Sleep disturbances in obsessive-compulsive disorder: Association with non-response to repetitive transcranial magnetic stimulation (rTMS)

Item does not contain fulltextBackground Repetitive transcranial magnetic stimulation (rTMS) is a promising augmentation strategy for treatment-refractory OCD. However, a substantial group still fails to respond. Sleep disorders, e.g. circadian rhythm sleep disorders (CRSD), are highly prevalent in OCD and might mediate treatment response. The aims of the current study were to compare sleep disturbances between OCD patients and healthy subjects as well as between rTMS responders and non-responders, and most importantly to determine sleep-related predictors of rTMS non-response. Methods 22 OCD patients received at least 10 sessions rTMS combined with psychotherapy. Sleep disturbances were measured using questionnaires and actigraphy. Sleep in patients was compared to healthy subjects. Treatment response was defined as >35% reduction on YBOCS. Treatment response prediction models were based on measures of CRSD and insomnia. Results Sleep disturbances were more prevalent in OCD patients than healthy subjects. The OCD group consisted of 12 responders and 10 non-responders. The CRSD model could accurately predict non-response with 83% sensitivity and 63% specificity, whereas the insomnia model could not. Conclusions CRSD is more prevalent in OCD patients than healthy subjects, specifically in rTMS non-responders. Therefore, CRSD may serve as a biomarker for different subtypes of OCD corresponding with response to specific treatment approaches

TMS and its applications in neuropsychiatry and clinical neuroscience

The main and best evidence-based indication to date to apply repetitive Transcranial Magnetic Stimulation (rTMS) in psychiatric disorders is major depression. Nevertheless, given that the high occurrence of major depressive disorders poses a major challenge for health systems worldwide, there is an urgent need for improving the clinical efficacy of the existing approved rTMS applications and promoting the development of effective rTMS treatment approaches. Besides providing an overview of the current evidence here, we discuss novel stimulation patterns, targets, and coils; combined treatments and maintenance; personalization and stratification of rTMS parameters; and the treatment of subpopulations.

Non-invasive brain stimulation in human stroke survivors

The use of electromagnetic currents toward understanding and curing human disease has long been of interest. In the 1980s, a dramatic increase in our understanding of brain function, along with parallel improvements in non-invasive brain stimulation (NIBS) technologies, subsequently caused rapid expansion of the field. Intraoperative monitoring techniques that incorporated single pulse stimulation were developed concurrently for the purpose of measuring corticospinal integrity (Merton & Morton, 1980a, 1980b); however, with the introduction of transcranial magnetic stimulation (TMS), the use of NIBS decisively exploded, opening a new window into the exploration and modulation of the brain (Barker and Jalinous, Lancet, 1(8437):1106–1107, 1985). Single pulse TMS, used initially to study inter-cortical physiology of the intact corticospinal tract, was thereafter investigated toward the rehabilitation of neurological and psychiatric conditions