title: Neural correlates associated with symptom provocation in pediatric obsessive compulsive disorder after a single session of sham-controlled repetitive transcranial magnetic stimulation.
abstract: Treatments for pediatric obsessive-compulsive disorder (OCD) could be enhanced if the physiological changes engendered by treatment were known. This study examined neural correlates of a provocation task in youth with OCD, before and after sham-controlled repetitive transcranial magnetic stimulation (rTMS). We hypothesized that rTMS to the right dorsolateral prefrontal cortex would inhibit activity in cortico-striato-thalamic (CST) circuits associated with OCD to a greater extent than sham rTMS. After baseline (Time 1) functional magnetic resonance imaging (fMRI) during a provocation task, subjects received one session of either fMRI-guided sham (SG; n=8) or active (AG; n=10) 1-Hz rTMS over the rDLPFC for 30min. During rTMS, subjects were presented with personalized images that evoked OCD-related anxiety. Following stimulation, fMRI and the provocation task were repeated (Time 2). Contrary to our prediction for the provocation task, the AG was associated with no changes in BOLD response from Times 1 to 2. In contrast, the SG had a significant increase at Time 2 in BOLD response in the right inferior frontal gyrus and right putamen, which persisted after adjusting for age, gender, and time to scanner as covariates. This study provides an initial framework for TMS interrogation of the CST circuit in pediatric OCD.
authors.affiliation: Division of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: ernest.pedapati@cchmc.org.
authors.forename: Ernest
authors.initials: E
authors.lastname: Pedapati
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: DiFrancesco
authors.affiliation: Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Wu
authors.affiliation: Division of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Giovanetti
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Nash
authors.affiliation: Department of Physiology, Pharmacology, and Neuroscience, City University of New York, New York, NY USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Mantovani
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Ammerman
authors.affiliation: Division of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Elana
authors.initials: E
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000175:diagnosis / Q000378:metabolism; D002648:Child; D004311:Double-Blind Method; D005260:Female; D005625:Frontal Lobe / Q000378:metabolism*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000378:metabolism*; D017397:Prefrontal Cortex / Q000378:metabolism; D011699:Putamen / Q000378:metabolism*; D013788:Thalamus / Q000378:metabolism; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: Neuronavigation; Obsessive compulsive disorder; Provocation task; Symptom provocation; Transcranial magnetic stimulation