Impaired Of Response Inhibition And Individualized Accurate Target Positioning TMS Treatment On Obsessive-Compulsive Disorder

Objective : Obsessive compulsive disorder(OCD)is a disabling mental disorder with the chronic and difficult course.DSM-5 separates OCD from the anxiety disorder,reflecting the deepening of accurate understanding of OCD and its unique pathogenesis and characteristics that are different from other anxiety disorders.Impairment of the executive function of OCD has been demonstrated by most studies.Deficits in response inhibition is the core cognitive impairment of OCD.Neurobiological models of OCD have implicated dysfunctional fronto-basal-ganglia network comprising the presupplementary motor area(Pre-SMA),the inferior frontal gyrus(IFG),and the subthalamic nucleus(STN)in the etiology of response inhibition.However,the study on the neural mechanism loop of response inhibition dysfunction is generally inadequate,and lack of targeted treatment.Repetitive transcranial magnetic stimulation(r TMS)is an important therapeutic method for functional circuit reestablishment,which can noninvasively regulate the functions of the local cortex and related brain networks.The efficacy of r TMS in the treatment of OCD has been investigated by more and more researchers,but its efficacy and mechanism remain unclear.We combine ERPs to observe the efficacy of inhibitory and repetitive 1-Hz TMS for OCD,which accurate targets the right pre-SMA that show most significant positive functional connectivity with STN-the main DBS target,and clarify the changes of clinical symptoms and response inhibition before and after r TMS treatment.Methods: Twenty-three patients with OCD admitted to the Mental Health Center of Anhui Province from September 2016 to December 2017 were selected.Among them,13 patients with OCD received active r TMS therapy,10 patients with OCD received sham stimulation with r TMS,and 1HZ-r TMS targeted pre-SMA lasted 15 days.All patients with OCD were tested for cognitive neuropsychological background(Stroop color-word test and Trail Making Test)and event-related potential acquisition(stop signal task)before and after treatment.At the same time,we recruited 23 healthy controls matched with the age,sex and education age of OCD patients and completed the cognitive neuropsychological background test and event-related potential acquisition.Results: Before treatment:(1)The reaction time of Stroop color-word test,Trail Making Test and stop-signal task was delayed in the OCD than that of healthy control group(P < 0.05);(2)The average amplitude of Stop-P3 at the FZ and CZ points in the OCD group was lower than in the healthy control group(P < 0.05),while the average amplitude of the N2 wave was not different between the two groups(P > 0.05);(3)Correlation analysis showed that the obsessive-compulsive symptoms were negatively correlated with the average amplitude of the Stop-P3 wave(P < 0.05).In OCD patients,the obsessivecompulsive symptoms were critically correlated with the reaction time of the stop task(P = 0.076).After treatment:(1)Obsessive-compulsive symptoms were improved in the active r TMS group and sham group,and the reaction time of the Trail Making Test was significantly shortened in the active r TMS group(P < 0.05),but the difference before and after treatment was not statistically significant(P > 0.05).The HAMA scores improved in the the active r TMS group,and the difference before and after treatment was a significant between the two groups(P < 0.05).In the stop-signal task,the reaction time of stop task in the active r TMS group was significantly shortened(P < 0.05),and the interaction with the sham r TMS group had a critical significance(P = 0.072);(2)The average amplitude of Stop-P3 at the FZ was significantly increased after treatment(P < 0.05)in the active r TMS group,and the Stop-P3 difference wave in the two groups reached a critical significance at the FZ point(P = 0.078);(3)The reaction time of stop task,stop signal delay time,and response accuracy in the stop signal task were significantly correlated with Obsessive-compulsive symptoms(P < 0.05)in the active r TMS group.Conclusions: Obsessive-compulsive disorder does exist defects in response inhibition,manifested in cognitive inhibition and behavioral inhibition in two aspects,and the degree of impairment of response inhibition was correlated with the severity of obsessive-compulsive disorder.1HZ-r TMS targeted pre-SMA can not only improve the severity of obsessive-compulsive disorder,but it can also improve the response inhibition of obsessive compulsive disorder,and the improvement of response inhibition is related to the improvement of the severity of Obsessive-compulsive disorder.