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WHAT IS THE ROLE OF rTMS IN DRUG ADDICTION

rTMS can Modulate
Cortical Excitability

Unfortunately, about half of all patients with OCD fail to respond to traditional medications. Moreover, OCD requires using higher doses of these medicines, which comes at the cost of serious side effects, causing patients to stop their treatment. Even in patients who do take their medications as prescribed, it’s seen that there is never a complete relief from symptoms.

Another option commonly employed by practitioners for OCD is behavioral therapy in the form of exposure and response prevention (ERP) and cognitive therapy. ERP involves exposing the patient to the very cues that evoke distressing and obsessive thoughts. That said, patients often feel frustrated after being exposed to distressing cues, resulting in high dropout rates from behavioral therapies.

Second-line options for
OCD Carry Serious Risks

If drug and behavioral therapies fail, the next step employed by practitioners is a procedure known as ventral capsulotomy. It involves surgically implanting a deep brain stimulator (DBS), which targets the area of the brain linked to OCD. Though this procedure has shown promise in treatment-refractory patients, just like any other surgery, DBS carries serious risks.

In the face of treatment-resistant OCD, there has been a pressing need to develop new, effective, safe, and tolerable therapies to minimize the huge burden of this condition. One of these therapies is TMS or dTMS.

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ocd treatment in costa mesa orange county

What is dTMS and how is it
different from Conventional TMS?

Up till now, clinical trials using TMS for OCD were being studied with non-deep TMS, which showed limitations in its results because the magnetic pulses only had access to the superficial cortical areas of the brain.

However, the advent of advances in neuroscience in the last few decades has paved the way for a novel third option for treating OCD, called deep transcranial magnetic stimulation, or dTMS.

dTMS therapy is now FDA-approved as an add-on treatment for OCD. The most popular method to apply dTMS in OCD is the Brainsway Method. It uses a lightweight helmet with magnetic pulses generated through a built-in coil known as an H-coil to specifically penetrate the deeper areas of the brain implicated in OCD. Hence, dTMS allows for stimulation of larger brain volume than conventional TMS.

Similar to conventional TMS, dTMS is also an entirely non-invasive therapy and done as an out-patient procedure with virtually no side effects.

Have questions?

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What is the Role of rTMS in Drug Addiction?

The areas specifically implicated in OCD are the orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC). These areas are located in the frontal lobes (that sit in the very front of the brain) and are responsible for error-detection and emotional, reward, and behavioral regulation.

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Research shows that the OFC and ACC:

  1. are hyperactive at rest in people with OCD compared to healthy patients
  2. become overly active when symptoms are provoked
  3. resume their normal activity after successful treatment with either medical or behavioral therapy

Normally, these regions are intimately connected to the basal ganglia — a cluster of nerve cells responsible for movement and regulating emotions and behavior. The basal ganglia receive the input from the cerebral cortex. These signals are then conveyed to another brain region called the thalamus, which then relays this information back to the cortex.

However, hyperactivity in the frontal lobes of OCD patients breaks the communication between the basal ganglia and thalamus. This causes the thalamus to get out of control. This failure of the frontal lobes to inhibit the thalamus is what triggers unrelenting intrusive thoughts and behaviors.

The usage of dTMS in tweaking brain activity in OCD is contingent upon the maladaptive behavior of neurons in these networks. It either excites or suppresses these target regions based on the frequency of magnetic pulses applied.

How Effective is dTMS for OCD?

dTMS therapy has optimized the odds for people with OCD to finally receive treatment that will benefit them.

2019 clinical study published in the American Journal of Psychiatry showed a statistically significant (30%) improvement in OCD symptoms in the dTMS group after 6 weeks of daily sessions, as measured by the Yale-Brown Obsessive-Compulsive Scale. The treatment was as effective as the medications available for treating OCD. Nonetheless, dTMS achieved quicker results relative to medical therapy.

This study was a rare one because it entailed provoking OCD symptoms in the participants prior to each treatment session. The idea behind provoking OCD symptoms was to activate the relevant brain circuitry.

How Effective is TMS in Anxiety Disorders?

2019 scientific survey compiled about 32 studies to evaluate the effects of rTMS on anxiety. Though this survey suggested the need for more studies to determine the effects of TMS on anxiety, it did reveal the beneficial impact of TMS on anxiety symptoms.

According to this survey, one of the clinical trials conducted on participants with a generalized anxiety disorder (GAD) showed a clinically substantial reduction in anxiety symptoms after receiving 25 rTMS sessions.

Another 2016 study conducted by Dr. Diefenbach and fellows showed improved outcomes in patients with GAD after a 3-month rTMS treatment. Six of nine patients in the active group achieved remission during the 3-month follow-up period.

Patients with anxious depression particularly appear to benefit from rTMS sessions. A 2019 study evaluated and compared the outcomes of 172 patients with comorbid anxiety disorders with patients who did not have comorbid anxiety. At the end of the TMS session, 39.5% of patients showed 50% improvement in their symptoms of depression. In addition, 23.3% of patients with depression and comorbid anxiety achieved remission.

Another condition that often follows anxiety symptoms is Restless Legs Syndrome (RLS). In fact, stress and anxiety are major triggers of RLS. A study done on patients with RLS who received TMS therapy revealed significant improvements in the symptoms of restless legs, anxiety symptoms, and sleep quality.

Summary

Though OCD is a treatable illness, not all patients respond to the currently available treatments. Even when patients do respond, it is rare to see them completely recovering from the condition.

Thanks to novel treatments like deep TMS that hold more promise for refractory OCD. Being a non-invasive therapy with minimal adverse effects, dTMS is considered a good alternative for people who fail to respond to first- or second-line therapies.

Two companies now offer FDA-cleared TMS devices for the treatment of OCD, namely Brainsway and MagVenture.

Get TMS Therapy today.

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