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Echevarria MAN, Batistuzzo MC, Silva RMF, Brunoni AR, Sato JR, Miguel EC, Hoexter MQ, Shavitt RG. Increases in functional connectivity between the default mode network and sensorimotor network correlate with symptomatic improvement after transcranial direct current stimulation for obsessive-compulsive disorder. J Affect Disord 2024; 355:175-183. [PMID: 38548207 DOI: 10.1016/j.jad.2024.03.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/10/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Non-invasive neuromodulation is a promising intervention for obsessive-compulsive disorder (OCD), although its neurobiological mechanisms of action are still poorly understood. Recent evidence suggests that abnormalities in the connectivity of the default mode network (DMN) and the supplementary motor area (SMA) with other brain regions and networks are involved in OCD pathophysiology. We examined if transcranial direct current stimulation (tDCS) alters these connectivity patterns and if they correlate with symptom improvement in treatment-resistant OCD. METHODS In 23 patients from a larger clinical trial (comparing active tDCS to sham) who underwent pre- and post-treatment MRI scans, we assessed resting-state functional MRI (rs-fMRI) data. The treatment involved 30-minute daily tDCS sessions for four weeks (weekdays only), with the cathode over the SMA and the anode over the left deltoid. We conducted whole-brain connectivity analysis comparing active tDCS-treated to sham-treated patients. RESULTS We found that active tDCS, but not sham, led to connectivity increasing between the DMN and the bilateral pre/postcentral gyri (p = 0.004, FDR corrected) and temporal-auditory areas plus the SMA (p = 0.028, FDR corrected). Also, symptom improvement was directly associated with connectivity increasing between the left lateral sensorimotor network and the left precuneus (r = 0.589, p = 0.034). LIMITATIONS Limited sample size (23 participants with resting-state neuroimaging), inability to analyze specific OCD symptom dimensions (e.g., harm, sexual/religious, symmetry/checking, cleaning/contamination). CONCLUSIONS These data offer novel information concerning functional connectivity changes associated with non-invasive neuromodulation interventions in OCD and can guide new brain stimulation interventions in the framework of personalized interventions.
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Affiliation(s)
- M A N Echevarria
- LIM-23, Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
| | - M C Batistuzzo
- LIM-23, Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil; Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, SP, Brazil
| | - R M F Silva
- LIM-23, Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - A R Brunoni
- LIM-23, Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - J R Sato
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, SP, Brazil
| | - E C Miguel
- LIM-23, Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - M Q Hoexter
- LIM-23, Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - R G Shavitt
- LIM-23, Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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Agrawal A, Agarwal V, Kar SK, Arya A. Transcranial direct current stimulation as early augmentation in adolescent obsessive compulsive disorder: A pilot proof-of-concept randomized control trial. World J Clin Pediatr 2024; 13:93138. [PMID: 38947993 PMCID: PMC11212764 DOI: 10.5409/wjcp.v13.i2.93138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/09/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is proven to be safe in treating various neurological conditions in children and adolescents. It is also an effective method in the treatment of OCD in adults. AIM To assess the safety and efficacy of tDCS as an add-on therapy in drug-naive adolescents with OCD. METHODS We studied drug-naïve adolescents with OCD, using a Children's Yale-Brown obsessive-compulsive scale (CY-BOCS) scale to assess their condition. Both active and sham groups were given fluoxetine, and we applied cathode and anode over the supplementary motor area and deltoid for 20 min in 10 sessions. Reassessment occurred at 2, 6, and 12 wk using CY-BOCS. RESULTS Eighteen adolescents completed the study (10-active, 8-sham group). CY-BOCS scores from baseline to 12 wk reduced significantly in both groups but change at baseline to 2 wk was significant in the active group only. The mean change at 2 wk was more in the active group (11.8 ± 7.77 vs 5.25 ± 2.22, P = 0.056). Adverse effects between the groups were comparable. CONCLUSION tDCS is safe and well tolerated for the treatment of OCD in adolescents. However, there is a need for further studies with a larger sample population to confirm the effectiveness of tDCS as early augmentation in OCD in this population.
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Affiliation(s)
- Aditya Agrawal
- Department of Psychiatry, King George Medical University, Uttar Pradesh, Lucknow 226003, India
| | - Vivek Agarwal
- Department of Psychiatry, King George Medical University, Uttar Pradesh, Lucknow 226003, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George Medical University, Uttar Pradesh, Lucknow 226003, India
| | - Amit Arya
- Department of Psychiatry, King George Medical University, Uttar Pradesh, Lucknow 226003, India
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Martín-González E, Prados-Pardo Á, Sawiak SJ, Dalley JW, Padro D, Ramos-Cabrer P, Mora S, Moreno-Montoya M. Mapping the neuroanatomical abnormalities in a phenotype of male compulsive rats. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2023; 19:19. [PMID: 37932782 PMCID: PMC10626819 DOI: 10.1186/s12993-023-00221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 10/28/2023] [Indexed: 11/08/2023]
Abstract
Compulsivity is considered a transdiagnostic dimension in obsessive-compulsive and related disorders, characterized by heterogeneous cognitive and behavioral phenotypes associated with abnormalities in cortico-striatal-thalamic-cortical circuitry. The present study investigated the structural morphology of white and gray matter in rats selected for low- (LD) and high- (HD) compulsive drinking behavior on a schedule-induced polydipsia (SIP) task. Regional brain morphology was assessed using ex-vivo high-resolution magnetic resonance imaging (MRI). Voxel-based morphometry of segmented MRI images revealed larger white matter volumes in anterior commissure and corpus callosum of HD rats compared with LD rats. HD rats also showed significantly larger regional volumes of dorsolateral orbitofrontal cortex, striatum, amygdala, hippocampus, midbrain, sub-thalamic nucleus, and cerebellum. By contrast, the medial prefrontal cortex was significantly smaller in HD rats compared with LD rats with no significant group differences in whole brain, ventricular, or cerebrospinal fluid volumes. These findings show that limbic cortico-basal ganglia structures implicated in impulse control disorders are distinct in rats that are vulnerable to develop compulsive behavior. Such abnormalities may be relevant to the etiology of compulsive disorders in humans.
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Affiliation(s)
- Elena Martín-González
- Department of Psychology and Health Research Centre (CEINSA), University of Almería, Carretera de Sacramento s/n, 04120, Almería, Spain
| | - Ángeles Prados-Pardo
- Department of Psychology and Health Research Centre (CEINSA), University of Almería, Carretera de Sacramento s/n, 04120, Almería, Spain
| | - Stephen J Sawiak
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Jeffrey W Dalley
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Daniel Padro
- Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo Miramón 182, 20014, Donostia-San Sebastián, Spain
| | - Pedro Ramos-Cabrer
- Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo Miramón 182, 20014, Donostia-San Sebastián, Spain
- Ikerbasque, Basque Foundation for Science, 48013, Bilbao, Spain
| | - Santiago Mora
- Department of Neuroscience, University of Copenhagen Panum Institute, Copenhagen, Denmark
| | - Margarita Moreno-Montoya
- Department of Psychology and Health Research Centre (CEINSA), University of Almería, Carretera de Sacramento s/n, 04120, Almería, Spain.
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Fineberg NA, Cinosi E, Smith MVA, Busby AD, Wellsted D, Huneke NTM, Garg K, Aslan IH, Enara A, Garner M, Gordon R, Hall N, Meron D, Robbins TW, Wyatt S, Pellegrini L, Baldwin DS. Feasibility, acceptability and practicality of transcranial stimulation in obsessive compulsive symptoms (FEATSOCS): A randomised controlled crossover trial. Compr Psychiatry 2023; 122:152371. [PMID: 36709558 DOI: 10.1016/j.comppsych.2023.152371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive form of neurostimulation with potential for development as a self-administered intervention. It has shown promise as a safe and effective treatment for obsessive compulsive disorder (OCD) in a small number of studies. The two most favourable stimulation targets appear to be the left orbitofrontal cortex (L-OFC) and the supplementary motor area (SMA). We report the first study to test these targets head-to-head within a randomised sham-controlled trial. Our aim was to inform the design of future clinical research studies, by focussing on the acceptability and safety of the intervention, feasibility of recruitment, adherence to and tolerability of tDCS, and the size of any treatment-effect. METHODS FEATSOCS was a randomised, double-blind, sham-controlled, cross-over, multicentre study. Twenty adults with DSM-5-defined OCD were randomised to treatment, comprising three courses of clinic-based tDCS (SMA, L-OFC, Sham), randomly allocated and delivered in counterbalanced order. Each course comprised four 20-min 2 mA stimulations, delivered over two consecutive days, separated by a 'washout' period of at least four weeks. Assessments were carried out by raters who were blind to stimulation-type. Clinical outcomes were assessed before, during, and up to four weeks after stimulation. Patient representatives with lived experience of OCD were actively involved at all stages. RESULTS Clinicians showed willingness to recruit participants and recruitment to target was achieved. Adherence to treatment and study interventions was generally good, with only two dropouts. There were no serious adverse events, and adverse effects which did occur were transient and mostly mild in intensity. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores were numerically improved from baseline to 24 h after the final stimulation across all intervention groups but tended to worsen thereafter. The greatest effect size was seen in the L-OFC arm, (Cohen's d = -0.5 [95% CI -1.2 to 0.2] versus Sham), suggesting this stimulation site should be pursued in further studies. Additional significant sham referenced improvements in secondary outcomes occurred in the L-OFC arm, and to a lesser extent with SMA stimulation. CONCLUSIONS tDCS was acceptable, practicable to apply, well-tolerated and appears a promising potential treatment for OCD. The L-OFC represents the most promising target based on clinical changes, though the effects on OCD symptoms were not statistically significant compared to sham. SMA stimulation showed lesser signs of promise. Further investigation of tDCS in OCD is warranted, to determine the optimal stimulation protocol (current, frequency, duration), longer-term effectiveness and brain-based mechanisms of effect. If efficacy is substantiated, consideration of home-based approaches represents a rational next step. TRIAL REGISTRATION ISRCTN17937049. https://doi.org/10.1186/ISRCTN17937049.
