title: Repetitive transcranial magnetic stimulation over the orbitofrontal cortex for obsessive-compulsive disorder: a double-blind, crossover study.
abstract: This pilot study was designed to assess the efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the right orbitofrontal cortex (OFC) by means of a double-cone coil in patients suffering from obsessive-compulsive disorder. We hypothesized that low-frequency stimulation of the OFC would lead to a reduction in clinical symptoms, as measured on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). A randomized, double-blind, crossover design was implemented with two 1-week treatment periods (active stimulation versus sham stimulation) separated by a 1-month washout period. Concomitantly, a subgroup of patients underwent a positron emission tomography (PET) scan after each stimulation sequence. Statistical analyses compared the Y-BOCS scores at the end of each period. At day 7, we observed a significant decrease from baseline in the Y-BOCS scores, after both active (P<0.01) and sham stimulation (P=0.02). This decrease tended to be larger after active stimulation than after sham stimulation: -6 (-29, 0) points versus -2 (-20, 4) points (P=0.07). Active versus sham PET scan contrasts showed that stimulation was related to a bilateral decrease in the metabolism of the OFC. The OFC should definitely be regarded as a key neuroanatomical target for rTMS, as it is easier to reach than either the striatum or the subthalamic nucleus, structures favored in neurosurgical approaches.
authors.affiliation: 1] EA-4712 Behavior and Basal Ganglia Unit, Université de Rennes 1, Rennes, France [2] Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de Psychiatrie, Rennes, France.
authors.forename: C
authors.initials: C
authors.lastname: Nauczyciel
authors.affiliation: 1] EA-4712 Behavior and Basal Ganglia Unit, Université de Rennes 1, Rennes, France [2] Département de Médecine Nucléaire, Centre Eugène Marquis, Rennes, France.
authors.forename: F
authors.initials: F
authors.lastname: Le Jeune
authors.affiliation: 1] EA-4712 Behavior and Basal Ganglia Unit, Université de Rennes 1, Rennes, France [2] Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de Psychiatrie, Rennes, France [3] Centre d'Investigation Clinique CIC-P INSERM 0203, Hôpital de Pontchaillou, Centre Hospitalier Universitaire de Rennes et Université de Rennes 1, Rennes, France.
authors.forename: F
authors.initials: F
authors.lastname: Naudet
authors.affiliation: Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de Psychiatrie, Rennes, France.
authors.forename: S
authors.initials: S
authors.lastname: Douabin
authors.affiliation: 1] EA-4712 Behavior and Basal Ganglia Unit, Université de Rennes 1, Rennes, France [2] Département de Neuroradiologie, Centre Eugène Marquis, Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Esquevin
authors.affiliation: EA-4712 Behavior and Basal Ganglia Unit, Université de Rennes 1, Rennes, France.
authors.forename: M
authors.initials: M
authors.lastname: Vérin
authors.affiliation: 1] EA-4712 Behavior and Basal Ganglia Unit, Université de Rennes 1, Rennes, France [2] Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de Psychiatrie, Rennes, France.
authors.forename: T
authors.initials: T
authors.lastname: Dondaine
authors.affiliation: 1] EA-4712 Behavior and Basal Ganglia Unit, Université de Rennes 1, Rennes, France [2] Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de Psychiatrie, Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Robert
authors.affiliation: 1] EA-4712 Behavior and Basal Ganglia Unit, Université de Rennes 1, Rennes, France [2] Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de Psychiatrie, Rennes, France.
authors.forename: D
authors.initials: D
authors.lastname: Drapier
authors.affiliation: 1] EA-4712 Behavior and Basal Ganglia Unit, Université de Rennes 1, Rennes, France [2] Centre Hospitalier Guillaume Régnier, Service Hospitalo-Universitaire de Psychiatrie, Rennes, France.
authors.forename: B
authors.initials: B
authors.lastname: Millet
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D004292:Dominance, Cerebral / Q000502:physiology; D004311:Double-Blind Method; D004734:Energy Metabolism / Q000502:physiology; D004867:Equipment Design; D005260:Female; D019788:Fluorodeoxyglucose F18; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D049268:Positron-Emission Tomography; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation / Q000295:instrumentation*
chemical_list: D019788:Fluorodeoxyglucose F18