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Integration of Cortical Brain Stimulation and Exposure and Response Prevention for Obsessive-compulsive Disorder (OCD)

2014; Elsevier BV; Volume: 7; Issue: 5 Linguagem: Inglês

10.1016/j.brs.2014.06.010

1935-861X

Thomas G. Adams, Bashar W. Badran, Mark S. George,

Neural and Behavioral Psychology Studies

Individuals diagnosed with obsessive-compulsive disorder (OCD) reliably evidence deficits in cognitive control [ [1] Chamberlain S. Blackwell A. Fineberg N. Robbins T.W. Sahakian B.J. The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers. Neurosci Biobehav Rev. 2005; 29: 399-419 Crossref PubMed Scopus (639) Google Scholar ] and recent findings suggest hyperactivity of the pre-supplementary motor area (pre-SMA) mediates deficits in cognitive control in OCD [ [2] de Wit S. de Vries F. van den Heuvel O. et al. Presupplementary motor area hyperactivity during response inhibition: a candidate endophenotype of obsessive-compulsive disorder. Am J Psychiatry. 2012; 169: 1100-1108 Crossref PubMed Scopus (225) Google Scholar ]. Six studies have attempted to treat OCD with low frequency repetitive transcranial magnetic stimulation (LF-rTMS) of the pre-SMA [ 3 Berlim Marcelo T. Neufeld N.H. Van den Eynde F. Repetitive transcranial magnetic stimulation (rTMS) for obsessive–compulsive disorder (OCD): an exploratory meta-analysis of randomized and sham-controlled trials. J Psychiatr Res. 2013; 47: 999-1006 Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar , 4 Blom R. Figee M. Vulink N. Denys D. Update on repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: different targets. Curr Psychiatry Rep. 2011; 13: 289-294 Crossref PubMed Scopus (40) Google Scholar ]. Much like the psychosocial treatment of choice, exposure and response prevention (ERP) [ [5] Schruers K. Koning K. Luermans J. Haack M.J. Griez E. Obsessive–compulsive disorder: a critical review of therapeutic perspectives. Acta Psychiatr Scand. 2005; 111: 261-271 Crossref PubMed Scopus (96) Google Scholar ], however, many OCD patients do not respond to TMS and symptom remission is rare [ 3 Berlim Marcelo T. Neufeld N.H. Van den Eynde F. Repetitive transcranial magnetic stimulation (rTMS) for obsessive–compulsive disorder (OCD): an exploratory meta-analysis of randomized and sham-controlled trials. J Psychiatr Res. 2013; 47: 999-1006 Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar , 4 Blom R. Figee M. Vulink N. Denys D. Update on repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: different targets. Curr Psychiatry Rep. 2011; 13: 289-294 Crossref PubMed Scopus (40) Google Scholar ]. While LF-rTMS of the pre-SMA is effective for symptoms related to incompleteness (e.g., symmetry) it has limited effectiveness for symptoms related to harm avoidance (e.g., responsibility/checking) [ [6] Mantovani A. Shubeck J. Gowatsky J. Simpson H.B. Greenberg B. P 247. Incompleteness and harm avoidance in obsessive compulsive disorder: different response to transcranial magnetic stimulation. Clin Neurophysiol. 2013; 124: e182-e183 Abstract Full Text Full Text PDF Google Scholar ]. Integration of rTMS and ERP may mitigate shortcomings of each individual treatment and improve treatment efficacy.