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Affiliation(s)
- Naomi A Fineberg
- Hertfordshire Partnership NHS University Foundation Trust, Highly Specialised OCD and BDD Service, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK; Clinical Medical School, University of Cambridge, UK
| | - Eduardo Cinosi
- Hertfordshire Partnership NHS University Foundation Trust, Highly Specialised OCD and BDD Service, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Megan V A Smith
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK.
| | - Amanda D Busby
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - David Wellsted
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Nathan T M Huneke
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Southern Health NHS Foundation Trust, Tatchbury Mount, Southampton, UK
| | - Kabir Garg
- The Lishman Unit, South London and Maudsley NHS Foundation Trust, UK
| | - Ibrahim H Aslan
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Arun Enara
- Camden and Islington NHS Foundation Trust, London, UK
| | - Matthew Garner
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; School of Psychology, University of Southampton, Southampton, UK
| | - Robert Gordon
- Southern Health NHS Foundation Trust, Tatchbury Mount, Southampton, UK
| | - Natalie Hall
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Daniel Meron
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Somerset NHS Foundation Trust, Taunton, Somerset, UK
| | | | - Solange Wyatt
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Luca Pellegrini
- Hertfordshire Partnership NHS University Foundation Trust, Highly Specialised OCD and BDD Service, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Southern Health NHS Foundation Trust, Tatchbury Mount, Southampton, UK; University Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Pinto BS, Cavendish BA, da Silva PHR, Suen PJC, Marinho KAP, Valiengo LDCL, Vanderhasselt MA, Brunoni AR, Razza LB. The Effects of Transcranial Direct Current Stimulation in Obsessive-Compulsive Disorder Symptoms: A Meta-Analysis and Integrated Electric Fields Modeling Analysis. Biomedicines 2022; 11:80. [PMID: 36672588 PMCID: PMC9855366 DOI: 10.3390/biomedicines11010080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 12/31/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been showing promising effects for the treatment of obsessive-compulsive disorder (OCD), but there is still no conclusion on its efficacy for this disorder. We performed a systematic review and meta-analysis of trials using tDCS for OCD and a computer modeling analysis to evaluate the electric field (EF) strengths of different electrode assemblies in brain regions of interest (ROIs) (PROSPERO-42021262465). PubMed/MEDLINE, Embase, Cochrane Library and Web of Science databases were searched from inception to 25 September 2022. Randomized controlled trials (RCTs) and open-label studies were included. The primary aim was the effect size (Hedges' g) of continuous outcomes and potential moderators of response. For EF modeling, SimNIBS software was used. Four RCTs and four open-label trials were included (n = 241). Results revealed a large effect of tDCS in the endpoint, but no significant effect between active and sham protocols. No predictor of response was found. EF analysis revealed that montages using the main electrode over the (pre)supplementary motor area with an extracephalic reference electrode might lead to stronger EFs in the predefined ROIs. Our results revealed that tDCS might be a promising intervention to treat OCD; however, larger studies are warranted.
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Affiliation(s)
- Bianca Silva Pinto
- Serviço Interdisciplinar de Neuromodulação (SIN), Instituto de Psiquiatria do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
| | - Beatriz Araújo Cavendish
- Serviço Interdisciplinar de Neuromodulação (SIN), Instituto de Psiquiatria do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
| | - Pedro Henrique Rodrigues da Silva
- Serviço Interdisciplinar de Neuromodulação (SIN), Instituto de Psiquiatria do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
| | - Paulo Jeng Chian Suen
- Serviço Interdisciplinar de Neuromodulação (SIN), Instituto de Psiquiatria do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
| | - Kalian Almeida Pereira Marinho
- Serviço Interdisciplinar de Neuromodulação (SIN), Instituto de Psiquiatria do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
- Programa de Fisiopatologia Experimental, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
| | - Leandro da Costa Lane Valiengo
- Serviço Interdisciplinar de Neuromodulação (SIN), Instituto de Psiquiatria do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
- Programa de Fisiopatologia Experimental, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
- Laboratório de Neurociências (LIM-27), Instituto de Psiquiatria do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Corneel Heymanslaan, 9000 Ghent, Belgium
- Ghent Experimental Psychiatry (GHEP) Lab, 9000 Ghent, Belgium
| | - André Russowsky Brunoni
- Serviço Interdisciplinar de Neuromodulação (SIN), Instituto de Psiquiatria do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
- Laboratório de Neurociências (LIM-27), Instituto de Psiquiatria do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
| | - Laís Boralli Razza
- Serviço Interdisciplinar de Neuromodulação (SIN), Instituto de Psiquiatria do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-903, Brazil
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Corneel Heymanslaan, 9000 Ghent, Belgium
- Ghent Experimental Psychiatry (GHEP) Lab, 9000 Ghent, Belgium
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Guidetti M, Arlotti M, Bocci T, Bianchi AM, Parazzini M, Ferrucci R, Priori A. Electric Fields Induced in the Brain by Transcranial Electric Stimulation: A Review of In Vivo Recordings. Biomedicines 2022; 10:biomedicines10102333. [PMID: 36289595 PMCID: PMC9598743 DOI: 10.3390/biomedicines10102333] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 01/12/2023] Open
Abstract
Transcranial electrical stimulation (tES) techniques, such as direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), cause neurophysiological and behavioral modifications as responses to the electric field are induced in the brain. Estimations of such electric fields are based mainly on computational studies, and in vivo measurements have been used to expand the current knowledge. Here, we review the current tDCS- and tACS-induced electric fields estimations as they are recorded in humans and non-human primates using intracerebral electrodes. Direct currents and alternating currents were applied with heterogeneous protocols, and the recording procedures were characterized by a tentative methodology. However, for the clinical stimulation protocols, an injected current seems to reach the brain, even at deep structures. The stimulation parameters (e.g., intensity, frequency and phase), the electrodes’ positions and personal anatomy determine whether the intensities might be high enough to affect both neuronal and non-neuronal cell activity, also deep brain structures.
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Affiliation(s)
- Matteo Guidetti
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | | | - Tommaso Bocci
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy
| | - Anna Maria Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Marta Parazzini
- Istituto di Elettronica e di Ingegneria dell’Informazione e delle Telecomunicazioni (IEIIT), Consiglio Nazionale delle Ricerche (CNR), 20133 Milan, Italy
| | - Roberta Ferrucci
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy
| | - Alberto Priori
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy
- Correspondence:
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Zhang Q, Li X, Liu X, Liu S, Zhang M, Liu Y, Zhu C, Wang K. The Effect of Non-Invasive Brain Stimulation on the Downregulation of Negative Emotions: A Meta-Analysis. Brain Sci 2022; 12:brainsci12060786. [PMID: 35741671 PMCID: PMC9221395 DOI: 10.3390/brainsci12060786] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/26/2022] [Accepted: 06/11/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Emotion regulation (ER) is regarded as a core treatment target for depression and other mental illnesses. In recent years, non-invasive brain stimulation (NIBS) has been extensively used as an intervention for mental illnesses, but there has been no systematic review conducted regarding its effect on emotion regulation. Therefore, we conducted a meta-analysis of the effectiveness of NIBS for emotion regulation; (2) Methods: Systematic searches were conducted in Embase, Web of Science, PubMed, and Cochrane Library. We analyzed the effects of NIBS on tasks assessing emotion regulation using a random-effects model, and further explored the moderating role of the following factors on transcranial direct current stimulation (tDCS) studies by conducting subgroup analyses and meta-regression: target electrode placement, return electrode placement, current intensity, target electrode size, and duration of intervention; (3) Results: A total of 17 studies were included. Our meta-analysis indicated a small but significant effect of NIBS on the downregulation of negative emotions. Separate analyses indicated that repetitive transcranial magnetic stimulation (rTMS) had a medium and significant effect on the downregulation of negative emotions, whereas tDCS had no significant effect. Subgroup analyses showed that the effect of tDCS was moderated by target and return electrode placemen; (4) Conclusions: These results indicate that NIBS had a positive effect on the downregulation of negative emotions. The stimulation protocols should be carefully considered and the underlying mechanisms should be further explored.
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Affiliation(s)
- Qingqing Zhang
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Xiaoming Li
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Xinying Liu
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Shanshan Liu
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Mengzhu Zhang
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Yueling Liu
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
| | - Chunyan Zhu
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei 230011, China
- Correspondence:
| | - Kai Wang
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; (Q.Z.); (X.L.); (X.L.); (S.L.); (M.Z.); (Y.L.); (K.W.)
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei 230011, China
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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Piretti L, Pappaianni E, Gobbo S, Rumiati RI, Job R, Grecucci A. Dissociating the role of dACC and dlPFC for emotion appraisal and mood regulation using cathodal tDCS. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2022; 22:304-315. [PMID: 34676495 DOI: 10.3758/s13415-021-00952-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
Several neuroimaging studies have shown that a distributed network of brain regions is involved in our ability to appraise the emotions we experience in daily life. In particular, scholars suggested that the dorsal anterior cingulate cortex (dACC) may play a role in the appraisal of emotional stimuli together with subcortical regions, especially when stimuli are negatively valenced, and the dorsolateral prefrontal cortex (dlPFC) may play a role in regulating emotions. However, proofs of the causal role of these regions are lacking. In the present study, we aim at testing this model by stimulating both the dACC and the left dlPFC via cathodal tDCS. Twenty-four participants were asked to attend and rate the arousal and valence of negative and neutral emotional stimuli (pictures and words) in three different experimental sessions: cathodal stimulation of dACC, left dlPFC, or sham. In addition to the experimental task, the baseline affective state was measured before and after the stimulation to further assess the effect of stimulation over the baseline affective state after the experimental session. Results showed that cathodal stimulation of dACC, but not the left dlPFC, was associated with reduced arousal ratings of emotional stimuli, both compared with the sham condition. Moreover, cathodal stimulation of left dlPFC decreased participant's positive affective state after the session. These findings suggest for the first time, a dissociation between the dACC and dlPFC, with the former more involved in emotion appraisal, and the latter more involved in mood modulation.
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Affiliation(s)
- L Piretti
- Department of Psychology and Cognitive Sciences - DipSCo, University of Trento, Corso Bettini 33, Rovereto, Italy.
- Marica De Vincenzi onlus Foundation, Rovereto, Italy.
| | - E Pappaianni
- Department of Psychology and Cognitive Sciences - DipSCo, University of Trento, Corso Bettini 33, Rovereto, Italy
| | - S Gobbo
- University of Padua, Padua, Italy
| | - R I Rumiati
- Neuroscience and Society Lab, Neuroscience Area, SISSA, Trieste, Italy
| | - R Job
- Department of Psychology and Cognitive Sciences - DipSCo, University of Trento, Corso Bettini 33, Rovereto, Italy
- Marica De Vincenzi onlus Foundation, Rovereto, Italy
- Center for Medical Sciences - CISMed, University of Trento, Trento, Italy
| | - A Grecucci
- Department of Psychology and Cognitive Sciences - DipSCo, University of Trento, Corso Bettini 33, Rovereto, Italy
- Center for Medical Sciences - CISMed, University of Trento, Trento, Italy
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9
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Cerebellum and Neurorehabilitation in Emotion with a Focus on Neuromodulation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1378:285-299. [DOI: 10.1007/978-3-030-99550-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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10
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Ren P, Ma M, Wu D, Ma Y. Frontopolar tDCS Induces Frequency-Dependent Changes of Spontaneous Low-Frequency Fluctuations: A Resting-State fMRI Study. Cereb Cortex 2021; 32:3542-3552. [PMID: 34918029 DOI: 10.1093/cercor/bhab432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/14/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique that can modulate cortical excitability and behavioral performance. However, its effects on spontaneous low-frequency fluctuations of brain activity are still poorly understood. Here, we systematically investigated the frontopolar tDCS effects on resting-state brain activity and connectivity. Twelve healthy participants were recruited and received anode, cathode, and sham stimulation in a randomized order. Resting-state functional magnetic resonance imaging was performed before and after stimulation. Functional connectivity was calculated to examine tDCS effects within and beyond the frontopolar network. To assess the frequency-dependent changes of brain activity, fractional amplitude of low-frequency fluctuations (fALFF) was computed in the slow-4 (0.027-0.073 Hz) and slow-5 (0.01-0.027 Hz) bands. The results showed anodal tDCS-induced widespread connectivity reduction within and beyond the frontopolar network. Regardless of tDCS polarity, stimulation effect on fALFF was significantly larger in slow-5 band compared with the slow-4. Notably, anodal tDCS-induced connectivity changes were associated with pre-tDCS fALFF in slow-4 band, showing positive correlations in the frontal regions and negative correlations in the temporal regions. Our findings imply that tDCS-induced brain alterations may be frequency-dependent, and pre-tDCS regional brain activity could be used to predict post-tDCS connectivity changes.
