Journal: Indian J Psychol Med
Authors: Kammammettu, C; Mudunuru, A; Gunthakandla, S; Sailaja B; Ayyadevara, R; Venkata R.
Background:
Obsessive-compulsive disorder (OCD) is a chronic debilitating mental illness with waxing and waning courses. The H7 coil used for deep repetitive transcranial magnetic stimulation (dTMS) is designed to produce deeper and broader neuronal stimulation in the dorsomedial prefrontal cortex and anterior cingulate cortex, which is known to alleviate the symptoms of OCD.
Objective:
EEG studies in OCD explain frontal theta or delta predominance in some patients. In the same line, we planned to record resting EEG and customize the intermittent theta burst stimulation (iTBS) according to peak frequency in the bilateral prefrontal areas.
Methods:
The protocol was customized, replacing the standard 5Hz train frequency with 3Hz. Burst frequency remained at 50Hz. After obtaining the consent, six customized EEG-iTBS sessions were given prior to the regular high-frequency stimulation as priming sessions.
Results:
From the third session onwards, the patient reported a 50% fall in the severity of obsessions. By the sixth session, she reported great symptom relief and happiness. Her emotional pain score on the Visual Analog Scale dropped to two from the previous score of eight. YBOCS reduced from 20 to 8. The good response shown by the patient in just six sessions was maintained thereafter for 15 months.
Conclusions:
To conclude, the new customized protocol delivering 540 pulses per session, each session consisting of 20 trains of 3Hz, 3s duration, and nine triplet bursts with an interval of 8s at an intensity of 80%, has helped our patient achieve remission. Adjusting train frequency in this patient must have led to better stimulation of neurons in the target area falling in phase with the resting state neuronal firing. Further research is required in this direction.
