Obsessive Compulsive Disorder, often referred to as “OCD,” is a chronic condition involving recurrent obsessions, compulsions or both. Obsessions are repetitive, intrusive thoughts that are often meaningless, inappropriate, or irrelevant. The obsessions can also take the form of ideas, images, impulses, or urges. Obsessions can be distressing and typically persist regardless of how hard someone tries to suppress, resist, or ignore them. Compulsions are repetitive, stereotyped behaviors. Compulsive behaviors often serve as rituals, used to try and neutralize the obsessions. Both the obsessions and compulsions are distressing to the individual and may consume several hours each day.
The Neurobiology of OCD
The neurobiology of OCD has several models, including the executive control model, the modulatory control model, and the uncertainty disorder model. Each of these models are connected to imbalances in the cortical-striatal-thalamic-cortical (CSTC) pathway.The CSTC pathway consists of multiple, parallel loops connecting the cortical and subcortical areas of the brain. These areas include the dorsolateral prefrontal cortex (DLPFC), orbitofrontal cortex (OFC), medial prefrontal cortex (mPFC), cingulate cortex, caudate nucleus, striatum and thalamus. The function of the CSTC pathway is to determine which actions our brains select as important, and which are ignored. When there is a disturbance in this pathway, individuals will experience greater impulsivity, compulsivity, obsessions, uncertainty, and deficits in attention, in addition to many other problems.
How TMS Therapy for OCD Works
The Brainsway H7 Deep TMS coil targets the Anterior Cingulate Cortex. OCD treatment with TMS therapy involves a “provocation” of the OCD symptoms, in order to activate the CSTC pathway.Once the CSTC has been activated, the H7 TMS coil is used to stimulate the Anterior Cingulate Cortex. This treatment is administered 5 days a week, for a total of 30-42 sessions. Positive results led to FDA-clearance of the Brainsway H7 for the treatment of OCD. The Brainsway H7 OCD study, the only multi-center trial in OCD patients ever conducted, showed statistically significant improvement in the active treatment group after only six weeks of treatment.The improvement persisted one month after the end of treatment at week 10.The benefits can be extended for much longer, often indefinitely, with once or twice monthly maintenance TMS.
The Brainsway H7 TMS coil is placed over the Anterior Cingulate Cortex, 4 cm anterior to the motor cortex and beneath the dorsomedial prefrontal cortex. Deep TMS therapy for OCD is performed 5 days per week for 6 weeks, for a minimum of 30 sessions, including the mapping session. The mapping session is where the motor threshold and treatment location are determined.Each treatment starts with an individualized OCD provocation to activate the cortical-striatal-thalamic-cortical (CSTC) pathway. The provocation is followed by the active treatment, which takes approximately 20 minutes.There are no activity restrictions after treatment (such as driving or operating heavy machinery).TMS is usually combined with appropriate pharmacotherapy to achieve the best results.
How to Start TMS Therapy
It is important to speak to a medical professional experienced in treating Obsessive Compulsive Disorder before you begin Transcranial Magnetic Stimulation therapy. At the Delray Center for Healing, every prospective TMS recipient receives a comprehensive psychiatric evaluation by a psychiatrist or psychiatric nurse practitioner to determine if TMS therapy is the proper course of treatment. If you are interested in speaking to certified professional about whether TMS therapy is right for you, we encourage you to contact our office today.
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Dr. Rodriguez founded the Delray Center in 2003 and built it on a foundation of core clinical, professional, and ethical principles that are adhered to still to this day. Dr. Rodriguez founded the Delray Center in 2003 and built it on a foundation of core clinical, professional, and ethical principles that are adhered to still to this day.