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Affiliation(s)
- Ping Ren
- The Division of Geriatric Psychiatry, Shenzhen Mental Health Center, Shenzhen, Guangdong 518020, China.,The Division of Geriatric Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong 518020, China.,Institute of Biophysics, The Chinese Academy of Sciences, Beijing 100101, China
| | - Manxiu Ma
- Institute of Biophysics, The Chinese Academy of Sciences, Beijing 100101, China.,Fralin Biomedical Research Institute, Virginia Tech Carilion, Virginia Tech, Roanoke, VA 24016, USA
| | - Donghui Wu
- The Division of Geriatric Psychiatry, Shenzhen Mental Health Center, Shenzhen, Guangdong 518020, China.,The Division of Geriatric Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong 518020, China
| | - Yuanye Ma
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
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11
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Cinosi E, Adam D, Aslan I, Baldwin D, Chillingsworth K, Enara A, Gale T, Garg K, Garner M, Gordon R, Hall N, Huneke NTM, Kucukterzi-Ali S, McCarthy J, Meron D, Monji-Patel D, Mooney R, Robbins T, Smith M, Sireau N, Wellsted D, Wyatt S, Fineberg NA. Feasibility and acceptability of transcranial stimulation in obsessive-compulsive symptoms (FEATSOCS): study protocol for a randomised controlled trial of transcranial direct current stimulation (tDCS) in obsessive-compulsive disorder (OCD). Pilot Feasibility Stud 2021; 7:213. [PMID: 34872621 PMCID: PMC8646008 DOI: 10.1186/s40814-021-00945-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder which often proves refractory to current treatment approaches. Transcranial direct current stimulation (tDCS), a noninvasive form of neurostimulation, with potential for development as a self-administered intervention, has shown potential as a safe and efficacious treatment for OCD in a small number of trials. The two most promising stimulation sites are located above the orbitofrontal cortex (OFC) and the supplementary motor area (SMA). METHODS The aim of this feasibility study is to inform the development of a definitive trial, focussing on the acceptability, safety of the intervention, feasibility of recruitment, adherence and tolerability to tDCS and study assessments and the size of the treatment effect. To this end, we will deliver a double-blind, sham-controlled, crossover randomised multicentre study in 25 adults with OCD. Each participant will receive three courses of tDCS (SMA, OFC and sham), randomly allocated and given in counterbalanced order. Each course comprises four 20-min stimulations, delivered over two consecutive days, separated by at least 4 weeks' washout period. We will collect information about recruitment, study conduct and tDCS delivery. Blinded raters will assess clinical outcomes before, during and up to 4 weeks after stimulation using validated scales. We will include relevant objective neurocognitive tasks, testing cognitive flexibility, motor disinhibition, cooperation and habit learning. DISCUSSION We will analyse the magnitude of the effect of the interventions on OCD symptoms alongside the standard deviation of the outcome measure, to estimate effect size and determine the optimal stimulation target. We will also measure the duration of the effect of stimulation, to provide information on spacing treatments efficiently. We will evaluate the usefulness and limitations of specific neurocognitive tests to determine a definitive test battery. Additionally, qualitative data will be collected from participants to better understand their experience of taking part in a tDCS intervention, as well as the impact on their overall quality of life. These clinical outcomes will enable the project team to further refine the methodology to ensure optimal efficiency in terms of both delivering and assessing the treatment in a full-scale trial. TRIAL REGISTRATION ISRCTN17937049 . (date applied 08/07/2019). Recruitment (ongoing) began 23rd July 2019 and is anticipated to complete 30th April 2021.
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Affiliation(s)
- Eduardo Cinosi
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK.
- University of Hertfordshire, Hertfordshire, UK.
| | - David Adam
- ORCHARD-Advancing Global OCD Research Charity, Cambridge, UK
| | - Ibrahim Aslan
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - David Baldwin
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - Kieran Chillingsworth
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - Arun Enara
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
| | - Tim Gale
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
- University of Hertfordshire, Hertfordshire, UK
| | - Kabir Garg
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
| | - Matthew Garner
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
| | - Robert Gordon
- Southern Health NHS Foundation Trust, Southampton, UK
| | | | - Nathan T M Huneke
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Sonay Kucukterzi-Ali
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
- University of Hertfordshire, Hertfordshire, UK
| | | | - Daniel Meron
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
- Somerset NHS Foundation Trust, Taunton, UK
| | - Deela Monji-Patel
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
- University of Hertfordshire, Hertfordshire, UK
| | | | - Trevor Robbins
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Megan Smith
- University of Hertfordshire, Hertfordshire, UK
| | - Nick Sireau
- ORCHARD-Advancing Global OCD Research Charity, Cambridge, UK
| | | | | | - Naomi A Fineberg
- Highly Specialised OCD and BDD Service, Hertfordshire Partnership NHS University Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
- University of Hertfordshire, Hertfordshire, UK
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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12
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Shephard E, Stern ER, van den Heuvel OA, Costa DL, Batistuzzo MC, Godoy PB, Lopes AC, Brunoni AR, Hoexter MQ, Shavitt RG, Reddy JY, Lochner C, Stein DJ, Simpson HB, Miguel EC. Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder. Mol Psychiatry 2021; 26:4583-4604. [PMID: 33414496 PMCID: PMC8260628 DOI: 10.1038/s41380-020-01007-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive-compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.
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Affiliation(s)
- Elizabeth Shephard
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. .,Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
| | - Emily R. Stern
- Department of Psychiatry, The New York University School of Medicine, New York, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Odile A. van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Daniel L.C. Costa
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo C. Batistuzzo
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Priscilla B.G. Godoy
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio C. Lopes
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andre R. Brunoni
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Q. Hoexter
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roseli G. Shavitt
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Janardhan Y.C Reddy
- Department of Psychiatry OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Christine Lochner
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - H. Blair Simpson
- Center for OCD and Related Disorders, New York State Psychiatric Institute and the Department of Psychiatry, Columbia University Irving Medical Center, New York New York
| | - Euripedes C. Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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13
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Acevedo N, Bosanac P, Pikoos T, Rossell S, Castle D. Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review. Brain Sci 2021; 11:brainsci11070948. [PMID: 34356182 PMCID: PMC8307974 DOI: 10.3390/brainsci11070948] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 01/16/2023] Open
Abstract
Invasive and noninvasive neurostimulation therapies for obsessive-compulsive and related disorders (OCRD) were systematically reviewed with the aim of assessing clinical characteristics, methodologies, neuroanatomical substrates, and varied stimulation parameters. Previous reviews have focused on a narrow scope, statistical rather than clinical significance, grouped together heterogenous protocols, and proposed inconclusive outcomes and directions. Herein, a comprehensive and transdiagnostic evaluation of all clinically relevant determinants is presented with translational clinical recommendations and novel response rates. Electroconvulsive therapy (ECT) studies were limited in number and quality but demonstrated greater efficacy than previously identified. Targeting the pre-SMA/SMA is recommended for transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). TMS yielded superior outcomes, although polarity findings were conflicting, and refinement of frontal/cognitive control protocols may optimize outcomes. For both techniques, standardization of polarity, more treatment sessions (>20), and targeting multiple structures are encouraged. A deep brain stimulation (DBS) 'sweet spot' of the striatum for OCD was proposed, and CBT is strongly encouraged. Tourette's patients showed less variance and reliance on treatment optimization. Several DBS targets achieved consistent, rapid, and sustained clinical response. Analysis of fiber connectivity, as opposed to precise neural regions, should be implemented for target selection. Standardization of protocols is necessary to achieve translational outcomes.
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Affiliation(s)
- Nicola Acevedo
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
- Correspondence:
| | - Peter Bosanac
- St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
- Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Toni Pikoos
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
| | - Susan Rossell
- Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, Australia; (T.P.); (S.R.)
- St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
| | - David Castle
- St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, Australia; (P.B.); (D.C.)
- Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
- Centre for Addiction and Mental Health, 252 College Street, Toronto, ON M5T 1R7, Canada
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14
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Efficacy and safety of transcranial direct current stimulation as an add-on treatment for obsessive-compulsive disorder: a randomized, sham-controlled trial. Neuropsychopharmacology 2021; 46:1028-1034. [PMID: 33452434 PMCID: PMC8115679 DOI: 10.1038/s41386-020-00928-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/27/2020] [Accepted: 11/20/2020] [Indexed: 01/29/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a frequent, disabling disorder with high rates of treatment resistance. Transcranial direct current stimulation (tDCS) is a safe, tolerable noninvasive neuromodulation therapy with scarce evidence for OCD. This double-blind, randomized, and sham-controlled study investigates the efficacy of tDCS as add-on treatment for treatment-resistant OCD (failure to respond to at least one previous pharmacological treatment). On 20 consecutive weekdays (4 weeks), 43 patients with treatment-resistant OCD underwent 30 min active or sham tDCS sessions, followed by a 8 week follow-up. The cathode was positioned over the supplementary motor area (SMA) and the anode over the left deltoid. The primary outcome was the change in baseline Y-BOCS score at week 12. Secondary outcomes were changes in mood and anxiety and the occurrence of adverse events. Response was evaluated considering percent decrease of baseline Y-BOCS scores and the Improvement subscale of the Clinical Global Impression (CGI-I) between baseline and week 12. Patients that received active tDCS achieved a significant reduction of OCD symptoms than sham, with mean (SD) Y-BOCS score changes of 6.68 (5.83) and 2.84 (6.3) points, respectively (Cohen's d: 0.62 (0.06-1.18), p = 0.03). We found no between-group differences in responders (four patients in the active tDCS and one in the sham group). Active tDCS of the SMA was not superior to sham in reducing symptoms of depression or anxiety. Patients in both groups reported mild adverse events. Our results suggest that cathodal tDCS over the SMA is an effective add-on strategy in treatment-resistant OCD.
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15
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The effect of non-invasive brain stimulation on executive functioning in healthy controls: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 125:122-147. [PMID: 33503477 DOI: 10.1016/j.neubiorev.2021.01.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 12/07/2020] [Accepted: 01/11/2021] [Indexed: 01/01/2023]
Abstract
In recent years, there has been a heightened interest in the effect of non-invasive brain stimulation on executive functioning. However, there is no comprehensive overview of its effects on different executive functioning domains in healthy individuals. Here, we assessed the state of the field by conducting a systematic review and meta-analysis on the effectiveness of non-invasive brain stimulation (i.e. repetitive transcranial magnetic stimulation and transcranial direct current stimulation) over prefrontal regions on tasks assessing working memory, inhibition, flexibility, planning and initiation performance. Our search yielded 63 studies (n = 1537), and the effectiveness of excitatory and inhibitory non-invasive brain stimulation were assessed per executive functioning task. Our analyses showed that excitatory non-invasive brain stimulation had a small but positive effect on Stop Signal Task and Go/No-Go Task performance, and that inhibitory stimulation had a small negative effect on Flanker Task performance. Non-invasive brain stimulation did not affect performance on working memory and flexibility tasks, and effects on planning tasks were inconclusive.
