Anxiety and mood (대한불안의학회지)

Korean Academy of Anxiety Disorders (대한불안의학회)
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Application of Transcranial Direct Current Stimulation in Obsessive-Compulsive Disorder

강박장애에 대한 경두개 직류자극술의 적용

  • Boo, Young Jun (Air Force Education and Training Command Base Hospital) ;
  • Kim, Se Joo (Department of Psychiatry and Institute of Behavioral Science in Medicine , Yonsei University College of Medicine)
  • 부영준 (공군교육사령부 기지병원) ;
  • 김세주 (연세대학교 의과대학 정신과학교실, 의학행동과학연구소)
  • Received : 2021.01.13
  • Accepted : 2021.02.09
  • Published : 2021.04.30
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Abstract

Treating obsessive-compulsive disorder (OCD) is a difficult challenge since less than a half of the OCD patients show a significant treatment response to 1st line treatment. Therefore, various treatment tools including brain stimulation methods have been studied to solve the treatment-resistance of OCD. Transcranial direct current stimulation (tDCS) is one of the emerging treatment options for OCD. In this review, literatures on tDCS for OCD treatment were evaluated by assessing the treatment effects and safety issues. In most studies, tDCS caused a significant improvement in treatment-resistant OCD without serious adverse event, although its settings including electrode positions and polarity remain unestablished. Further studies are needed to develop protocols for applying tDCS in OCD and to strengthen the evidence of its efficacy.

본 종설에서는 현재까지 진행된 강박장애에서의 tDCS의 임상연구에 대하여 체계적으로 고찰하였다. tDCS는 비침습적이고 비교적 안전한 치료법으로, 치료 저항성을 보이는 강박장애 환자를 대상으로 적용한 다수의 실험 연구 및 사례 보고에서 중대한 이상반응 없이 치료 효과를 나타내었다. 다만 최근 연구에 따르면 치료저항성이 없는 환자에 대해 기존 치료를 대체할 수 있는 수준의 효과를 보이지는 못했으므로, 치료저항성이 없는 환자에서 어느 정도의 효과를 보일 것인지에 대해서는 추가적인 연구가 필요할 것으로 보인다. 강박장애 치료에 있어서 tDCS 활용의 프로토콜은 완전히 정립되지는 않았다. 현 시점까지 출판된 문헌을 토대로 분석하였을 때 대부분의 연구는 2 mA, 세션당 20~30분, 총 10~20 세션으로 이루어졌다. 최근 출판된 근거-기반 tDCS 치료지침에서는 양극 pre-SMA tDCS를 다른 방법보다 우선 채택하였으나, 그 극성에 따른 효과는 아직 논란의 여지가 있는 것으로 보인다. 다만, 해당 치료지침에 포함된 연구 이후에 다수의 RCT 연구들이 출판되었으므로, 연구 결과들을 종합해보면 pre-SMA를 표적으로 한 양극 tDCS 외에 좌측 OFC에 대한 음극 tDCS도 치료 방식의 후보로서 고려를 해볼 수 있을 것으로 보인다. 그 외 DLPFC와 소뇌 등도 tDCS의 표적 위치로 연구된 바가 있어 추가적인 연구가 필요할 것으로 생각된다. 현재까지 진행된 연구를 바탕으로 더욱 더 많은 연구가 진행된다면 tDCS가 추후 치료 저항성 강박장애 환자에서 시도될 수 있는 치료법 중 하나로 정립될 수 있는 가능성이 높을 것으로 기대된다.

Keywords

Acknowledgement

이 연구는 한국연구재단의 연구비 지원으로 이루어졌음(NRF-2018R1A2B2007714).

