TMS-induced plasticity improving cognitive control in OCD I: Clinical and neuroimaging outcomes from a randomised trial

Sophie M D D Fitzsimmons; Tjardo Postma; A Dilene van Campen; Chris Vriend; Neeltje M Batelaan; Patricia van Oppen; Adriaan W Hoogendoorn; Ysbrand D van der Werf; Odile A van den Heuvel

doi:10.1016/j.biopsych.2024.06.029

TMS-induced plasticity improving cognitive control in OCD I: Clinical and neuroimaging outcomes from a randomised trial

Biol Psychiatry. 2024 Jul 30:S0006-3223(24)01488-4. doi: 10.1016/j.biopsych.2024.06.029. Online ahead of print.

Authors

Sophie M D D Fitzsimmons¹, Tjardo Postma², A Dilene van Campen², Chris Vriend³, Neeltje M Batelaan⁴, Patricia van Oppen⁴, Adriaan W Hoogendoorn⁵, Ysbrand D van der Werf⁶, Odile A van den Heuvel³

Affiliations

¹ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, de Boelelaan, 1117, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, de Boelelaan, 1117, Amsterdam, The Netherlands. Electronic address: s.fitzsimmons@amsterdamumc.nl.
² Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, de Boelelaan, 1117, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, de Boelelaan, 1117, Amsterdam, The Netherlands.
³ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, de Boelelaan, 1117, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, de Boelelaan, 1117, Amsterdam, The Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands.
⁴ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, de Boelelaan, 1117, Amsterdam, The Netherlands; Amsterdam Public Health, Amsterdam, The Netherlands; GGZ inGeest, Amsterdam, The Netherlands.
⁵ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, de Boelelaan, 1117, Amsterdam, The Netherlands; Amsterdam Public Health, Amsterdam, The Netherlands.
⁶ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Anatomy & Neurosciences, de Boelelaan, 1117, Amsterdam, The Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands.

PMID: 39089567
DOI: 10.1016/j.biopsych.2024.06.029

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for obsessive-compulsive disorder (OCD). The neurobiological mechanisms of rTMS in OCD have been incompletely characterized. We compared clinical outcomes and changes in task-based brain activation following three different rTMS stimulation protocols, all combined with exposure and response prevention (ERP).

Methods: In this three-arm proof-of-concept randomized trial, 61 treatment-refractory adult OCD patients received 16 sessions of rTMS immediately prior to ERP over 8 weeks, with task-based functional MRI (tb-fMRI) scans and clinical assessments pre- and post-treatment. Patients received either: high frequency (HF) rTMS to the left dorsolateral prefrontal cortex (DLPFC)(n=19(6M/13F)); HF rTMS to the left pre-supplementary motor area (preSMA)(n=23(10M/13F)); or control rTMS to the vertex(n=19(6M/13F)). Changes in tb-fMRI activation pre-post treatment were compared using both a Bayesian region-of-interest and a general linear model whole-brain approach.

Results: Mean OCD symptom severity decreased significantly in all treatment groups (delta=-10.836, p<0.001, 95% CI[-12.504,-9.168]), with no differences between groups. Response rate in the entire sample was 57.4%. The DLPFC rTMS group showed decreased planning-related activation post-treatment that was associated with greater symptom improvement. No group-level activation changes were observed for the preSMA or vertex rTMS groups. Participants with greater symptom improvement in the preSMA group showed decreased error-related activation, and symptom improvement in the vertex group was associated with increased inhibition-related activation.

Conclusions: PreSMA and DLPFC rTMS combined with ERP led to activation decreases in targeted task networks in individuals showing greater symptom improvement, although we observed no differences in symptom reduction between groups.

Keywords: OCD; cognitive control; exposure and response prevention psychotherapy; functional MRI; rTMS; task-based fMRI.