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16
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Yoosefee S, Amanat M, Salehi M, Mousavi SV, Behzadmanesh J, Safary V, Yoonesi A, Salehi B. The safety and efficacy of transcranial direct current stimulation as add-on therapy to fluoxetine in obsessive-compulsive disorder: a randomized, double-blind, sham-controlled, clinical trial. BMC Psychiatry 2020; 20:570. [PMID: 33256659 PMCID: PMC7708220 DOI: 10.1186/s12888-020-02979-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 11/22/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is an anxiety disorder that causes impairment in daily activities. This study aimed to assess the safety and efficacy of transcranial direct current stimulation (tDCS) as adjunctive therapy with fluoxetine in individuals diagnosed with moderate to severe OCD. METHODS This is a randomized, double-blind sham-controlled trial. Individuals with OCD who had baseline Yale-Brown obsessive-compulsive scale (Y-BOCS) of > 15 were enrolled. Eligible cases were randomly assigned in 1:1 ratio to receive either 20-min-period of stimulation with tDCS and fluoxetine (experimental arm) or fluoxetine only (sham control arm). The anodal electrode of tDCS was placed over the left dorsolateral prefrontal cortex (Fp3) and the cathodal electrode was placed over the right orbitofrontal cortex (F8). Two mA electrical stimulation with the tDCS was used for 20 min in individuals of experimental group. In the control group, electrodes were placed and stimulation was administered for 30 s to induce the same skin sensation as in experimental group. This procedure was performed three times per week for 8 weeks. Y-BOCS test was assessed at baseline, week 4 (after 12th stimulation), week 8 (after 24th stimulation), and 1 month after the last stimulation. The primary endpoints were the mean changes in Y-BOCS total score from baseline to the last visit. The secondary endpoints were the mean changes in obsession and compulsion sub-scores from baseline to the last visit. Adverse events were also assessed. Mixed design repeated measures analysis of variance assessed the endpoints. RESULTS Sixty individuals (30 in each group) were participated. All individuals in control group and 28 cases in experimental arm completed the trial. The mean Y-BOCS (F(1.85) = 30.83; P < 0.001), OCD obsession (F(2.23) = 25.01; P < 0.001), and compulsion (F(2.06) = 10.81; P < 0.001) scores decreased significantly during the study. No statistical differences were, however, detected between experimental and control groups (P > 0.05). The tDCS was well tolerated and no major adverse events were reported. CONCLUSION This study showed that among individuals with moderate to severe OCD, there was no significant difference regarding OC symptoms between cases used tDCS as adjunctive therapy with fluoxetine and individuals used fluoxetine only. TRIAL REGISTRATION IRCT2017030632904N1 . Registered 14 July 2017, http://irct.ir/user/trial/44193/view.
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Affiliation(s)
- Sadegh Yoosefee
- Neurosciences Research Center, Qom University of Medical Sciences, Qom, Iran
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Man Amanat
- Faculty of Medicine, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Salehi
- Faculty of Medicine, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Vahid Mousavi
- NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | | | - Victoria Safary
- Department of Psychiatry, Arak University of Medical Sciences, Arak, Iran
| | - Ali Yoonesi
- Department of Neurosciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Salehi
- Department of Psychiatry, Arak University of Medical Sciences, Arak, Iran.
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17
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Szechtman H, Harvey BH, Woody EZ, Hoffman KL. The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap. Pharmacol Rev 2020; 72:80-151. [PMID: 31826934 DOI: 10.1124/pr.119.017772] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This review evaluates current knowledge about obsessive-compulsive disorder (OCD), with the goal of providing a roadmap for future directions in research on the psychopharmacology of the disorder. It first addresses issues in the description and diagnosis of OCD, including the structure, measurement, and appropriate description of the disorder and issues of differential diagnosis. Current pharmacotherapies for OCD are then reviewed, including monotherapy with serotonin reuptake inhibitors and augmentation with antipsychotic medication and with psychologic treatment. Neuromodulatory therapies for OCD are also described, including psychosurgery, deep brain stimulation, and noninvasive brain stimulation. Psychotherapies for OCD are then reviewed, focusing on behavior therapy, including exposure and response prevention and cognitive therapy, and the efficacy of these interventions is discussed, touching on issues such as the timing of sessions, the adjunctive role of pharmacotherapy, and the underlying mechanisms. Next, current research on the neurobiology of OCD is examined, including work probing the role of various neurotransmitters and other endogenous processes and etiology as clues to the neurobiological fault that may underlie OCD. A new perspective on preclinical research is advanced, using the Research Domain Criteria to propose an adaptationist viewpoint that regards OCD as the dysfunction of a normal motivational system. A systems-design approach introduces the security motivation system (SMS) theory of OCD as a framework for research. Finally, a new perspective on psychopharmacological research for OCD is advanced, exploring three approaches: boosting infrastructure facilities of the brain, facilitating psychotherapeutic relearning, and targeting specific pathways of the SMS network to fix deficient SMS shut-down processes. SIGNIFICANCE STATEMENT: A significant proportion of patients with obsessive-compulsive disorder (OCD) do not achieve remission with current treatments, indicating the need for innovations in psychopharmacology for the disorder. OCD may be conceptualized as the dysfunction of a normal, special motivation system that evolved to manage the prospect of potential danger. This perspective, together with a wide-ranging review of the literature, suggests novel directions for psychopharmacological research, including boosting support systems of the brain, facilitating relearning that occurs in psychotherapy, and targeting specific pathways in the brain that provide deficient stopping processes in OCD.
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Affiliation(s)
- Henry Szechtman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Brian H Harvey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Erik Z Woody
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Kurt Leroy Hoffman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
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18
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Harika-Germaneau G, Heit D, Chatard A, Thirioux B, Langbour N, Jaafari N. Treating refractory obsessive-compulsive disorder with transcranial direct current stimulation: An open label study. Brain Behav 2020; 10:e01648. [PMID: 32406608 PMCID: PMC7375126 DOI: 10.1002/brb3.1648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a complex disorder with 40%-60% of patients' refractory to treatment. Transcranial direct current stimulation (tDCS) has been shown to induce potent and long-lasting effects on cortical excitability. The aim of the present clinical trial was to evaluate the therapeutic efficacy and tolerability of cathodal tDCS over the supplementary motor area (SMA) in treatment-resistant OCD patients. METHODS Twenty-one treatment-resistant OCD outpatients received 10 sessions of tDCS. Each treatment session consisted of 2 mA stimuli for 30 min. The cathode was positioned over the bilateral SMA and the anode over the right supraorbital area. Patients were evaluated at baseline, end of treatment, one-month follow-up, and three-month follow-up. Response to treatment was defined as at least a decrease of 35% on the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and a score of 2 or less on the Clinical Global Impressions-Improvement (CGI-I) between baseline and 1-month follow-up. RESULTS There was a significant decrease of YBOCS scores between baseline and one-month assessment. At one month, five patients (24%) were considered as responders and 3 (15%) at 3 months. We also observed concomitant changes in depressive symptoms, and insight. The treatment was well tolerated. Short-lasting side effects were reported as localized tingling sensation and skin redness. CONCLUSION Our results suggest that the use of cathodal tDCS over the SMA and anodal tDCS over the right supraorbital area in OCD treatment-refractory patients is safe and promising to improve obsessive and compulsive symptoms. Large randomized controlled trials are needed to confirm this positive result.
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Affiliation(s)
- Ghina Harika-Germaneau
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale, Centre Hospitalier Henri Laborit, Poitiers, France.,Université de Poitiers, Poitiers, France.,Laboratoire de Neurosciences Expérimentales et Cliniques, INSERM U 1084, Poitiers, France
| | - Damien Heit
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Armand Chatard
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale, Centre Hospitalier Henri Laborit, Poitiers, France.,Université de Poitiers, Poitiers, France.,Laboratoire CeRCA, CNRS 7295, Poitiers, France
| | - Berangere Thirioux
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nicolas Langbour
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nemat Jaafari
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale, Centre Hospitalier Henri Laborit, Poitiers, France.,Université de Poitiers, Poitiers, France.,Laboratoire de Neurosciences Expérimentales et Cliniques, INSERM U 1084, Poitiers, France
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19
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Rapinesi C, Kotzalidis GD, Ferracuti S, Sani G, Girardi P, Del Casale A. Brain Stimulation in Obsessive-Compulsive Disorder (OCD): A Systematic Review. Curr Neuropharmacol 2020; 17:787-807. [PMID: 30963971 PMCID: PMC7059162 DOI: 10.2174/1570159x17666190409142555] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is a highly prevalent, severe, and chronic disease. There is a need for alternative strategies for treatment-resistant OCD. Objective This review aims to assess the effect of brain stimulation techniques in OCD. Method We included papers published in peer-reviewed journals dealing with brain stimulation techniques in OCD. We conducted treatment-specific searches for OCD (Technique AND ((randomized OR randomised) AND control* AND trial) AND (magnetic AND stimulation OR (rTMS OR dTMS)) AND (obsess* OR compuls* OR OCD)) on six databases, i.e., PubMed, Cochrane, Scopus, CINAHL, PsycINFO, and Web of Science to identify randomised controlled trials and ClinicalTrials.gov for possible additional results. Results Different add-on stimulation techniques could be effective for severely ill OCD patients unresponsive to drugs and/or behavioural therapy. Most evidence regarded deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS), while there is less evidence regarding transcranial direct current stimulation (tDCS), electroconvulsive therapy, and vagus nerve stimulation (for these last two there are no sham-controlled studies). Low-frequency TMS may be more effective over the supplementary motor area or the orbitofrontal cortex. DBS showed best results when targeting the crossroad between the nucleus accumbens and the ventral capsule or the subthalamic nucleus. Cathodal tDCS may be better than anodal in treating OCD. Limitations. We had to include methodologically inconsistent underpowered studies. Conclusion Different brain stimulation techniques are promising as an add-on treatment of
refractory OCD, although studies frequently reported inconsistent results. TMS, DBS, and tDCS could possibly find some use with adequate testing, but their standard methodology still needs to be established.
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Affiliation(s)
- Chiara Rapinesi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; "Sant'Andrea" University Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; "Sant'Andrea" University Hospital, Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neuroscience, Sapienza University; Risk Management Unit, "Sant'Andrea" University Hospital, Rome, Italy
| | - Gabriele Sani
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; "Sant'Andrea" University Hospital, Rome, Italy.,"Lucio Bini" Center, "Aretaeus Onlus", Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; "Sant'Andrea" University Hospital, Rome, Italy.,"Lucio Bini" Center, "Aretaeus Onlus", Rome, Italy
| | - Antonio Del Casale
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; "Sant'Andrea" University Hospital, Rome, Italy
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20
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Transcranial direct current stimulation in patients with obsessive
compulsive disorder: A randomized controlled trial. Eur Psychiatry 2020; 62:38-44. [DOI: 10.1016/j.eurpsy.2019.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/13/2019] [Accepted: 08/26/2019] [Indexed: 01/27/2023] Open
Abstract
Abstract
Background:
Obsessive-compulsive disorder (OCD) is a severe mental disorder with
poor response to the available treatments. Neuroimaging studies have
identified dysfunctions within the
orbito-fronto-striato-pallido-thalamic network in patients with OCD.
