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Psych Congress  

Deep Transcranial Magnetic Stimulation of the Anterior Cingulate Cortex for Obsessive Compulsive Disorder Patients

Abraham Zangen, PhD
Lior Carmi, PhD
Uri Alyagon, PhD
Joseph Zohar, MD
Aron Tendler, MD

This poster was presented at the 29th Annual U.S. Psychiatric & Mental Health Congress, held October 21-24, 2016, in San Antonio, Texas.

Objective: Evaluate whether dTMS targeting the medial prefrontal and the anterior cingulate cortices influences symptom severity in Obsessive Compulsive Disorder (OCD).

Background: Converging evidence points towards the involvement of a dysfunctional cortico-striato-thalamo-cortical (CSTC) circuit in OCD. Transcranial magnetic stimulation (TMS) has been applied to treat and investigate OCD. However, conventional TMS coils lack the ability to target the CSTC circuits directly and treatment protocols for OCD showed diversified results. The use of dTMS coils allows direct stimulation of deeper neuronal pathways relative to those affected by conventional TMS coils. We evaluated whether dTMS targeting the medial prefrontal and the anterior cingulate cortices may influence symptom severity.

Methods: Forty OCD patients were treated with either dTMS H7/HAC high (20Hz) or low (1Hz) stimulation frequencies or sham coil daily for five weeks in a double blind controlled study. OCD symptoms were provoked in each patient in order to activate the OCD circuitry before treatment. EEG measurements were taken at baseline and at the end of treatment.

Results: The active 20Hz dTMS group improved significantly in YBOCS score compared to the 1Hz and sham groups (26 vs. 6% reduction), {t (93) = -2.29 (p=0.0243)} with three month durability. EEG evoked responses over the anterior cingulate cortex correlated with clinical response, providing an objective measure, or biomarker of dTMS efficacy.

Conclusions: High frequency dTMS treatment with the H7 coil, targeting the medial prefrontal and anterior cingulate cortices is a promising therapeutic intervention in OCD.

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