References

  1. Fawcett EJ, Power H, Fawcett JM. Women Are at Greater Risk of OCD Than Men: A Meta-Analytic Review of OCD Prevalence Worldwide. J Clin Psychiatry 2020;81.
  2. Hong JP, Lee DE, Hahm BJ, Lee JY, Suh TW, Cho SJ, et al. Lifetime prevalence and comorbidity in obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in Korea. Anxiety and Mood 2009;5:29-35.
  3. Ost LG, Havnen A, Hansen B, Kvale G. Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014. Clin Psychol Rev 2015; 40:156-169. https://doi.org/10.1016/j.cpr.2015.06.003
  4. American Psychiatric Association. Pratice guideline for the treatment of patients with Obsessive-Compulsive Disorder. Washington, DC: American Psychiatric Association,; 2007. Available from: http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd.pdf.
  5. American Psychiatric Association. Guideline watch (march 2013): practice guideline for the treatment of patients with Obsessive-Compulsive Disorder. Washington, DC: American Psychiatric Association; 2013. Available from: http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd-watch.pdf.
  6. Fregni F, El-Hagrassy MM, Pacheco-Barrios K, Carvalho S, Leite J, Simis M, et al. Evidence-based guidelines and secondary metaanalysis for the use of transcranial direct current stimulation (tDCS) in neurological and psychiatric disorders. Int J Neuropsychopharmacol 2020.
  7. Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di Iorio R, et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol 2015;126:1071-1107. https://doi.org/10.1016/j.clinph.2015.02.001
  8. Woods AJ, Antal A, Bikson M, Boggio PS, Brunoni AR, Celnik P, et al. A technical guide to tDCS, and related non-invasive brain stimulation tools. Clin Neurophysiol 2016;127:1031-1048. https://doi.org/10.1016/j.clinph.2015.11.012
  9. Gomez-Tames J, Asai A, Hirata A. Significant group-level hotspots found in deep brain regions during transcranial direct current stimulation (tDCS): a computational analysis of electric fields. Clin Neurophysiol 2020;131:755-765. https://doi.org/10.1016/j.clinph.2019.11.018
  10. Loo CK, Husain MM, McDonald WM, Aaronson S, O'Reardon JP, Alonzo A, et al. International randomized-controlled trial of transcranial direct current stimulation in depression. Brain Stimul 2018; 11:125-133. https://doi.org/10.1016/j.brs.2017.10.011
  11. Brunoni AR, Moffa AH, Sampaio-Junior B, Borrione L, Moreno ML, Fernandes RA, et al. Trial of electrical direct-current therapy versus escitalopram for depression. N Engl J Med 2017;376:2523-2533. https://doi.org/10.1056/NEJMoa1612999
  12. Kantrowitz JT, Sehatpour P, Avissar M, Horga G, Gwak A, Hoptman MJ, et al. Significant improvement in treatment resistant auditory verbal hallucinations after 5 days of double-blind, randomized, sham controlled, fronto-temporal, transcranial direct current stimulation (tDCS): a replication/extension study. Brain Stimul 2019;12: 981-991. https://doi.org/10.1016/j.brs.2019.03.003
  13. Bose A, Shivakumar V, Agarwal SM, Kalmady SV, Shenoy S, Sreeraj VS, et al. Efficacy of fronto-temporal transcranial direct current stimulation for refractory auditory verbal hallucinations in schizophrenia: a randomized, double-blind, sham-controlled study. Schizophr Res 2018;195:475-480. https://doi.org/10.1016/j.schres.2017.08.047
  14. Bation R, Mondino M, Le Camus F, Saoud M, Brunelin J. Transcranial direct current stimulation in patients with obsessive compulsive disorder: a randomized controlled trial. Eur Psychiatry 2019;62:38-44. https://doi.org/10.1016/j.eurpsy.2019.08.011
  15. Gowda SM, Narayanaswamy JC, Hazari N, Bose A, Chhabra H, Balachander S, et al. Efficacy of pre-supplementary motor area transcranial direct current stimulation for treatment resistant obsessive compulsive disorder: a randomized, double blinded, sham controlled trial. Brain Stimul 2019;12:922-929. https://doi.org/10.1016/j.brs.2019.02.005
  16. Dadashi M, Asl VY, Morsali Y. Cognitive-behavioral therapy versus transcranial direct current stimulation for augmenting selective serotonin reuptake inhibitors in obsessive-compulsive disorder patients. Basic and Clinical Neuroscience 2020;11:111-120. https://doi.org/10.32598/bcn.11.1.13333.2
