Modulation of motor cortex excitability in obsessive-compulsive disorder: an exploratory study on the relations of neurophysiology measures with clinical outcome.
Modulation of motor cortex excitability in obsessive-compulsive disorder: an exploratory study on the relations of neurophysiology measures with clinical outcome.
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DOI：
10.1016/j.psychres.2013.08.054
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发表时间：
2013-12-30
影响因子：
11.3
通讯作者：
Lisanby SH
中科院分区：
文献类型：
--
作者：
Mantovani A;Rossi S;Bassi BD;Simpson HB;Fallon BA;Lisanby SH
低频重复经颅磁刺激（rTMS）辅助运动区（SMA）显示出对强迫症（OCD）的临床益处。在这里，我们测试了临床改善是否与单脉冲和双脉冲TMS变量测量的皮层抑制增强相关。在一项双盲随机试验中，我们对18例接受4周主动或假rTMS的强迫症患者进行了双侧静息和主动运动阈值（RMT和AMT）、皮质沉默期（CSP）、短间隔皮质内抑制（SICI）和皮质内易化（ICF）评估。我们测试了Yale-Brown强迫症量表-自我报告（Y-BOCS-SR），临床总体印象-严重程度子量表（CGI-S）和皮质兴奋性指标变化之间的相关性。活动性rTMS增加右半球RMT，其变化与Y-BOCS-SR改善相关。基线RMT半球不对称性（定义为左右半球RMT之间的差异）及其在主动rTMS后的正常化与Y-BOCS-SR和CGI-S改善相关。活动性rTMS也增加了右半球SICI，其变化与第4周时的Y-BOCS-SR和CGI-S相关，并与基线RMT半球不对称性的正常化相关。治疗引起的皮质兴奋性指标的变化与SMA rTMS对强迫症运动回路功能障碍的抑制作用一致。神经生理学测量与治疗结果的相关性支持SMA在调节强迫症症状中的作用。
Low-frequency repetitive transcranial magnetic stimulation (rTMS) to supplementary motor area (SMA) showed clinical benefit in obsessive-compulsive disorder (OCD). Here we tested whether clinical improvement was associated with enhanced cortical inhibition as measured by single and paired-pulse TMS variables. In 18 OCD patients receiving 4 weeks of either active or sham rTMS in a doubleblind randomized trial, we assessed bilateral resting and active motor thresholds (RMT and AMT), cortical silent period (CSP), short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). We tested correlations between changes in Yale-Brown Obsessive Compulsive Scale-Self-report (Y-BOCS-SR), Clinical Global Impression-Severity subscale (CGI-S) and cortical excitability measures. Active rTMS increased right hemisphere RMT whose change correlated with Y-BOCS-SR improvement. Baseline RMT hemispheric asymmetry, defined as the difference between left and right hemispheres RMT, and its normalization after active rTMS correlated with Y-BOCS-SR and CGI-S improvements. Active rTMS also increased right hemisphere SICI whose change correlated with Y-BOCS-SR and CGI-S at week 4, and with normalization of baseline RMT hemispheric asymmetry. Treatment-induced changes in cortical excitability measures are consistent with an inhibitory action of SMA rTMS on dysfunctional motor circuits in OCD. Correlations of neurophysiology measures with therapeutic outcome are supportive of the role of SMA in the modulation of OCD symptoms.
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