Article2000

Altered cortical excitability in obsessive–compulsive disorder

Benjamin David Greenberg · Ulf Ziemann · Gabriela Cora‐Locatelli · Ann Harmon · Dennis L. Murphy · Eric M. Wassermann

285 citations0/0 files storedNeurology

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Obsessive-Compulsive Spectrum Disorders Neurological disorders and treatments Transcranial Magnetic Stimulation Studies

Abstract

OBJECTIVE: To assess cortical inhibitory and excitatory mechanisms in obsessive-compulsive disorder (OCD). BACKGROUND: Transcranial magnetic stimulation (TMS) studies have found decreased neuronal inhibition and a reduced cortical silent period in the primary motor area in Tourette's syndrome, focal dystonia, and other disorders believed to involve dysfunction of subcortical structures, including the basal ganglia. Dysfunction of the basal ganglia and linked regions also has been implicated in OCD, which has significant clinical and familial overlap with tic disorders. METHODS: We applied the TMS techniques previously used in Tourette's syndrome to a group of 16 OCD patients (seven unmedicated) and 11 age-matched healthy volunteers extensively screened for psychopathology. Measures of motor cortex excitability included resting and active motor threshold, cortical silent period duration, and intracortical inhibition and facilitation using a paired-pulse TMS technique with a subthreshold conditioning stimulus. RESULTS: Similar to recent findings in Tourette's syndrome and focal dystonia, this study reports significantly decreased intracortical inhibition (ICI) relative to the volunteers at interstimulus intervals from 2 to 5 msec. We also found decreased active and resting motor evoked potential threshold in the OCD patients, another indication of increased cortical excitability. Neither abnormality appeared medication related. The decreases in ICI and motor threshold were greatest in OCD patients with comorbid tics, but remained significant in patients without tics. CONCLUSIONS: The data suggest abnormal cortical excitability in obsessive-compulsive disorder. These findings are congruent with the hypothesis that Tourette's syndrome and obsessive-compulsive disorder (OCD) are analogous disorders with overlapping dysfunction in corticobasal circuits. Patients with tic-related OCD may have more abnormal motor cortex excitability than OCD patients without tics.

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References

1992Caudate Glucose Metabolic Rate Changes With Both Drug and Behavior Therapy for Obsessive-Compulsive Disorder 1996Systematic Changes in Cerebral Glucose Metabolic Rate After Successful Behavior Modification Treatment of Obsessive-Compulsive Disorder 1986Gilles de la Tourette's Syndrome and Obsessive-Compulsive Disorder 1997Decreased motor inhibition in Tourette's disorder: evidence from transcranial magnetic stimulation 1998Toward a Neurodevelopmental Model of Obsessive–Compulsive Disorder

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