Increased Amygdala Activation During Symptom Provocation Predicts Response to Combined Repetitive Transcranial Magnetic Stimulation and Exposure Therapy in Obsessive-Compulsive Disorder in a Randomized Controlled Trial
Milan Houben , Tjardo S. Postma , Sophie M.D.D. Fitzsimmons , Chris Vriend , Neeltje M. Batelaan , Adriaan W. Hoogendoorn , Ysbrand D. van der Werf , Odile A. van den Heuvel
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Abstract
Background
Repetitive transcranial magnetic stimulation (rTMS) combined with exposure and response prevention is a promising treatment modality for treatment-refractory obsessive-compulsive disorder (OCD). However, not all patients respond sufficiently to this treatment. We investigated whether brain activation during a symptom provocation task could predict treatment response.
Methods
Sixty-one adults with OCD (39 female/22 male) underwent symptom provocation with OCD- and fear-related visual stimuli during functional magnetic resonance imaging prior to an 8-week combined rTMS and exposure and response prevention treatment regimen. Participants received one of the following 3 rTMS treatments as part of a randomized controlled trial: 1) 10-Hz rTMS (110% resting motor threshold) to the left dorsolateral prefrontal cortex, 2) 10-Hz rTMS (110% resting motor threshold) to the left presupplementary motor area, or 3) 10-Hz control rTMS (60% resting motor threshold) to the vertex. Multiple regression and correlation were used to examine the predictive value of task-related brain activation for treatment response in the following regions of interest: the dorsomedial prefrontal cortex, amygdala, dorsolateral prefrontal cortex, and left presupplementary motor area.
Results
The different treatment groups responded equally to treatment. Higher pretreatment task-related activation of the right amygdala to OCD-related stimuli showed a positive association with treatment response in all groups. Exploratory whole-brain analyses showed positive associations between activation in multiple task-relevant regions and treatment response. Only dorsal anterior cingulate cortex activation to fear-related stimuli showed a negative association with treatment outcome.
Conclusions
Higher pretreatment right amygdala activation during symptom provocation predicts better treatment response to combined rTMS and exposure and response prevention in OCD.
期刊介绍：
Biological Psychiatry: Cognitive Neuroscience and Neuroimaging is an official journal of the Society for Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms, and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal focuses on studies using the tools and constructs of cognitive neuroscience, including the full range of non-invasive neuroimaging and human extra- and intracranial physiological recording methodologies. It publishes both basic and clinical studies, including those that incorporate genetic data, pharmacological challenges, and computational modeling approaches. The journal publishes novel results of original research which represent an important new lead or significant impact on the field. Reviews and commentaries that focus on topics of current research and interest are also encouraged.
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