High-frequency electrical stimulation, personalized to the pattern of reward-controlled brain network activity, may reduce obsessive-compulsive behavior, a new study suggests.
In the study, normal transcranial alternating stimulation (HD-tACS) was personalized to the beta-gamma frequency of the reward network associated with reduced obsessive-compulsive behavior. Participants with the worst symptoms showed the greatest benefits.
“This result is promising, as it suggests that neuromodulation may be helpful in severe and anxious clinical conditions, such as obsessive-compulsive disorder and substance use disorder,” said lead investigator Robert Reinhart, PhD, Center for Neuroscience Systems, Boston University, Boston, Massachusetts, told Medscape Medical News
The findings were published online Jan. 18 in Nature’s cure.
Quick and strong relief
An emerging view is that obsessive-compulsive behavior is the result of learning maladaptive use, which may be related to rare beta-gamma neurophysiology of orbitofrontal cortex (OFC) circulation during reward processing.
In two experiments, the researchers used HD-tACS to establish the functional contribution of beta-gamma OFC rhythms in reward learning and examined its ability to normalize obsessive-compulsive behavior.
In the first trial, which involved 60 volunteers, they showed that targeting the OFC with HD-tACS was personalized to the sexual beta-gamma frequency of the reward network leading to “rapid” modeling of reward behavior and learning.
“This observation could help advance our understanding of the brain processes that cause obsessive-compulsive behavior,” Reinhart said.
The second trial included 64 individuals with obsessive-compulsive symptoms in the subclinical and clinical domain. In this group, beta-gamma modeling through the application of HD-tACS for 30 min over 5 consecutive days “strongly” reduces obsessive-compulsive behavior for up to 3 months.
On average, overall scores on the Obsessive-Compulsive – Revised Account, the most common self-report scale in obsessive-compulsive disorder (OCD) research, were lower by nearly 28% over 3 months. The greatest benefits were seen in those with more severe symptoms.
“Personalization is increasingly recognized as an important feature for improving the effectiveness of neuromodulation. We propose a way to personalize neuromodulation for obsessive-compulsive behavior according to an individual’s patterns of brain activity as they learn from rewards,” said Reinhart.
He noted that the researchers would like to investigate the potential effectiveness of this approach for patients with other ailments, including gambling disorder, addiction, disability -creative use, compulsory eating, and compulsory purchase and internet use.
“Further research will be needed to better understand the ways in which obsessive-compulsive behavior can be reduced by using this approach and to identify features that will lead to even stronger and longer lasting improvements,” he said.
“Very promising” results
Referring to the study for Medscape Medical News, Brittany LeMonda, PhD, senior neuropsychologist at Lenox Hill Hospital, New York City, said the findings are “very promising because we have limited treatments for true OCD, so anything that can us to add to the mixture to help patients ’symptoms improve.
“What stood out to me was that patients had symptom relief for about 3 months, and people with the most severe symptoms showed the strongest benefit, which is great because many of the Those patients usually resist other treatment modalities, “said LeMonda, who was not involved in the investigation.
Patients with OCD often take medications that can cause adverse events, she said. Neuromodulation is noninvasive and has “few side effects, which is also important.
“We know that the striatal front system is linked to OCD, so it makes sense from a scientific point of view that a change in that system or a break in that feedback loop could be helpful, “said LeMonda.
She also noted that Tourette syndrome, OCD, and attention deficit / attention deficit disorder are thought to be associated with the same type of disorder in the striatal frontal tracts.
“So we could use this as a springboard to explore other numbers as well,” LeMonda concluded.
The study was funded by a grant from the National Institutes of Health and a gift from an individual philanthropist donated to Reinhart. The auditors and LeMonda have not reported any material financial relationships.
Nat Med. Published online January 18, 2021. Summary
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