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Transcranial direct current stimulation for compulsivity in adolescent fraternal twins with neurodevelopmental disorders
Brain Stimulation ( IF 7.7 ) Pub Date : 2020-07-01 , DOI: 10.1016/j.brs.2020.05.007
Sunday M Francis 1 , Katie L Beard 1 , Angela Tseng 1 , Mo Chen 2 , Bernadette T Gillick 3 , Suma Jacob 1 , Christine A Conelea 1
Affiliation  

Compulsivity, a transdiagnostic symptom, is observed across multiple neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD). Growing evidence suggests that diagnostic labels such as ASD, OCD, attention-deficit/hyperactivity disorder (ADHD), and anxiety do not have distinct etiologies and phenotypes, frequently co-existing [1]. Historically, research studies have recruited “clean” diagnostic samples which limits translational application in realworld clinical populations. Our goal was to design a symptomspecific, biobehavioral treatment strategy for youth experiencing compulsivity. Defined as feedback-insensitive, repetitive, habitual behaviors, compulsivity, is subserved by orbitofronto-striatal-thalamic neural circuitry. The right inferior frontal gyrus (rIFG) is a key node in this circuit, disrupting response tendencies by suppressing basal ganglia output to the motor cortex. Compulsivity has been associated with hypoactivity in this area [2]. With the aim of increasing activity in rIFG, we implemented our transcranial direct current stimulation (tDCS) montage (Fig. 1A) with anode placement over rIFG (FC6) and cathode over left orbitofrontal cortex (lOFC; Fp1). Neuromodulation was paired with computer-based cognitive training to augment behavioral outcomes [3]. With the approval of the IRB, we utilized a double-blind, between-subject, shamcontrolled design to investigate the impact of tDCS paired with cognitive training in 15-year old, female, fraternal adolescent twins. This design enabled us to capitalize on the reduced environmental, genetic, and developmental variance. Participants were diagnosed with ASD, ADHD, and anxiety. Both twins had parent-reported compulsive symptoms, and one had OCD as a comorbid diagnosis (P1). Each participant completed the following: (1) baseline assessments including parentcompleted surveyswithin oneweek of the first stimulation session; (2) five stimulation visits over seven days; and (3) postintervention assessments within 24 hours of the last stimulation session. We measured compulsivity using the Children’s YaleBrown Obsessive-Compulsive Scale (CY-BOCS), the ObsessiveCompulsive Inventory (OCI), and the Repetitive Behavior ScaleRevised (RBS-R). We also assessed hyperactivity-impulsivity using the ADHD Rating Scale-IV (ADHD-RS-IV). One twin (P1) received ten sessions of active (1mA) tDCS (StarStim 8, Neuroelectric; Barcelona, Spain) paired with cognitive training tasks (BrainHQ, Posit; San Francisco, USA) over one week, while the second twin (P2) was in the sham condition. Each study visit consisted of two 13min stimulation sessions separated by 20 minutes (Fig. 1B). P2 received a short ramp up of the current similar to the active condition followed by termination of the current in conjunctionwith the

中文翻译:

经颅直流电刺激青少年神经发育障碍异卵双胞胎的强迫症

强迫症是一种跨诊断症状,在多种神经发育障碍 (NDD) 中观察到,包括自闭症谱系障碍 (ASD) 和强迫症 (OCD)。越来越多的证据表明,诸如 ASD、强迫症、注意力缺陷/多动障碍 (ADHD) 和焦虑症等诊断标签没有不同的病因和表型,通常并存 [1]。从历史上看,研究已经招募了“干净”的诊断样本,这限制了在现实世界临床人群中的转化应用。我们的目标是为患有强迫症的青少年设计一种针对症状的生物行为治疗策略。被定义为反馈不敏感、重复、习惯性行为、强迫性,由眶额-纹状体-丘脑神经回路辅助。右额下回 (rIFG) 是该回路中的关键节点,通过抑制基底神经节向运动皮层的输出来破坏反应倾向。强迫症与该领域的活动减退有关[2]。为了增加 rIFG 的活动,我们实施了经颅直流电刺激 (tDCS) 蒙太奇 (图 1A),阳极放置在 rIFG (FC6) 上,阴极放置在左眶额皮质 (lOFC; Fp1) 上。神经调节与基于计算机的认知训练相结合,以增强行为结果 [3]。经 IRB 批准,我们采用双盲、受试者间、假控制设计来研究 tDCS 与认知训练对 15 岁女性异卵双胞胎的影响。这种设计使我们能够利用减少的环境、遗传、和发育变异。参与者被诊断出患有自闭症、多动症和焦虑症。两对双胞胎都有父母报告的强迫症状,一个有强迫症作为共病诊断(P1)。每位参与者完成以下内容: (1) 基线评估,包括家长在第一次刺激会议后一周内完成的调查;(2) 7 天内进行 5 次刺激访问;(3) 在最后一次刺激会议后 24 小时内进行干预后评估。我们使用儿童耶鲁布朗强迫症量表 (CY-BOCS)、强迫症量表 (OCI) 和修订的重复行为量表 (RBS-R) 测量强迫症。我们还使用 ADHD 评定量表-IV (ADHD-RS-IV) 评估了多动冲动。一对双胞胎 (P1) 接受了十次活动 (1mA) tDCS(StarStim 8,Neuroelectric;巴塞罗那,西班牙)与认知训练任务(BrainHQ,Posit;旧金山,美国)配对超过一周,而第二对双胞胎(P2)处于假状态。每次研究访问包括两个 13 分钟的刺激会话,间隔 20 分钟(图 1B)。P2 接收到类似于活动状态的电流的短暂上升,然后终止电流与
更新日期:2020-07-01
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