title: Transcranial direct current stimulation in treatment-resistant obsessive-compulsive disorder: An open-label pilot study.
abstract: BACKGROUND
  Obsessive-compulsive disorder (OCD) is a severe mental illness. OCD symptoms are often resistant to available treatments. Abnormalities within the orbitofronto-striato-pallido-thalamic circuitry, especially orbitofrontal cortex (OFC) hyperactivity and cerebellar hypoactivity have been observed in patients. Non-invasive brain stimulation studies have indicated that transcranial direct current stimulation (tDCS) may be a useful alternative to alleviate treatment-resistant symptoms in various neuropsychiatric conditions.
  
  
  METHODS
  In an open-label pilot study, 8 patients with treatment-resistant OCD received 10 sessions (twice a day) of 2mA tDCS applied with the cathode over the left OFC and the anode over the right cerebellum. OCD (Y-BOCS and OCD-VAS) as well as depressive (MADRS) symptoms were measured 4 times: one time before tDCS and 3 times after (immediately after, 1 and 3months after the 10th tDCS session).
  
  
  RESULTS
  We reported a significant 26.4% (±15.8) decrease of Y-BOCS score (p=0.002). The beneficial effect lasted during the 3month follow-up. No effect of tDCS was observed on depressive symptoms. At end point, 5 out of 8 patients had a decrease of ≥25%; and 3 out of 8 patients had a decrease of ≥35% in Y-BOCS score. tDCS was well tolerated.
  
  
  CONCLUSIONS
  tDCS with the cathode placed over the left OFC combined with the anode placed over the right cerebellum is a suitable and safe approach to decrease OCD symptoms in patients with treatment-resistant OCD. Large scale randomized controlled studies are needed to confirm this promising result.
authors.affiliation: Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France. Electronic address: remy.bation@ch-le-vinatier.fr.
authors.forename: Remy
authors.initials: R
authors.lastname: Bation
authors.affiliation: Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France; CHU de Lyon - Groupement Hospitalier Edouard Herriot - Service de Psychiatrie des Urgences, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Poulet
authors.affiliation: Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Haesebaert
authors.affiliation: Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France; CHU de Lyon - Groupement Hospitalier Est - Hôpital Pierre Wertheimer - Psychiatrie adultes - Consultations/Liaison, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Saoud
authors.affiliation: Université de Lyon, F-69003, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Brunelin
mesh_terms: D000328:Adult; D002531:Cerebellum / Q000503:physiopathology; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Cerebellum; OCD; OFC; Obsessive–compulsive disorder; Orbitofrontal cortex; Transcranial direct current stimulation; tDCS