Here, we assessed the efficacy and safety of transcranial direct current
stimulation (tDCS) applied with the cathode over the orbitofrontal
cortex (OFC) and the anode over the right cerebellum to decrease OCD
symptoms in patients with treatment-resistant OCD.
Methods:
In a randomized sham-controlled double-blind study, 21 patients with
OCD were assigned to receive ten 20-min sessions (two sessions per day)
of either active (2 mA) or sham tDCS. The clinical symptoms were
measured using the Yale-Brown Obsessive and Compulsive Scale (YBOCS).
Acute effects on the symptoms were measured from baseline to immediately
after the 10 tDCS sessions. Long-lasting effects were measured 1 and 3
months after the 10th tDCS session.
Results:
Compared with the sham tDCS, active tDCS significantly decreased OCD
symptoms immediately after the 10th tDCS session
(F(1,19) = 5.26, p = 0.03). However, no
significant differences were observed between the active and sham groups
in terms of changes in YBOCS score or the number of responders one and 3
months after tDCS.
Conclusion:
Despite significant acute effects, tDCS with the cathode placed over
the left OFC and the anode placed over the right cerebellum was not
significantly effective in inducing a long-lasting reduction of symptoms
in patients with treatment-resistant OCD.
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21
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Ruttorf M, Kristensen S, Schad LR, Almeida J. Transcranial Direct Current Stimulation Alters Functional Network Structure in Humans: A Graph Theoretical Analysis. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:2829-2837. [PMID: 31071024 DOI: 10.1109/tmi.2019.2915206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Transcranial direct current stimulation (tDCS) is routinely used in basic and clinical research, but its efficacy has been challenged on a methodological, statistical and technical basis recently. The arguments against tDCS derive from an insufficient understanding of how this technique interacts with brain processes physiologically. Because of its potential as a central tool in neuroscience, it is important to clarify whether tDCS affects neuronal activity. Here, we investigate influences of offline tDCS on network architecture measured by functional magnetic resonance imaging. Applied to one network node only, offline tDCS affects the architecture of the entire functional network. Furthermore, offline tDCS exerts polarity-specific effects on the topology of the functional network attached. Our results confirm in a functioning brain and in a bias free and independent fashion that offline tDCS influences neuronal activity. Moreover, our results suggest that network-specific connectivity has an important role in improving our understanding of the effects of tDCS.
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22
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Translating preclinical findings in clinically relevant new antipsychotic targets: focus on the glutamatergic postsynaptic density. Implications for treatment resistant schizophrenia. Neurosci Biobehav Rev 2019; 107:795-827. [DOI: 10.1016/j.neubiorev.2019.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/20/2019] [Accepted: 08/22/2019] [Indexed: 02/07/2023]
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23
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Dell'Osso B, Cremaschi L, Oldani L, Altamura AC. New Directions in the Use of Brain Stimulation Interventions in Patients with Obsessive-Compulsive Disorder. Curr Med Chem 2019; 25:5712-5721. [PMID: 28474552 DOI: 10.2174/0929867324666170505113631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/20/2017] [Accepted: 04/23/2017] [Indexed: 01/03/2023]
Abstract
Obsessive-Compulsive Disorder (OCD) is a highly disabling condition with early onset and chronic course in most of the affected patients. In addition, OCD may show high comorbidity and suicide attempt rates, which worsen the overall burden of the disease for patients and their caregivers. First-line treatments for OCD consist of pro-serotonergic compounds and cognitive-behavioral therapy. Nonetheless, many patients show only limited benefit from such interventions and require additional "next-step" interventions, including augmentative antipsychotics and glutamate-modulating agents. Based on the knowledge about altered neurocircuitry in OCD, brain stimulation techniques, including transcranial magnetic and electrical stimulations (TMS and tDCS) and deep brain stimulation (DBS), have been increasingly investigated over the last decade, revealing positive results for otherwise intractable and treatment-refractory patients. Available evidence in the field is in continuous evolution and professionals actively involved in the management of OCD patients, psychiatrists in particular, need to be updated about latest developments. Through the analysis of controlled studies, meta-analyses, and International treatment guidelines, the present article is aimed at providing the state of the art on the use of brain stimulation techniques for the treatment of OCD.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, CA, United States
| | - Laura Cremaschi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucio Oldani
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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24
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Woody EZ, Hoffman KL, Szechtman H. Obsessive compulsive disorder (OCD): Current treatments and a framework for neurotherapeutic research. ADVANCES IN PHARMACOLOGY 2019; 86:237-271. [PMID: 31378254 DOI: 10.1016/bs.apha.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
We briefly review current approaches to the diagnosis and treatment of OCD, noting their lack of a strong theoretical foundation. In keeping with the Research Domain Criteria project (RDoC) calls for reconceptualizing psychopathology in ways that better link up with normal brain systems, we advance an adaptationist, brain-network perspective on OCD and propose that OCD represents a dysfunction in the stopping dynamics of a normal brain network that evolved to handle potential danger. We then illustrate how this theoretical perspective can be used to organize possibilities for research on neurotherapeutics for OCD and suggest novel directions for future work.
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Affiliation(s)
- Erik Z Woody
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Kurt Leroy Hoffman
- Centro de Investigación en Reproducción Animal (CIRA), Universidad Autónoma de Tlaxcala-CINVESTAV, Tlaxcala, Mexico
| | - Henry Szechtman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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25
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Stein DJ, Costa DLC, Lochner C, Miguel EC, Reddy YCJ, Shavitt RG, van den Heuvel OA, Simpson HB. Obsessive-compulsive disorder. Nat Rev Dis Primers 2019; 5:52. [PMID: 31371720 PMCID: PMC7370844 DOI: 10.1038/s41572-019-0102-3] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 12/15/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the 'obsessive-compulsive and related disorders', a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town and SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa.
| | - Daniel L C Costa
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Christine Lochner
- Department of Psychiatry, Stellenbosch University and SA MRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch, South Africa
| | - Euripedes C Miguel
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Roseli G Shavitt
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - H Blair Simpson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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26
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Lee D, Mahon BZ, Almeida J. Action at a distance on object-related ventral temporal representations. Cortex 2019; 117:157-167. [PMID: 30981039 DOI: 10.1016/j.cortex.2019.02.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/07/2019] [Accepted: 02/23/2019] [Indexed: 11/16/2022]
Abstract
The representation of objects in ventral temporal cortex is relatively resilient to transformations in the stimuli. There is emerging recognition that ventral temporal object representations are forged via interactions among a broader network of regions that receive independent inputs about a stimulus. Here we test whether ventral temporal representations are causally modulated by disrupting processing in distal associative areas. We used transcranial direct current stimulation (tDCS) to stimulate left parietal areas and functional Magnetic Resonance Imaging (fMRI) to measure object-related neural responses in the ventral stream. We find that representational geometries and category discriminability within ventral temporal cortex, as well as functional connectivity between ventral temporal and parietal areas, are enhanced by anodal compared to cathodal stimulation of left parietal associative cortex. These results demonstrate that ventral temporal representations can be causally modulated by processing distal to the ventral stream.
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Affiliation(s)
- Dongha Lee
- Proaction Laboratory, Faculty of Psychology and Education Sciences, University of Coimbra, Portugal; Faculty of Psychology and Education Sciences, University of Coimbra, Portugal
| | - Bradford Z Mahon
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA; Center for Visual Science, University of Rochester, Rochester, NY, USA; Department of Neurosurgery, University of Rochester, Rochester, NY, USA; Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Jorge Almeida
- Proaction Laboratory, Faculty of Psychology and Education Sciences, University of Coimbra, Portugal; Faculty of Psychology and Education Sciences, University of Coimbra, Portugal.
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27
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da Silva RDMF, Batistuzzo MC, Shavitt RG, Miguel EC, Stern E, Mezger E, Padberg F, D'Urso G, Brunoni AR. Transcranial direct current stimulation in obsessive-compulsive disorder: an update in electric field modeling and investigations for optimal electrode montage. Expert Rev Neurother 2019; 19:1025-1035. [PMID: 31244347 DOI: 10.1080/14737175.2019.1637257] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation intervention that has been investigated for several psychiatric disorders, including Obsessive-Compulsive Disorder (OCD). As there are several candidate brain regions for targeting OCD relevant networks, clinical studies using tDCS have considerably varied in terms of the electrode montages used. Computer modeling of electric field currents induced by tDCS can help guiding the research of relevant targets for OCD. In this review, the authors used this tool to investigate targeted brain areas from previous studies of tDCS in OCD. Areas covered: A literature search for articles with the keywords 'tDCS', 'Transcranial Direct Current Stimulation' and 'Obsessive Compulsive Disorder' was conducted to identify relevant publications. For comparing different electrode montages, electric field (EF) models were performed using high-resolution brain scan templates. Authors found 13 studies mostly showing an improvement in OCD symptoms. The electrode montages varied considerably between studies. Nonetheless, two main patterns of EFs could be identified: 'focal montages', with EFs concentrated in the prefrontal cortex, and 'diffuse montages', with widespread EFs over cortical areas. Expert opinion: Electric field simulation can guide future clinical trials in psychiatry, using personalized tDCS montages with distinct electrode positioning according to clusters of symptoms.
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Affiliation(s)
- Renata de Melo Felipe da Silva
- Department and Institute of Psychiatry, Obsessive-Compulsive Spectrum Disorders Program, Laboratory of Psychopathology and Psychiatric treatment (LIM-23), Service of Interdisciplinary Neuromodulation (SIN), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Marcelo Camargo Batistuzzo
- Department and Institute of Psychiatry, Obsessive-Compulsive Spectrum Disorders Program, Laboratory of Psychopathology and Psychiatric treatment (LIM-23), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Roseli Gedanke Shavitt
- Department and Institute of Psychiatry, Obsessive-Compulsive Spectrum Disorders Program, Laboratory of Psychopathology and Psychiatric treatment (LIM-23), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Eurípedes Constantino Miguel
- Department and Institute of Psychiatry, Obsessive-Compulsive Spectrum Disorders Program, Laboratory of Psychopathology and Psychiatric treatment (LIM-23), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Emily Stern
- Department of Psychiatry, New York University School of Medicine , New York , NY , USA.,Nathan Kline Institute for Psychiatric Research , Orangeburg , NY , USA
| | - Eva Mezger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich , Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich , Germany
| | - Giordano D'Urso
- Unit of Psychiatry, Department of Clinical Neuroscience, University of Naples Federico II , Naples , Italy
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil
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28
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Kumar S, Kumar N, Verma R. Safety and efficacy of adjunctive transcranial direct current stimulation in treatment-resistant obsessive-compulsive disorder: An open-label trial. Indian J Psychiatry 2019; 61:327-334. [PMID: 31391634 PMCID: PMC6657554 DOI: 10.4103/psychiatry.indianjpsychiatry_509_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The current pharmacological and psychotherapeutic approaches have limited benefit in symptom management of obsessive-compulsive disorder (OCD) urging clinicians and researchers to seek newer avenues of management. Transcranial direct current stimulation (tDCS) has shown promise in this aspect from a neuromodulatory perspective. The current study aims to study the response to tDCS as an adjunctive treatment in patients with treatment-resistant OCD. MATERIALS AND METHODS This open-label study was conducted among 20 patients with treatment-resistant OCD. All participants received 20 sessions of tDCS with the cathode at the supplementary motor area (SMA) and the anode at right occipital area. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the secondary outcome was evaluated on the clinical global impression (CGI) and side effect checklist for tDCS. RESULTS There was a significant improvement from baseline in the mean scores of Y-BOCS and CGI scales after tDCS intervention. An improvement of >35% Y-BOCS score change was observed in 15% of participants. Short-lasting side effects were reported as mild headache and localized tingling sensation. CONCLUSION Cathodal tDCS at SMA may be a useful approach to manage treatment-resistant OCD. The use of tDCS was not associated with any significant harmful consequence to the participants.
