and showed significant reduction in the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) score and a normalization of the abnormal hemispheric laterality (Mantovani, Simpson, Fallon, Rossi, & Lisanby, 2010). "

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    • "Since the first introduction in the late 1980s, rTMS has been used as a potential treatment for a variety of neurological and psychiatric disorders [1]. Studies and meta-analyses have included the therapeutic use of rTMS in depression (FDA approved since 2008) [12] [13] [14], schizophrenia [15] [16] [17], stroke [18] [19], tinnitus [20] [21] [22], addiction [23] [24], obsessive–compulsive disorder [25], Tourette's syndrome [26] and many other diseases. The fundamental rationale for therapeutic use of rTMS is the fact that the effect of rTMS on cerebral cortex outlasts the duration of stimulation . "
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    ABSTRACT: Repetitive transcranial magnetic stimulation (rTMS) represents a promising tool for studying and influencing cognition in people with neurodegenerative diseases. This procedure is noninvasive and painless, and it does not require the use of anesthesia or pharmacological substances. In this systematic critical review we report outcomes from research focused on behavioral cognitive effects induced by rTMS in patients with Alzheimer's disease (AD), Parkinson's disease (PD), and mild cognitive impairment (MCI) preceding AD. There are still major limitations to rTMS use, such as a poor understanding of its after-effects and inter-individual variability in their magnitude, discrepancies in stimulation protocols and study designs, varied selection of the specific stimulated areas and control procedures, and neuropsychological methods for assessment of after-effects; hence, the results of the present research can only be considered preliminary. The future directions are discussed.
    Journal of the neurological sciences 02/2014; 339(1-2). DOI:10.1016/j.jns.2014.01.037 · 2.47 Impact Factor
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