Reductions in cortico-striatal hyperconnectivity accompany successful treatment of obsessive-compulsive disorder with dorsomedial prefrontal rTMS

Dunlop, Katharine; Woodside, Blake; Olmsted, Marion P.; Colton, Patricia; Giacobbe, Peter; Downar, Jonathan

doi:10.1016/j.brs.2015.01.050

Cited by 18 publications

(37 citation statements)

References 51 publications

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“…In keeping with this observation, dopamine agonists and antagonists can potentiate or block the effects of rTMS . Baseline cortico–striatal–thalamic functional connectivity on resting‐state fMRI predicts treatment outcome across multiple conditions, including MDD, eating disorders, OCD, and movement disorders . Pre–post treatment changes in this measure also track outcomes across all of these disorders.…”

Section: Nibs As a Treatment For Mdd/sudsmentioning

confidence: 76%

Noninvasive brain stimulation treatments for addiction and major depression

Dunlop

Hanlon

Downar

2016

Annals of the New York Academy of Sciences

134

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Major depressive disorder (MDD) and substance use disorders (SUDs) are prevalent, disabling, and challenging illnesses for which new treatment options are needed, particularly in comorbid cases. Neuroimaging studies of the functional architecture of the brain suggest common neural substrates underlying MDD and SUDs. Intrinsic brain activity is organized into a set of functional networks, of which two are particularly relevant to psychiatry. The salience network (SN) is crucial for cognitive control and response inhibition, and deficits in SN function are implicated across a wide variety of psychiatric disorders, including MDD and SUDs. The ventromedial network (VMN) corresponds to the classic reward circuit, and pathological VMN activity for drug cues/negative stimuli is seen in SUDs/MDD. Noninvasive brain stimulation (NIBS) techniques, including rTMS and tDCS, have been used to enhance cortico–striatal–thalamic activity through the core SN nodes in the dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, and anterior insula. Improvements in both MDD and SUD symptoms ensue, including in comorbid cases, via enhanced cognitive control. Inhibition of the VMN also appears promising in preclinical studies for quenching the pathological incentive salience underlying SUDs and MDD. Evolving techniques may further enhance the efficacy of NIBS for MDD and SUD cases that are unresponsive to conventional treatments.

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Section: Nibs As a Treatment For Mdd/sudsmentioning

confidence: 76%

Noninvasive brain stimulation treatments for addiction and major depression

Dunlop

Hanlon

Downar

2016

Annals of the New York Academy of Sciences

134

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“…First, compared to DLPFC, the DMPFC shows more consistent structural and functional abnormalities in neuroimaging studies of PTSD (Goodkind et al, 2015;Meng et al, 2014); second, in healthy controls, the DMPFC is more closely associated with emotional and behavioral self-control. Previously, we have reported beneficial effects for DMPFC-rTMS in major depression (18), binge eating and purging (Downar, Sankar, Giacobbe, Woodside, & Colton, 2012), and obsessive-compulsive disorder (OCD) (Dunlop et al, 2015b). In the same studies, functional magnetic resonance imaging (fMRI) has revealed changes in the activity of frontal lobe circuits involved in emotion regulation, accompanying clinical improvements.…”

Section: Introductionmentioning

confidence: 97%

“…Another exploratory meta-analysis (Berlim, Broadbent, & Van den Eynde, 2013) of randomized and sham-controlled studies using DLPFC-rTMS found significantly improved outcomes overall in anxiety and depressive symptoms. Previously, we have reported beneficial effects for DMPFC-rTMS in major depression (18), binge eating and purging (Downar, Sankar, Giacobbe, Woodside, & Colton, 2012), and obsessive-compulsive disorder (OCD) (Dunlop et al, 2015b). Previously, we have reported beneficial effects for DMPFC-rTMS in major depression (18), binge eating and purging (Downar, Sankar, Giacobbe, Woodside, & Colton, 2012), and obsessive-compulsive disorder (OCD) (Dunlop et al, 2015b).…”

Section: Introductionmentioning

confidence: 99%

Dorsomedial prefrontal cortex repetitive transcranial magnetic stimulation treatment of posttraumatic stress disorder in eating disorders: An open‐label case series

Woodside

Colton

Lam

et al. 2017

Intl J Eating Disorders

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Posttraumatic stress disorder (PTSD) is a common comorbid condition in anorexia nervosa (AN) and bulimia nervosa (BN), and may be associated with reduced response to treatment. We report on a case series employing repetitive transcranial magnetic stimulation (rTMS) with a novel target, the dorsomedial prefrontal cortex (DMPFC). Fourteen subjects with eating disorders and comorbid PTSD received 20-30 neuronavigated DMPFC-rTMS treatments on an open-label basis. PTSD symptoms were assessed pretreatment and posttreatment with the PTSD checklist-Civilian (PCL-C) and the Difficulties in Emotional Regulation Scale (DERS). PCL-C scores were reduced by 51.99% ± 27.24% overall, from a mean of 54.29 ± 19.34 pretreatment to 24.86 ± 17.43 posttreatment (p < .001). Of the 14, 8 showed an improvement of >50%. DERS scores improved by 36.02% ± 24.24% overall, from 140.00 ± 22.09 at pretreatment to 89.29 ± 38.31 at posttreatment (p < .001). OF the 14 subjects, 5 achieved >50% improvement. These data may suggest that DMPFC-rTMS could be helpful in the treatment of PTSD in some ED patients.

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“…Moreover, imaging studies revealed brain connectivity changes in treatment responders without a clear pattern across studies. In OCD both treatment with 10 Hz and 1 Hz resulted in symptom improvement. Further indications in which dmPFC‐DCC‐rTMS was explored include binge/purge behavior, bulimia, alcohol craving, tinnitus, and fibromyalgia .…”

Section: Discussionmentioning

confidence: 95%

“…In a subsequent study (56), the effects of 20-30 sessions of bilateral 10 Hz dmPFC-rTMS in treatment-resistant patients suffering from obsessive compulsive disorder (OCD) were investigated. Fifty percent of the treated patients met response criteria and reductions in fronto-striatal hyperconnectivity were associated with treatment response to dmPFC-rTMS (56). The same research group reported results of an open-label-study on patients with treatment-resistant major depression.…”

Section: Clinical Studiesmentioning

confidence: 99%