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Affiliation(s)
- Satish Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Verma
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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29
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Abstract
Obsessive-compulsive disorder (OCD) is characterized by distressing thoughts and repetitive behaviors that are interfering, time-consuming, and difficult to control. Although OCD was once thought to be untreatable, the last few decades have seen great success in reducing symptoms with exposure and response prevention (ERP), which is now considered to be the first-line psychotherapy for the disorder. Despite these significant therapeutic advances, there remain a number of challenges in treating OCD. In this review, we will describe the theoretical underpinnings and elements of ERP, examine the evidence for its effectiveness, and discuss new directions for enhancing it as a therapy for OCD.
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Affiliation(s)
- Dianne M Hezel
- Anxiety Disorders Clinic, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,Department of Psychiatry, Columbia University, New York, NY, USA
| | - H Blair Simpson
- Anxiety Disorders Clinic, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,Department of Psychiatry, Columbia University, New York, NY, USA
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Transcranial direct current stimulation for the treatment of obsessive-compulsive disorder? A qualitative review of safety and efficacy. Psychiatry Res 2019; 271:259-264. [PMID: 30508669 DOI: 10.1016/j.psychres.2018.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 10/09/2018] [Accepted: 11/15/2018] [Indexed: 12/17/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a highly disabling psychiatric disorder characterized by recurrent obsessions and compulsions. It has a lifetime prevalence of 1-3% in the general population and commonly has a chronic course. First-line treatments consist of selective serotonin reuptake inhibitors and cognitive-behavioral therapy but up to 60% of patients respond partially or not at all to these treatments. This paper reviewed the literature on the safety and efficacy of transcranial direct current stimulation (tDCS) for the treatment of obsessive-compulsive disorder and discussed future directions for research and clinical application. Criteria for inclusion were open or controlled studies on tDCS and OCD that used validated rating scales along with well-described stimulus parameters. In the majority of the limited number of published studies, most patients with treatment-resistant obsessive-compulsive disorder had either moderate or marked benefit with this technique different stimulation targets, sometimes sustained for many months. This technique might be efficacious in the treatment of obsessive-compulsive disorder, although it is difficult to draw definitive conclusions about its efficacy, future well-designed sham-controlled studies are needed to confirm the safety and efficacy of tDCS for the treatment of this condition.
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Sauvaget A, Poulet E, Mantovani A, Bulteau S, Damier P, Moutaud B, Paternoster M, de Bartolomeis A, DʼUrso G. The Psychiatric Neuromodulation Unit: Implementation and Management. J ECT 2018; 34:211-219. [PMID: 29944606 DOI: 10.1097/yct.0000000000000513] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The proven effectiveness of neuromodulation and stimulation techniques for the management of psychiatric disorders has brought strongly needed innovation in psychiatry, given the high prevalence and high costs of treatment resistance. Although evidence-based guidelines in neuromodulation have been implemented to improve the clinical efficacy, safety, and research procedures, practical suggestions on how to design a psychiatric neuromodulation unit (PNU) are not available in the scientific literature. In this contribution, we have combined the results of a literature search with the suggestions of clinical psychiatrists, managers, and bioethicists who have had firsthand experience in building a PNU. Eleven key issues concerning the implementation and management of a PNU were identified: general context, team composition, environment, basic technical equipment, clinical versus research activities, target clinical population, education and training, interdisciplinarity, ethical aspects, regulatory and reimbursement issues, fund-raising, and partnership development. Moreover, a business plan comprising pragmatic solutions and recommendations for designing an efficient PNU was laid out.
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Affiliation(s)
| | | | | | | | - Philippe Damier
- CHU de Nantes, CIC0004, Nantes & Université de Nantes, UFR Médecine, Nantes
| | - Baptiste Moutaud
- CNRS, Cermes3, Research Center on Sciences, Health, Mental Health and Society, Paris, France
| | | | - Andrea de Bartolomeis
- Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Giordano DʼUrso
- Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
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Transcranial Direct Current Stimulation in Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, and Anxiety Disorders. J ECT 2018; 34:172-181. [PMID: 30095684 DOI: 10.1097/yct.0000000000000538] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and anxiety disorders share the basic clinical feature of anxiety, which probably explains their common response to similar pharmacological and psychological interventions. Transcranial direct current stimulation (tDCS) is a neuromodulation technique that has proved effective in reducing the symptoms of a number of neuropsychiatric disorders. It was also used in healthy subjects to modulate neuropsychological processes that are involved in the pathophysiology of anxiety. We review the published studies in which tDCS was administered to patients with OCD, PTSD, or anxiety disorders. Our systematic search in the major electronic databases resulted in 14 articles for OCD, 1 for an OCD-related disorder (ie, hoarding disorder), 2 for PTSD, and 2 for anxiety disorders. In the studies involving OCD patients, tDCS was targeted to either the dorsolateral prefrontal cortex or the orbitofrontal cortex or the pre-supplementary motor area and induced a clear reduction of obsessive-compulsive symptoms. However, the lack of sham control groups and the great diversity in sample selection and tDCS protocols among studies prevent us from generalizing these results. In the studies involving PTSD and anxiety disorders patients, tDCS was applied over the dorsolateral prefrontal cortex and reduced symptoms, but the number of treated patients is too little to draw any conclusion on efficacy. However, these reports highlighted the importance of combining tDCS with different procedures, including computerized tasks and behavioral paradigms. In conclusion, even in its infancy, the use of tDCS for the treatment of OCD, PTSD, and anxiety disorders does show promise and deserves extensive research effort.
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Transcranial Direct Current Stimulation for Obsessive-Compulsive Disorder: A Systematic Review. Brain Sci 2018; 8:brainsci8020037. [PMID: 29495298 PMCID: PMC5836056 DOI: 10.3390/brainsci8020037] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 11/26/2022] Open
Abstract
Despite the advances in psychopharmacology and established psychotherapeutic interventions, more than 40% of patients with obsessive-compulsive disorder (OCD) do not respond to conventional treatment approaches. Transcranial direct current stimulation (tDCS) has been recently proposed as a therapeutic tool to alleviate treatment-resistant symptoms in patients with OCD. The aim of this review was to provide a comprehensive overview of the current state of the art and future clinical applications of tDCS in patients with OCD. A literature search conducted on the PubMed database following PRISMA guidelines and completed by a manual search yielded 12 results: eight case reports, three open-label studies (with 5, 8, and 42 participants), and one randomized trial with two active conditions (12 patients). There was no sham-controlled study. A total of 77 patients received active tDCS with a large diversity of electrode montages mainly targeting the dorsolateral prefrontal cortex, the orbitofrontal cortex or the (pre-) supplementary motor area. Despite methodological limitations and the heterogeneity of stimulation parameters, tDCS appears to be a promising tool to decrease obsessive-compulsive symptoms as well as comorbid depression and anxiety in patients with treatment-resistant OCD. Further sham-controlled studies are needed to confirm these preliminary results.
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Fineberg NA, Apergis-Schoute AM, Vaghi MM, Banca P, Gillan CM, Voon V, Chamberlain SR, Cinosi E, Reid J, Shahper S, Bullmore ET, Sahakian BJ, Robbins TW. Mapping Compulsivity in the DSM-5 Obsessive Compulsive and Related Disorders: Cognitive Domains, Neural Circuitry, and Treatment. Int J Neuropsychopharmacol 2018; 21:42-58. [PMID: 29036632 PMCID: PMC5795357 DOI: 10.1093/ijnp/pyx088] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Compulsions are repetitive, stereotyped thoughts and behaviors designed to reduce harm. Growing evidence suggests that the neurocognitive mechanisms mediating behavioral inhibition (motor inhibition, cognitive inflexibility) reversal learning and habit formation (shift from goal-directed to habitual responding) contribute toward compulsive activity in a broad range of disorders. In obsessive compulsive disorder, distributed network perturbation appears focused around the prefrontal cortex, caudate, putamen, and associated neuro-circuitry. Obsessive compulsive disorder-related attentional set-shifting deficits correlated with reduced resting state functional connectivity between the dorsal caudate and the ventrolateral prefrontal cortex on neuroimaging. In contrast, experimental provocation of obsessive compulsive disorder symptoms reduced neural activation in brain regions implicated in goal-directed behavioral control (ventromedial prefrontal cortex, caudate) with concordant increased activation in regions implicated in habit learning (presupplementary motor area, putamen). The ventromedial prefrontal cortex plays a multifaceted role, integrating affective evaluative processes, flexible behavior, and fear learning. Findings from a neuroimaging study of Pavlovian fear reversal, in which obsessive compulsive disorder patients failed to flexibly update fear responses despite normal initial fear conditioning, suggest there is an absence of ventromedial prefrontal cortex safety signaling in obsessive compulsive disorder, which potentially undermines explicit contingency knowledge and may help to explain the link between cognitive inflexibility, fear, and anxiety processing in compulsive disorders such as obsessive compulsive disorder.
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Affiliation(s)
- Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, United Kingdom
- University of Hertfordshire, Department of Postgraduate Medicine, College Lane Hatfield, United Kingdom
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Annemieke M Apergis-Schoute
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Behavioral and Clinical Neurosciences Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Matilde M Vaghi
- Behavioral and Clinical Neurosciences Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Paula Banca
- Behavioral and Clinical Neurosciences Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Claire M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Valerie Voon
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Samuel R Chamberlain
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Cambridge and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Eduardo Cinosi
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, United Kingdom
- University of Hertfordshire, Department of Postgraduate Medicine, College Lane Hatfield, United Kingdom
| | - Jemma Reid
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, United Kingdom
- University of Hertfordshire, Department of Postgraduate Medicine, College Lane Hatfield, United Kingdom
| | - Sonia Shahper
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, United Kingdom
| | - Edward T Bullmore
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Barbara J Sahakian
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Trevor W Robbins
- Behavioral and Clinical Neurosciences Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
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Eapen V, Baker R, Walter A, Raghupathy V, Wehrman JJ, Sowman PF. The Role of Transcranial Direct Current Stimulation (tDCS) in Tourette Syndrome: A Review and Preliminary Findings. Brain Sci 2017; 7:brainsci7120161. [PMID: 29292730 PMCID: PMC5742764 DOI: 10.3390/brainsci7120161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 12/24/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that is being investigated for a variety of neurological and psychiatric conditions. Preliminary evidence suggests that tDCS may be useful in the treatment of Tourette Syndrome (TS). This paper reviews the literature on the use of tDCS in commonly occurring comorbid conditions that are relevant to its proposed use in TS. We describe the protocol for a double-blind, crossover, sham-controlled trial of tDCS (Trial ID: ACTRN12615000592549, registered at www.anzctr.org.au) investigating the efficacy, feasibility, safety, and tolerability of tDCS in patients with TS aged 12 years and over. The intervention consists of cathodal tDCS positioned over the Supplementary Motor Area. Patients receive either sham tDCS for three weeks followed by six weeks of active tDCS (1.4 mA, 18 sessions over six weeks), or six weeks of active sessions followed by three weeks of sham sessions, with follow-up at three and six months. Pilot findings from two patients are presented. There was a reduction in the frequency and intensity of patients’ tics and premonitory urges, as well as evidence of improvements in inhibitory function, over the course of treatment. Larger scale studies are indicated to ascertain the maintenance of symptom improvement over time, as well as the long-term consequences of the repetitions of sessions.