  17. Yoosefee S, Amanat M, Salehi M, Mousavi SV, Behzadmanesh J, Safary V, et al. The safety and efficacy of transcranial direct current stimulation as add-on therapy to fluoxetine in obsessive-compulsive disorder: a randomized, double-blind, sham-controlled, clinical trial. BMC Psychiatry 2020;20:570. https://doi.org/10.1186/s12888-020-02979-1
  18. Rapinesi C, Kotzalidis GD, Ferracuti S, Sani G, Girardi P, Del Casale A. Brain Stimulation in Obsessive-Compulsive Disorder (OCD): a systematic review. Curr Neuropharmacol 2019;17:787-807. https://doi.org/10.2174/1570159X17666190409142555
  19. Rachid F. Transcranial direct current stimulation for the treatment of obsessive-compulsive disorder? A qualitative review of safety and efficacy. Psychiatry Res 2019;271:259-264. https://doi.org/10.1016/j.psychres.2018.11.033
  20. da Silva RMF, Brunoni AR, Miguel EC, Shavitt RG. Transcranial direct current stimulation for Obsessive-Compulsive Disorder: patient selection and perspectives. Neuropsychiatr Dis Treat 2019;15: 2663-2669. https://doi.org/10.2147/NDT.S184839
  21. Medical Subject Headings 2021. U.S. National Library of Medicine. Available from: https://meshb.nlm.nih.gov/search. [Accessed 19 December, 2020].
  22. D'Urso G, Brunoni AR, Mazzaferro MP, Anastasia A, de Bartolomeis A, Mantovani A. Transcranial direct current stimulation for obsessive-compulsive disorder: a randomized, controlled, partial crossover trial. Depress Anxiety 2016;33:1132-1140. https://doi.org/10.1002/da.22578
  23. da Silva RMF, Batistuzzo MC, Shavitt RG, Miguel EC, Stern E, Mezger E, et al. Transcranial direct current stimulation in obsessive-compulsive disorder: an update in electric field modeling and investigations for optimal electrode montage. Expert Rev Neurother 2019;19:1025-1035. https://doi.org/10.1080/14737175.2019.1637257
  24. Stagg CJ, Best JG, Stephenson MC, O'Shea J, Wylezinska M, Kincses ZT, et al. Polarity-sensitive modulation of cortical neurotransmitters by transcranial stimulation. J Neurosci 2009;29:5202-5206. https://doi.org/10.1523/JNEUROSCI.4432-08.2009
  25. de Wit SJ, de Vries FE, van der Werf YD, Cath DC, Heslenfeld DJ, Veltman EM, et al. Presupplementary motor area hyperactivity during response inhibition: a candidate endophenotype of obsessivecompulsive disorder. Am J Psychiatry 2012;169:1100-1108. https://doi.org/10.1176/appi.ajp.2012.12010073
  26. Banca P, Voon V, Vestergaard MD, Philipiak G, Almeida I, Pocinho F, et al. Imbalance in habitual versus goal directed neural systems during symptom provocation in obsessive-compulsive disorder. Brain 2015;138:798-811. https://doi.org/10.1093/brain/awu379
  27. Kumar S, Kumar N, Verma R. Safety and efficacy of adjunctive transcranial direct current stimulation in treatment-resistant obsessivecompulsive disorder: an open-label trial. Indian J Psychiatry 2019;61: 327-334. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_509_18
  28. Harika-Germaneau G, Heit D, Chatard A, Thirioux B, Langbour N, Jaafari N. Treating refractory obsessive-compulsive disorder with transcranial direct current stimulation: an open label study. Brain Behav 2020;10:e01648.
  29. Narayanaswamy JC, Jose D, Chhabra H, Agarwal SM, Shrinivasa B, Hegde A, et al. Successful application of add-on transcranial Direct Current Stimulation (tDCS) for treatment of SSRI resistant OCD. Brain Stimul 2015;8:65-657.
  30. Hazari N, Narayanaswamy JC, Chhabra H, Bose A, Venkatasubramanian G, Reddy YC. Response to transcranial direct current stimulation in a case of episodic obsessive compulsive disorder. J ECT 2016;32:144-146. https://doi.org/10.1097/YCT.0000000000000309
  31. Robbins TW, Vaghi MM, Banca P. Obsessive-compulsive disorder: puzzles and prospects. Neuron 2019;102:27-47. https://doi.org/10.1016/j.neuron.2019.01.046
