Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-28T19:53:28.828Z Has data issue: false hasContentIssue false

Transcranial Magnetic Stimulation as a Probe and Potential Treatment in Obsessive-Compulsive Disorder

Published online by Cambridge University Press:  07 November 2014

Extract

Transcranial magnetic stimulation (TMS), a relatively noninvasive probe of cortical function, permits new kinds of explorations of relationships between regional brain activity and symptomatology in obsessive-compulsive disorder (OCD). In TMS, a pulsed magnetic field affects activity in cerebral cortex underlying an electromagnetic coil placed on the scalp. Results of exploratory studies suggest that the single- or paired-pulse TMS techniques, and the newer repetitive method (rTMS), in which trains of stimuli are delivered at a given frequency, are potentially useful probes of cortical mechanisms involved in psychopathologic conditions, as in studies of motor, sensory, and cognitive physiology. For example, single-pulse TMS of motor cortex can produce muscle potentials or movement. Higher-frequency repetitive stimulation (rTMS) of occipital cortex can produce phosphenes or visual extinction, stimulation of Broca's area results in word-finding difficulties or speech arrest, and rTMS of prefrontal cortex affects verbal recall and other cognitive functions. Prefrontal rTMS can alter mood in healthy individuals. Both open and controlled clinical studies suggest that single-pulse TMS, and rTMS, may have antidepressant effects. Although the cerebral cortex is the only human brain structure subject to direct magnetic stimulation with current technology, TMS may influence activity in subcortical sites via their functional relationships with cortical areas. The effects of TMS on cortical excitability may depend on a combination of factors including coil design, stimulus frequency and intensity, and possibly the functional state of the cortex before stimulation.

Type
Supplement Monograph
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Pascual-Leone, A, Grafman, J, Cohen, LG, Roth, BJ, Hallett, M. Transcranial magnetic stimulation: a new tool for the study of higher cognitive function in humans. In: Grafman, J, Boller, N, eds. Handbook of Neuropsychology. Amsterdam, The Netherlands: Elsevier Science Publishing; 1997.Google Scholar
2.Pascual-Leone, A, Catala, MD, Pascual, AP. Lateralized effect of rapid-rate transcranial magnetic stimulation on mood. Neurology. 1996;46:499502.CrossRefGoogle ScholarPubMed
3.George, MS, Wassermann, EM, Williams, W, et al.Changes in mood and hormone levels after rapid-rate transcranial magnetic stimulation (rTMS) of the prefrontal cortex. J Neuropsychiatry Clin Neurosci. 1996;8:172180.Google ScholarPubMed
4.Martin, JD, George, MS, Greenberg, BD, et al.Mood effects of prefrontal repetitive high frequency magnetic stimulation (rTMS) in healthy volunteers. CNS Spectrum. 1997;2:5354.CrossRefGoogle Scholar
5.George, MS, Speer, AM, Wassermann, EM, Kimbrell, TA, Williams, WA, Kellner, CH, Risch, SC, Stallings, L, Post, R. Repetitive TMS as a probe in health and disease. CNS Spectrums. 1997;2:3944.CrossRefGoogle Scholar
6.Rauch, SL. Neuroimaging in obsessive-compulsive disorder and related disorders. Recent development in the neurobiology of obsessive-compulsive disorder. J Clin Psychiat. 1996;57:492495.Google Scholar
7.Hoehn-Saric, R, Benkelfat, C. Structural and functional brain imaging in OCD. In: Hollander, E, Zohar, J, Marazziti, D, eds. Current Concepts in OCD. New York: John Wiley & Sons;1994:183211.Google Scholar
8.Hoehn-Saric, R, Greenberg, BD. Psychobiology of obsessive-compulsive disorder: anatomical and physiological considerations. Int Rev Psychiatry. 1997;9:1530.CrossRefGoogle Scholar
9.Rauch, SL, Jenike, MA, Alpert, NM. Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography. Arch Gen Psychiatry. 1994;51:6270.CrossRefGoogle ScholarPubMed
10.Baxter, LR, Schwartz, JM, Bergman, KS. Caudate glucose metabolic rate changes with drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry. 1992;49:681689.CrossRefGoogle ScholarPubMed
11.Schwartz, JM, Stoessel, PW, Baxter, LRJ, Martin, KM, Phelps, ME. Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Arch Gen Psychiatry. 1996;53:109113.CrossRefGoogle ScholarPubMed
12.Mindus, P, Rauch, SL, Nyman, H, Baer, L, Edman, G, Jenicke, M. Capsulotomy and cingulotomy as treatments for malignant obsessive-compulsive disorder: an update. In: Hollander, E, Zohar, J, Marazziti, D, eds. Current Concepts in OCD. New York: John Wiley & Sons;1994:244276.Google Scholar
13.Mindus, P, Ericson, K, Greitz, T, Meyerson, BA, Nyman, H, Sjogren, I. Regional cerebral glucose metabolism in anxiety disorders studied with positron emission tomography before and after psychosurgical intervention. A preliminary report. Acta Radiol Suppl (Stockholm). 1986;369:444448.Google ScholarPubMed
14.Greenberg, BD, George, MS, Martin, JD, et al.Effect of prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a preliminary study. Am J Psychiatry. 1997;154:867869.Google ScholarPubMed
15.Greenberg, BD, Ziemann, U, Harmon, A, Corá-Locatelli, G, Murphy, DL, Wassermann, EM. Intracortical inhibition and excitation in obsessive-compulsive disorder. Neurology. 1998;50:A362.Google Scholar
16.Ziemann, U, Paulus, W, Rothenberger, A. Decreased motor inhibition in Tourette's disorder: evidence from transcranial magnetic stimulation. Am J Psychiatry. 1997;154:12771284.Google ScholarPubMed