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Affiliation(s)
- Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney and Ingham Institute, Liverpool Hospital, Sydney 2170, Australia.
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney 2052, Australia.
| | - Richard Baker
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney 2052, Australia.
- The Sydney Children's Hospital at Randwick, Sydney 2031, Australia.
| | - Amelia Walter
- Academic Unit of Child Psychiatry South West Sydney and Ingham Institute, Liverpool Hospital, Sydney 2170, Australia.
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney 2052, Australia.
| | | | - Jordan J Wehrman
- Department of Cognitive Science, Macquarie University, Sydney 2109, Australia.
- Perception and Action Research Centre, Faculty of Human Sciences, Macquarie University, Sydney 2109, Australia.
- ARC Centre of Excellence for Cognition and Its Disorders (CCD), Sydney 2109, Australia.
| | - Paul F Sowman
- Department of Cognitive Science, Macquarie University, Sydney 2109, Australia.
- Perception and Action Research Centre, Faculty of Human Sciences, Macquarie University, Sydney 2109, Australia.
- ARC Centre of Excellence for Cognition and Its Disorders (CCD), Sydney 2109, Australia.
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36
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Biundo R, Weis L, Fiorenzato E, Antonini A. Cognitive Rehabilitation in Parkinson's Disease: Is it Feasible? Arch Clin Neuropsychol 2017; 32:840-860. [DOI: 10.1093/arclin/acx092] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/30/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Roberta Biundo
- Parkinson's Disease and Movement Disorders Unit, San Camillo Hospital IRCCS, Venice, Italy
| | - Luca Weis
- Parkinson's Disease and Movement Disorders Unit, San Camillo Hospital IRCCS, Venice, Italy
| | - Eleonora Fiorenzato
- Parkinson's Disease and Movement Disorders Unit, San Camillo Hospital IRCCS, Venice, Italy
- Department of general Psychology, University of Padua, Padua, Italy
| | - Angelo Antonini
- Parkinson's Disease and Movement Disorders Unit, San Camillo Hospital IRCCS, Venice, Italy
- Department of Neuroscience, University of Padua, Padua, Italy
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37
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D'Urso G, Dell'Osso B, Rossi R, Brunoni AR, Bortolomasi M, Ferrucci R, Priori A, de Bartolomeis A, Altamura AC. Clinical predictors of acute response to transcranial direct current stimulation (tDCS) in major depression. J Affect Disord 2017; 219:25-30. [PMID: 28505499 DOI: 10.1016/j.jad.2017.05.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/01/2017] [Accepted: 05/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a promising neuromodulation intervention for poor-responding or refractory depressed patients. However, little is known about predictors of response to this therapy. The present study aimed to analyze clinical predictors of response to tDCS in depressed patients. METHODS Clinical data from 3 independent tDCS trials on 171 depressed patients (including unipolar and bipolar depression), were pooled and analyzed to assess predictors of response. Depression severity and the underlying clinical dimensions were measured using the Hamilton Depression Rating Scale (HDRS) at baseline and after the tDCS treatment. Age, gender and diagnosis (bipolar/unipolar depression) were also investigated as predictors of response. Linear mixed models were fitted in order to ascertain which HDRS factors were associated with response to tDCS. RESULTS Age, gender and diagnosis did not show any association with response to treatment. The reduction in HDRS scores after tDCS was strongly associated with the baseline values of "Cognitive Disturbances" and "Retardation" factors, whilst the "Anxiety/Somatization" factor showed a mild association with the response. LIMITATIONS Open-label design, the lack of control group, and minor differences in stimulation protocols. CONCLUSIONS No differences in response to tDCS were found between unipolar and bipolar patients, suggesting that tDCS is effective for both conditions. "Cognitive disturbance", "Retardation", and "Anxiety/Somatization", were identified as potential clinical predictors of response to tDCS. These findings point to the pre-selection of the potential responders to tDCS, therefore optimizing the clinical use of this technique and the overall cost-effectiveness of the psychiatric intervention for depressed patients.
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Affiliation(s)
- Giordano D'Urso
- Unit of Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda, Policlinico, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, CA, USA
| | - Rodolfo Rossi
- Unit of Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.
| | - Andre Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27), University of São Paulo, São Paulo, Brazil; Interdisciplinary Center for Applied Neuromodulation, University Hospital of São Paulo, São Paulo, Brazil
| | - Marco Bortolomasi
- Casa di cura Villa Santa Chiara, Quinto di Valpantena, Verona, Italy
| | - Roberta Ferrucci
- Fondazione IRCCS Ca' Granda, Policlinico, Milan, Italy; Department of Health Sciences, University of Milan, Italy
| | - Alberto Priori
- Department of Health Sciences, University of Milan, Italy; III Clinica Neurologica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Andrea de Bartolomeis
- Unit of Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Alfredo Carlo Altamura
- Department of Psychiatry, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda, Policlinico, Milan, Italy
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38
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Almeida J, Martins AR, Bergström F, Amaral L, Freixo A, Ganho-Ávila A, Kristensen S, Lee D, Nogueira J, Ruttorf M. Polarity-specific transcranial direct current stimulation effects on object-selective neural responses in the inferior parietal lobe. Cortex 2017; 94:176-181. [DOI: 10.1016/j.cortex.2017.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/03/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
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39
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Biundo R, Fiorenzato E, Antonini A. Nonmotor Symptoms and Natural History of Parkinson's Disease: Evidence From Cognitive Dysfunction and Role of Noninvasive Interventions. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:389-415. [PMID: 28802926 DOI: 10.1016/bs.irn.2017.05.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder, characterized by motor and nonmotor symptoms (NMS). Several subsequent studies substantiate the great functional burden related to NMS, their progression, and negative effect on quality of life in PD. Additional evidence indicates interesting relationships between striatal dopaminergic function and NMS. The basal ganglia are implicated in the modulation and integration of sensory information and pain, bladder function is under control of both inhibitory (D1) and facilitatory (D2) dopaminergic inputs, finally reduced dopaminergic activity in the mesocortical and mesolimbic pathways is involved in the development of several NMS including mood, motivational, and cognitive alterations. Some NMS fluctuate in response to dopaminergic treatment and are relieved by dopamine replacement therapy, other are insensitive to current therapeutic strategies. The relation among the overall disease complications, perhaps the most important for PD patients and family members' well-being and functionality is dementia that affects most PD patients over the course of disease. Specific pharmacological treatment is lacking, and alternative approaches have been implemented to improve everyday functionality and quality of life. The state of the art suggests that cognitive rehabilitation in PD is possible and may either increase performance or preserve cognitive level over the time. However, it is also evident that cognitive abnormalities in PD are heterogeneous and we still do not have biomarkers to detect early patients at risk for dementia. Cognitive dysfunction is one the most prevalent NMS and is a clinically and functionally important disease milestone. Given the available clinical and imaging evidence it is possible to use cognition to model NMS progression and design nonpharmacological interventions. In this chapter we will address the use of cognitive rehabilitation and noninvasive brain stimulation techniques to modulate cognitive performance and rescue connectivity in affected brain circuitry.
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Affiliation(s)
- Roberta Biundo
- Parkinson's Disease and Movement Disorders Unit, San Camillo Hospital IRCCS, Venice-Lido, Italy
| | - Eleonora Fiorenzato
- Parkinson's Disease and Movement Disorders Unit, San Camillo Hospital IRCCS, Venice-Lido, Italy; University of Padua, Padua, Italy
| | - Angelo Antonini
- Parkinson's Disease and Movement Disorders Unit, San Camillo Hospital IRCCS, Venice-Lido, Italy; University of Padua, Padua, Italy.
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40
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Palm U, Leitner B, Kirsch B, Behler N, Kumpf U, Wulf L, Padberg F, Hasan A. Prefrontal tDCS and sertraline in obsessive compulsive disorder: a case report and review of the literature. Neurocase 2017; 23:173-177. [PMID: 28427306 DOI: 10.1080/13554794.2017.1319492] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Obsessive-compulsive (OC) disorder is a disabling disorder resulting in tremendous individual and social burden. It has a large overlap with depression and anxiety disorders and shows treatment resistance in a relevant proportion of patients. Since a couple of years, different noninvasive brain stimulation methods have been investigated to improve OC symptoms. The application of transcranial direct current stimulation (tDCS) has shown inconsistent results which can probably be attributed to a lack in randomized controlled trials with adequate sample size. Anodal stimulation of pre-supplementary motor areas has shown promising results, and there is also sparse data on orbitofrontal and prefrontal stimulation. Here, we provide the first report on a patient with treatment-refractory OC disorder treated with sertraline and an enhanced prefrontal tDCS protocol (twice per day, 10 days) with a classic left-anodal/right cathodal montage, experiencing a 22% reduction of OC symptoms as well as reduction in depression (-10%) and anxiety symptoms (-21%). Due to multifactorial origin of OC disorder and the variety of brain circuits involved, there are probably multiple approaches for brain stimulation regarding site, polarity, and frequency to be assessed in future studies.
