High frequency repetitive transcranial magnetic stimulation of supplementary motor cortex for obsessive compulsive...

Obsessive compulsive disorder (OCD) is a common psychiatric disorder that can lead to significant dysfunction. It is treated with medications and or cognitive behavior therapy. Many patients with OCD do not respond to above mentioned conventional treatments. OCD is also a disorder with well delineated neuropathology in brain areas that form cortico-striato-thalamocortical loop. Transcranial magnetic stimulation (TMS) can not only offer a noninvasive treatment modality for many of these patients but can also specifically and beneficially affect involved neuronal areas. TMS stimulation of various brain areas including supplementary motor cortex, dorsolateral prefrontal cortex, orbitofrontal cortex and anterior cingulate cortex has been found to be beneficial in alleviating OCD symptoms in various studies. Low frequency and less often high frequency TMS of these areas has been found to be effective. High frequency deep TMS, as opposed to conventional TMS, of medial prefrontal cortex and anterior cingulate cortex was found to be effective and is approved as an adjunctive treatment option for severe OCD. There is no consensus as to the target stimulation site and optimal TMS stimulation protocol that can achieve maximum improvement in OCD symptoms. We hypothesize that high frequency r-TMS of supplementary motor cortex will alleviate OCD symptoms.