  32. Bation R, Poulet E, Haesebaert F, Saoud M, Brunelin J. Transcranial direct current stimulation in treatment-resistant obsessive-compulsive disorder: an open-label pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2016;65:153-157. https://doi.org/10.1016/j.pnpbp.2015.10.001
  33. Dinn WM, Aycicegi-Dinn A, Goral F, Karamursel S, Yildirim EA, Hacioglu-Yildirim M, et al. Treatment-resistant obsessive-compulsive disorder: Insights from an open trial of transcranial direct current stimulation (tDCS) to design a RCT. Neurology Psychiatry and Brain Research 2016;22:146-154. https://doi.org/10.1016/j.npbr.2016.08.003
  34. Mondino M, Haesebaert F, Poulet E, Saoud M, Brunelin J. Efficacy of Cathodal transcranial direct current stimulation over the left orbitofrontal cortex in a patient with treatment-resistant obsessive-compulsive disorder. J ECT 2015;31:271-272. https://doi.org/10.1097/YCT.0000000000000218
  35. Palm U, Leitner B, Kirsch B, Behler N, Kumpf U, Wulf L, et al. Prefrontal tDCS and sertraline in obsessive compulsive disorder: a case report and review of the literature. Neurocase 2017;23:173-177. https://doi.org/10.1080/13554794.2017.1319492
  36. Volpato C, Piccione F, Cavinato M, Duzzi D, Schiff S, Foscolo L, et al. Modulation of affective symptoms and resting state activity by brain stimulation in a treatment-resistant case of obsessive-compulsive disorder. Neurocase 2013;19:360-370. https://doi.org/10.1080/13554794.2012.667131
  37. Ghaffari H, Yoonessi A, Darvishi MJ, Ahmadi A. Normal electrical activity of the brain in obsessive-compulsive patients after anodal stimulation of the left dorsolateral prefrontal cortex. Basic Clin Neurosci 2018;9:135-146. https://doi.org/10.29252/nirp.bcn.9.2.135
  38. Najafi K, Fakour Y, Zarrabi H, Heidarzadeh A, Khalkhali M, Yeganeh T, et al. Efficacy of transcranial direct current stimulation in the treatment: resistant patients who suffer from severe obsessive-compulsive disorder. Indian J Psychol Med 2017;39:573-578. https://doi.org/10.4103/IJPSYM.IJPSYM_388_16
  39. Nikolin S, Huggins C, Martin D, Alonzo A, Loo CK. Safety of repeated sessions of transcranial direct current stimulation: a systematic review. Brain Stimul 2018;11:278-288. https://doi.org/10.1016/j.brs.2017.10.020
  40. Donde C, Amad A, Nieto I, Brunoni AR, Neufeld NH, Bellivier F, et al. Transcranial direct-current stimulation (tDCS) for bipolar depression: a systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2017;78:123-131. https://doi.org/10.1016/j.pnpbp.2017.05.021
  41. Vigod SN, Murphy KE, Dennis CL, Oberlander TF, Ray JG, Daskalakis ZJ, et al. Transcranial direct current stimulation (tDCS) for depression in pregnancy: a pilot randomized controlled trial. Brain Stimul 2019;12:1475-1483. https://doi.org/10.1016/j.brs.2019.06.019
  42. Parlikar R, Sreeraj VS, Chhabra H, Thimmashetty VH, Parameshwaran S, Selvaraj S, et al. Add-on HD-tDCS for obsessive-compulsive disorder with comorbid bipolar affective disorder: a case series. Asian J Psychiatr 2019;43:87-90. https://doi.org/10.1016/j.ajp.2019.05.015
  43. Verma R, Kumar N, Mahapatra A, Shah B. Effectiveness of tDCS augmentation for co-morbid obsessive compulsive disorder in chronic schizophrenia: a case report. Asian J Psychiatr 2018;38:9-11. https://doi.org/10.1016/j.ajp.2018.10.013
  44. Silva RM, Brunoni AR, Miguel EC, Shavitt RG. Transcranial direct current stimulation for treatment-resistant obsessive-compulsive disorder: report on two cases and proposal for a randomized, shamcontrolled trial. Sao Paulo Med J 2016;134:446-450. https://doi.org/10.1590/1516-3180.2016.0155010716
  45. Todder D, Gershi A, Perry Z, Kaplan Z, Levine J, Avirame K. Immediate effects of transcranial direct current stimulation on obsession-induced anxiety in refractory obsessive-compulsive disorder: a pilot study. J ECT 2018;34:e51-e57. https://doi.org/10.1097/YCT.0000000000000473
  46. D'Urso G, Brunoni AR, Anastasia A, Micillo M, de Bartolomeis A, Mantovani A. Polarity-dependent effects of transcranial direct current stimulation in obsessive-compulsive disorder. Neurocase 2016; 22:60-64. https://doi.org/10.1080/13554794.2015.1045522