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Affiliation(s)
- Ulrich Palm
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilian University, Klinikum der Universität München , Munich , Germany
| | - Bianka Leitner
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilian University, Klinikum der Universität München , Munich , Germany
| | - Beatrice Kirsch
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilian University, Klinikum der Universität München , Munich , Germany
| | - Nora Behler
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilian University, Klinikum der Universität München , Munich , Germany
| | - Ulrike Kumpf
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilian University, Klinikum der Universität München , Munich , Germany
| | - Linda Wulf
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilian University, Klinikum der Universität München , Munich , Germany
| | - Frank Padberg
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilian University, Klinikum der Universität München , Munich , Germany
| | - Alkomiet Hasan
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilian University, Klinikum der Universität München , Munich , Germany
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Huang Y, Liu AA, Lafon B, Friedman D, Dayan M, Wang X, Bikson M, Doyle WK, Devinsky O, Parra LC. Measurements and models of electric fields in the in vivo human brain during transcranial electric stimulation. eLife 2017; 6:18834. [PMID: 28169833 PMCID: PMC5370189 DOI: 10.7554/elife.18834] [Citation(s) in RCA: 321] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 02/06/2017] [Indexed: 11/13/2022] Open
Abstract
Transcranial electric stimulation aims to stimulate the brain by applying weak electrical currents at the scalp. However, the magnitude and spatial distribution of electric fields in the human brain are unknown. We measured electric potentials intracranially in ten epilepsy patients and estimated electric fields across the entire brain by leveraging calibrated current-flow models. When stimulating at 2 mA, cortical electric fields reach 0.8 V/m, the lower limit of effectiveness in animal studies. When individual whole-head anatomy is considered, the predicted electric field magnitudes correlate with the recorded values in cortical (r = 0.86) and depth (r = 0.88) electrodes. Accurate models require adjustment of tissue conductivity values reported in the literature, but accuracy is not improved when incorporating white matter anisotropy or different skull compartments. This is the first study to validate and calibrate current-flow models with in vivo intracranial recordings in humans, providing a solid foundation to target stimulation and interpret clinical trials. DOI:http://dx.doi.org/10.7554/eLife.18834.001
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Affiliation(s)
- Yu Huang
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
| | - Anli A Liu
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Belen Lafon
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
| | - Daniel Friedman
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Michael Dayan
- Department of Neurology, Mayo Clinic, Rochester, United States
| | - Xiuyuan Wang
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Marom Bikson
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
| | - Werner K Doyle
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Lucas C Parra
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
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42
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D'Urso G, Brunoni AR, Mazzaferro MP, Anastasia A, de Bartolomeis A, Mantovani A. Transcranial direct current stimulation for obsessive-compulsive disorder: A randomized, controlled, partial crossover trial. Depress Anxiety 2016; 33:1132-1140. [PMID: 27802585 DOI: 10.1002/da.22578] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/29/2016] [Accepted: 09/28/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Presupplementary motor area (pre-SMA) hyperactivity has been detected in obsessive-compulsive disorder (OCD) patients. However, it is not understood whether this is a putative primary cause or a compensatory mechanism in OCD pathophysiology. Considering the polarity-dependent effects on cortical excitability of transcranial direct current stimulation (tDCS), we applied cathodal and/or anodal tDCS to the pre-SMA of OCD patients to test which current polarity might better improve symptoms. METHODS Twelve OCD patients received initially 10 anodal (n = 6) or cathodal (n = 6) daily consecutive 2 mA/20 min tDCS sessions with the active electrode placed bilaterally on the pre-SMA. In case of improvement or no change in symptoms severity, the subjects were maintained on the same current polarity for 10 more sessions. In case of symptoms worsening after the first 10 sessions they were switched to the other polarity for 10 more sessions to test the hypothesis of a polarity-dependent effect. Therefore, each subject received 20 tDCS sessions. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Sheehan Disability Scale (SDS) were administered biweekly to assess changes in symptoms severity. RESULTS After 10 sessions, 50% of patients who initially received anodal stimulation were switched to cathodal, while 100% of patients initially assigned to cathodal stimulation continued on the same polarity. At the end of the study, a statistically significant decrease was observed in the mean Y-BOCS scores of those patients who underwent cathodal tDCS. No pre-post difference was found in the scores of patients following anodal tDCS. CONCLUSIONS Cathodal but not anodal tDCS over the pre-SMA significantly improved OCD symptoms.
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Affiliation(s)
- Giordano D'Urso
- Department of Clinical Neurosciences, Anesthesiology and Pharmacoutilization, University Hospital of Naples Federico II, Naples, Italy
| | - Andre R Brunoni
- Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Maria Pia Mazzaferro
- Residency Program in Psychiatry, University of Naples Federico II, Naples, Italy
| | - Annalisa Anastasia
- Residency Program in Psychiatry, University of Naples Federico II, Naples, Italy
| | - Andrea de Bartolomeis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Mantovani
- Department of Physiology, Pharmacology & Neuroscience, Sophie Davis School of Biomedical Education, City University of New York, New York, NY, USA.,Division of Experimental Therapeutics, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA
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Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol 2016; 128:56-92. [PMID: 27866120 DOI: 10.1016/j.clinph.2016.10.087] [Citation(s) in RCA: 1044] [Impact Index Per Article: 130.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 12/19/2022]
Abstract
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.
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Iannone A, Cruz APDM, Brasil-Neto JP, Boechat-Barros R. Transcranial magnetic stimulation and transcranial direct current stimulation appear to be safe neuromodulatory techniques useful in the treatment of anxiety disorders and other neuropsychiatric disorders. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:829-835. [DOI: 10.1590/0004-282x20160115] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/21/2016] [Indexed: 12/28/2022]
Abstract
ABSTRACT Transcranial magnetic stimulation (TMS) has recently been investigated as a possible adjuvant treatment for many neuropsychiatric disorders, and has already been approved for the treatment of drug-resistant depression in the United States and in Brazil, among other countries. Although its use in other neuropsychiatric disorders is still largely experimental, many physicians have been using it as an off-label add-on therapy for various disorders. More recently, another technique, transcranial direct current stimulation (tDCS), has also become available as a much cheaper and portable alternative to TMS, although its mechanisms of action are different from those of TMS. The use of off-label therapeutic TMS or tDCS tends to occur in the setting of diseases that are notoriously resistant to other treatment modalities. Here we discuss the case of anxiety disorders, namely panic and post-traumatic stress disorders, highlighting the uncertainties and potential problems and benefits of the clinical use of these neuromodulatory techniques at the current stage of knowledge.
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da Silva RDMF, Brunoni AR, Miguel EC, Shavitt RG. Transcranial direct current stimulation for treatment-resistant obsessive-compulsive disorder: report on two cases and proposal for a randomized, sham-controlled trial. SAO PAULO MED J 2016; 134:446-450. [PMID: 27901245 PMCID: PMC10871858 DOI: 10.1590/1516-3180.2016.0155010716] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 01/10/2023] Open
Abstract
CONTEXT AND OBJECTIVE Neuromodulation techniques for treating obsessive-compulsive disorder (OCD) have expanded through greater understanding of the brain circuits involved in this disorder. Transcranial direct current stimulation (tDCS), a non-invasive technique, has been studied as an alternative for treatment-resistant OCD. We describe the design of a clinical trial using tDCS for OCD and report on the outcomes from two patients with primary OCD who were resistant to cognitive-behavioral therapy and to selective serotonin reuptake inhibitors, and who received tDCS in an open manner during the training phase for the study procedures. DESIGN AND SETTING Methodological description of a clinical trial using tDCS for treatment-resistant OCD at a university hospital; and a report on two cases. METHODS The proposed study is randomized, sham-controlled and double-blind. Forty-four patients will be randomized to either active or sham intervention. The active intervention consists of applying an electric current of 2 mA, with the cathode positioned in the region corresponding to the supplementary motor cortex (bilaterally) and the anode positioned in the deltoid. The primary outcome will be the reduction in baseline YBOCS (Yale-Brown Obsessive Compulsive Scale) score at the end of week 4. The secondary outcomes will be depression and anxiety symptoms. Genetic markers, cortical excitability and neurocognitive performance will be investigated. RESULTS The first patient showed significant improvement, whereas the second remained symptomatic after four weeks and after six months. tDCS was well tolerated. CONCLUSION tDCS for treatment-resistant OCD merits randomized controlled trials that test its effectiveness.
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Affiliation(s)
- Renata de Melo Felipe da Silva
- MD. Doctoral Student, Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - André Russowsky Brunoni
- MD, PhD. Director, Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Eurípedes Constantino Miguel
- MD, PhD. Full Professor of Psychiatry, Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Roseli Gedanke Shavitt
- MD, PhD. Director, Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil.
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Bation R, Poulet E, Haesebaert F, Saoud M, Brunelin J. Transcranial direct current stimulation in treatment-resistant obsessive-compulsive disorder: An open-label pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:153-7. [PMID: 26439873 DOI: 10.1016/j.pnpbp.2015.10.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/17/2015] [Accepted: 10/02/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a severe mental illness. OCD symptoms are often resistant to available treatments. Abnormalities within the orbitofronto-striato-pallido-thalamic circuitry, especially orbitofrontal cortex (OFC) hyperactivity and cerebellar hypoactivity have been observed in patients. Non-invasive brain stimulation studies have indicated that transcranial direct current stimulation (tDCS) may be a useful alternative to alleviate treatment-resistant symptoms in various neuropsychiatric conditions. METHODS In an open-label pilot study, 8 patients with treatment-resistant OCD received 10 sessions (twice a day) of 2mA tDCS applied with the cathode over the left OFC and the anode over the right cerebellum. OCD (Y-BOCS and OCD-VAS) as well as depressive (MADRS) symptoms were measured 4 times: one time before tDCS and 3 times after (immediately after, 1 and 3months after the 10th tDCS session). RESULTS We reported a significant 26.4% (±15.8) decrease of Y-BOCS score (p=0.002). The beneficial effect lasted during the 3month follow-up. No effect of tDCS was observed on depressive symptoms. At end point, 5 out of 8 patients had a decrease of ≥25%; and 3 out of 8 patients had a decrease of ≥35% in Y-BOCS score. tDCS was well tolerated. CONCLUSION tDCS with the cathode placed over the left OFC combined with the anode placed over the right cerebellum is a suitable and safe approach to decrease OCD symptoms in patients with treatment-resistant OCD. Large scale randomized controlled studies are needed to confirm this promising result.
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Affiliation(s)
- Remy Bation
- Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France.
| | - Emmanuel Poulet
- Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France; CHU de Lyon - Groupement Hospitalier Edouard Herriot - Service de Psychiatrie des Urgences, France
| | - Frederic Haesebaert
- Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France
| | - Mohamed Saoud
- Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France; CHU de Lyon - Groupement Hospitalier Est - Hôpital Pierre Wertheimer - Psychiatrie adultes - Consultations/Liaison, France
| | - Jerome Brunelin
- Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France
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Bikson M, Truong DQ, Mourdoukoutas AP, Aboseria M, Khadka N, Adair D, Rahman A. Modeling sequence and quasi-uniform assumption in computational neurostimulation. PROGRESS IN BRAIN RESEARCH 2015; 222:1-23. [PMID: 26541374 DOI: 10.1016/bs.pbr.2015.08.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Computational neurostimulation aims to develop mathematical constructs that link the application of neuromodulation with changes in behavior and cognition. This process is critical but daunting for technical challenges and scientific unknowns. The overarching goal of this review is to address how this complex task can be made tractable. We describe a framework of sequential modeling steps to achieve this: (1) current flow models, (2) cell polarization models, (3) network and information processing models, and (4) models of the neuroscientific correlates of behavior. Each step is explained with a specific emphasis on the assumptions underpinning underlying sequential implementation. We explain the further implementation of the quasi-uniform assumption to overcome technical limitations and unknowns. We specifically focus on examples in electrical stimulation, such as transcranial direct current stimulation. Our approach and conclusions are broadly applied to immediate and ongoing efforts to deploy computational neurostimulation.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA.
| | - Dennis Q Truong
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | | | - Mohamed Aboseria
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Niranjan Khadka
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Devin Adair
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Asif Rahman
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
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