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

• DOI: 10.1038/tp.2014.62
• Publication Date: 2014-09-09T14:45:57Z
• Authors: C Nauczyciel; F Le Jeune; F Naudet; S Douabin; A Esquevin; M Vérin; T Dondaine; G Robert; D Drapier; B Millet
• Keywords: Adult; Male; Psychiatric Status Rating Scales; Obsessive-Compulsive Disorder; Cross-Over Studies; [SDV]Life Sciences [q-bio]; Prefrontal Cortex; Equipment Design; Middle Aged; Transcranial Magnetic Stimulation; 03 medical and health sciences; 0302 clinical medicine; Double-Blind Method; Fluorodeoxyglucose F18; Positron-Emission Tomography; Humans; Original Article; Female; France; Dominance, Cerebral; Energy Metabolism

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