Transcranial direct current stimulation for obsessive-compulsive disorder: A randomized, controlled, partial crossover trial
Transcranial direct current stimulation for obsessive-compulsive disorder: A randomized, controlled, partial crossover trial
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DOI：
10.1002/da.22578
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发表时间：
2016-12-01
影响因子：
7.4
通讯作者：
Mantovani, Antonio
中科院分区：
文献类型：
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作者：
D'Urso, Giordano;Brunoni, Andre R.;Mantovani, Antonio
背景强迫症患者存在前辅助运动区（pre-supplementary motor area，pre-SMA）功能亢进。然而，这是否是一个假定的主要原因或在强迫症的病理生理补偿机制，目前还不清楚。考虑到经颅直流电刺激（tDCS）对皮层兴奋性的极性依赖效应，我们将阴极和/或阳极tDCS应用于OCD患者的SMA前，以测试哪种电流极性可能更好地改善症状。20分钟tDCS会话，有源电极双侧放置在SMA前。在症状严重程度改善或无变化的情况下，受试者保持相同的电流极性再持续10次。如果在前10个疗程后症状恶化，则将其转换为另一极性再进行10个疗程，以检验极性依赖性效应的假设。因此，每例受试者接受20次tDCS治疗。耶鲁-布朗强迫量表（Y-BOCS）和希恩残疾量表（SDS）进行管理，每两周一次，以评估症状severity.ResultsAfter 10届会议的变化，50%的患者最初接受阳极刺激切换到阴极，而100%的患者最初分配到阴极刺激继续在同一极性。在研究结束时，观察到接受阴极tDCS的患者的平均Y-BOCS评分出现统计学显著性降低。没有发现前后差异的患者的评分以下anodal tDCS.ConclusionsCathodal，但不是anodal tDCS在前SMA显着改善强迫症症状。
BackgroundPresupplementary 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.MethodsTwelve 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.ResultsAfter 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.ConclusionsCathodal but not anodal tDCS over the pre-SMA significantly improved OCD symptoms.