背景:大约40%的强迫症(OCD)患者对标准和二线增强治疗没有反应,从而探索了替代的生物治疗方法。连续theta爆发刺激(cTBS)是一种重复的经颅磁刺激,比后者对突触可塑性产生更快,更持久的影响。据我们所知,最近只有一项研究和一项病例报告调查了cTBS在强迫症辅助运动区(SMA)的影响。
目的:本研究旨在研究强迫症患者加速机器人化神经导航cTBS对SMA的影响。
方法:共纳入32例OCD患者,随机分为活动和假cTBS组。对于主动cTBS刺激,使用了加速方案。三个刺激在50赫兹爆发,在80%的MT,在5Hz重复使用。每天2次,每次900次脉冲,为期3周的共30次会议(每周10次),被给予了。耶鲁-布朗强迫症评定量表(YBOCS),临床整体印象量表(CGI),汉密尔顿抑郁量表(HAM-D),在基线和第3周和第8周结束时给予汉密尔顿焦虑量表(HAM-A)。
结果:共有26名患者完成了研究。活动cTBS组在YBOCS强迫症中表现出显著的群体×时间效应(P<.001,η2=0.288),强制(P=0.004,η2=0.207),YBOCS总计(P<.001,η2=0.288),CGI-S(P=.010,η2=0.248),CGI-C(P=.010,η2=0.248),HAM-D(P=0.014,η2=0.224)优于假cTBS组。
结论:我们的研究结果表明,辅助加速cTBS显著改善了精神病理学,疾病的严重程度,强迫症患者的抑郁症。未来样本量更大的研究将增加我们的知识。
BACKGROUND: Approximately 40% of patients treated for obsessive-compulsive disorder (OCD) do not respond to standard and second-line augmentation treatments leading to the exploration of alternate biological treatments. Continuous theta burst stimulation (cTBS) is a form of repetitive transcranial magnetic stimulation inducing more rapid and longer-lasting effects on synaptic plasticity than the latter. To the best of our knowledge, only one recent study and a case report investigated the effect of cTBS at the supplementary motor area (SMA) in OCD.
OBJECTIVE: This study aimed to examine the effect of accelerated robotized neuronavigated cTBS over SMA in patients with OCD.
METHODS: A total of 32 patients with OCD were enrolled and randomized into active and sham cTBS groups. For active cTBS stimulation, an accelerated protocol was used. Bursts of three stimuli at 50 Hz, at 80% of MT, repeated at 5 Hz were used. Daily 2 sessions of 900 pulses each, for a total of 30 sessions over 3 wk (weekly 10 sessions), were given. Yale-Brown Obsessive-Compulsive Rating Scale (YBOCS), Clinical Global Impressions scale (CGI), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were administered at baseline and at end of weeks 3 and 8.
RESULTS: A total of 26 patients completed the study. Active cTBS group showed significant group × time effect in YBOCS obsession (P < .001, η2 = 0.288), compulsion (P = .004, η2 = 0.207), YBOCS total (P < .001, η2 = 0.288), CGI-S (P = .010, η2 = 0.248), CGI-C (P = .010, η2 = 0.248), HAM-D (P = .014, η2 = 0.224) than sham cTBS group.
CONCLUSIONS: Findings from our study suggest that adjunctive accelerated cTBS significantly improves psychopathology, severity of illness, and depression among patients with OCD. Future studies with larger sample sizes will add to our knowledge.