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Repetitive transcranial magnetic stimulation over the orbitofrontal cortex for obsessive-compulsive disorder: a double-blind, crossover study.

Nauczyciel C, Le Jeune F, Naudet F, Douabin S, Esquevin A, Vérin M, Dondaine T, Robert G, Drapier D, Millet B - Transl Psychiatry (2014)

Bottom Line: Statistical analyses compared the Y-BOCS scores at the end of each period.Active versus sham PET scan contrasts showed that stimulation was related to a bilateral decrease in the metabolism of the OFC.The OFC should definitely be regarded as a key neuroanatomical target for rTMS, as it is easier to reach than either the striatum or the subthalamic nucleus, structures favored in neurosurgical approaches.

View Article: PubMed Central - PubMed

Affiliation: 1] EA-4712 Behavior and Basal Ganglia Unit, Université de Rennes 1, Rennes, France [2] Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de Psychiatrie, Rennes, France.

ABSTRACT
This pilot study was designed to assess the efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the right orbitofrontal cortex (OFC) by means of a double-cone coil in patients suffering from obsessive-compulsive disorder. We hypothesized that low-frequency stimulation of the OFC would lead to a reduction in clinical symptoms, as measured on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). A randomized, double-blind, crossover design was implemented with two 1-week treatment periods (active stimulation versus sham stimulation) separated by a 1-month washout period. Concomitantly, a subgroup of patients underwent a positron emission tomography (PET) scan after each stimulation sequence. Statistical analyses compared the Y-BOCS scores at the end of each period. At day 7, we observed a significant decrease from baseline in the Y-BOCS scores, after both active (P<0.01) and sham stimulation (P=0.02). This decrease tended to be larger after active stimulation than after sham stimulation: -6 (-29, 0) points versus -2 (-20, 4) points (P=0.07). Active versus sham PET scan contrasts showed that stimulation was related to a bilateral decrease in the metabolism of the OFC. The OFC should definitely be regarded as a key neuroanatomical target for rTMS, as it is easier to reach than either the striatum or the subthalamic nucleus, structures favored in neurosurgical approaches.

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Related in: MedlinePlus

Changes in OCD severity in 19 patients during the crossover study. Data are shown at the time of inclusion in the study (month 0), after the first period of active or sham stimulation (day 7), before (month 1) and after (day 7) the second period of active or sham stimulation and at the end of the study (month 2). (a) Shows the mean (s.d.) scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for the active–sham group (lines) and sham–active group (dashed lines). (b) Shows the individual Y-BOCS scores for the active–sham and sham–active groups. The active stimulation period is shown in red and the sham stimulation period in orange. OCD, obsessive-compulsive disorder.
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fig1: Changes in OCD severity in 19 patients during the crossover study. Data are shown at the time of inclusion in the study (month 0), after the first period of active or sham stimulation (day 7), before (month 1) and after (day 7) the second period of active or sham stimulation and at the end of the study (month 2). (a) Shows the mean (s.d.) scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for the active–sham group (lines) and sham–active group (dashed lines). (b) Shows the individual Y-BOCS scores for the active–sham and sham–active groups. The active stimulation period is shown in red and the sham stimulation period in orange. OCD, obsessive-compulsive disorder.

Mentions: Figure 1 indicates the changes in OCD severity observed in the 19 patients during the crossover study (summary measures and individual data).


Repetitive transcranial magnetic stimulation over the orbitofrontal cortex for obsessive-compulsive disorder: a double-blind, crossover study.

Nauczyciel C, Le Jeune F, Naudet F, Douabin S, Esquevin A, Vérin M, Dondaine T, Robert G, Drapier D, Millet B - Transl Psychiatry (2014)

Changes in OCD severity in 19 patients during the crossover study. Data are shown at the time of inclusion in the study (month 0), after the first period of active or sham stimulation (day 7), before (month 1) and after (day 7) the second period of active or sham stimulation and at the end of the study (month 2). (a) Shows the mean (s.d.) scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for the active–sham group (lines) and sham–active group (dashed lines). (b) Shows the individual Y-BOCS scores for the active–sham and sham–active groups. The active stimulation period is shown in red and the sham stimulation period in orange. OCD, obsessive-compulsive disorder.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4203001&req=5

fig1: Changes in OCD severity in 19 patients during the crossover study. Data are shown at the time of inclusion in the study (month 0), after the first period of active or sham stimulation (day 7), before (month 1) and after (day 7) the second period of active or sham stimulation and at the end of the study (month 2). (a) Shows the mean (s.d.) scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for the active–sham group (lines) and sham–active group (dashed lines). (b) Shows the individual Y-BOCS scores for the active–sham and sham–active groups. The active stimulation period is shown in red and the sham stimulation period in orange. OCD, obsessive-compulsive disorder.
Mentions: Figure 1 indicates the changes in OCD severity observed in the 19 patients during the crossover study (summary measures and individual data).

Bottom Line: Statistical analyses compared the Y-BOCS scores at the end of each period.Active versus sham PET scan contrasts showed that stimulation was related to a bilateral decrease in the metabolism of the OFC.The OFC should definitely be regarded as a key neuroanatomical target for rTMS, as it is easier to reach than either the striatum or the subthalamic nucleus, structures favored in neurosurgical approaches.

View Article: PubMed Central - PubMed

Affiliation: 1] EA-4712 Behavior and Basal Ganglia Unit, Université de Rennes 1, Rennes, France [2] Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de Psychiatrie, Rennes, France.

ABSTRACT
This pilot study was designed to assess the efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the right orbitofrontal cortex (OFC) by means of a double-cone coil in patients suffering from obsessive-compulsive disorder. We hypothesized that low-frequency stimulation of the OFC would lead to a reduction in clinical symptoms, as measured on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). A randomized, double-blind, crossover design was implemented with two 1-week treatment periods (active stimulation versus sham stimulation) separated by a 1-month washout period. Concomitantly, a subgroup of patients underwent a positron emission tomography (PET) scan after each stimulation sequence. Statistical analyses compared the Y-BOCS scores at the end of each period. At day 7, we observed a significant decrease from baseline in the Y-BOCS scores, after both active (P<0.01) and sham stimulation (P=0.02). This decrease tended to be larger after active stimulation than after sham stimulation: -6 (-29, 0) points versus -2 (-20, 4) points (P=0.07). Active versus sham PET scan contrasts showed that stimulation was related to a bilateral decrease in the metabolism of the OFC. The OFC should definitely be regarded as a key neuroanatomical target for rTMS, as it is easier to reach than either the striatum or the subthalamic nucleus, structures favored in neurosurgical approaches.

Show MeSH
Related in: MedlinePlus