Estimulação transcraniana por corrente contínua para o transtorno obsessivo compulsivo resistente ao tratamento:
relato de dois casos e proposta de um ensaio clínico randomizado e controlado por sham
Palavras-chave:
Transtorno obsessivo-compulsivo, Terapia por estimulação elétrica, Eletrodos, Estimulação elétrica, Estimulação transcraniana por corrente contínuaResumo
CONTEXTO E OBJETIVO: Técnicas de neuromodulação para o tratamento do transtorno obsessivo compulsivo (TOC) vêm se expandindo com o melhor entendimento dos circuitos cerebrais envolvidos no transtorno. A estimulação transcraniana por corrente contínua (ETCC), uma técnica não invasiva, vem sendo estudada como alternativa para o TOC resistente aos tratamentos convencionais. Descrevemos o desenho de um ensaio clínico utilizando a ETCC para o TOC e relatamos os desfechos de dois pacientes com TOC primário resistentes à terapia cognitivo-comportamental e aos inibidores seletivos de recaptura da serotonina, que receberam ETCC de modo aberto durante a fase de treino dos procedimentos do estudo. TIPO DE ESTUDO E LOCAL: Descrição metodológica de um ensaio clínico utilizando ETCC para o TOC resistente num hospital universitário e relato de dois casos. MÉTODOS: O estudo proposto é randomizado, controlado por sham e duplo-cego. 44 pacientes serão randomizados para intervenção ativa ou simulada (sham). A intervenção ativa consiste em aplicar uma corrente elétrica de 2 mA, com cátodo posicionado na região correspondente à área cortical motora suplementar (bilateralmente) e ânodo posicionado no deltoide. Desfecho primário: redução do escore inicial da escala YBOCS (Yale-Brown Obsessive Compulsive Scale) ao final da quarta semana. Desfechos secundários: sintomas depressivos e ansiosos. Marcadores genéticos, excitabilidade cortical e performance em testes neurocognitivos serão investigados. RESULTADOS: O primeiro paciente apresentou melhora significativa, enquanto o segundo permaneceu sintomático ao término das quatro semanas e após seis meses. A ETCC foi bem tolerada. CONCLUSÃO: A ETCC para o tratamento do TOC resistente merece ensaios clínicos randomizados que testem sua efetividade. REGISTRO DE ENSAIO CLÍNICO: NCT02743715.
Downloads
Referências
Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive- compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15(1):53-63.
Subramaniam M, Abdin E, Vaingankar JA, Chong SA. Obsessive- compulsive disorder: prevalence, correlates, help-seeking and quality of life in a multiracial Asian population. Soc Psychiatry Psychiatr Epidemiol. 2012;47(12):2035-43.
Almeida-Filho N, Mari J de J, Coutinho E, et al. Brazilian multicentric study of psychiatric morbidity. Methodological features and prevalence estimates. Br J Psychiatry. 1997;171:524-9.
Steketee G. Disability and family burden in obsessive-compulsive disorder. Can J Psychiatry. 1997;42(9):919-28.
Fontenelle IS, Fontenelle LF, Borges MC, et al. Quality of life and symptom dimensions of patients with obsessive-compulsive disorder. Psychiatry Res. 2010;179(2):198-203.
Bystritsky A, Liberman RP, Hwang S, et al. Social functioning and quality of life comparisons between obsessive-compulsive and schizophrenic disorders. Depress Anxiety. 2001;14(4):214-8.
Vikas A, Avasthi A, Sharan P. Psychological impact of obsessive- compulsive disorder on patients and their caregivers: a comparative study with depressive disorder. Int J Soc Psychiatry. 2011;57(1):45-56.
Simpson HB, Huppert JD, Petkova E, Foa EB, Liebowitz MR. Response versus remission in obsessive-compulsive disorder. J Clin Psychiatry. 2006;67(2):269-76.
Simpson HB, Foa EB, Liebowitz MR, et al. Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive- compulsive disorder: a randomized clinical trial. JAMA Psychiatry. 2013;70(11):1190-9.
Shah DB, Pesiridou A, Baltuch GH, Malone DA, O’Reardon JP. Functional neurosurgery in the treatment of severe obsessive compulsive disorder and major depression: overview of disease circuits and therapeutic targeting for the clinician. Psychiatry (Edgmot). 2008;5(9):24-33.
Alexander GE, Crutcher MD, DeLong MR. Basal ganglia-thalamocortical circuits: parallel substrates for motor, oculomotor, “prefrontal” and “limbic” functions. Prog Brain Res. 1990;85:119-46.
Greenberg BD, Rauch SL, Haber SN. Invasive circuitry-based neurotherapeutics: stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharmacology. 2010;35(1):317-36.
Berlin MT, Neufeld NH, Van den Eynde F. Repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD): an exploratory meta-analysis of randomized and sham-controlled trials. J Psychiatr Res. 2013;47(8):999-1006.
Miranda PC, Lomarev M, Hallett M. Modeling the current distribution during transcranial direct current stimulation. Clin Neurophysiol. 2006;117(7):1623-9.
Wagner T, Fregni F, Fecteau S, et al. Transcranial direct current stimulation: a computer-based human model study. Neuroimage. 2007;35(3):1113-24.
Brunoni AR, Nitsche MA, Bolognini N, et al. Clinical research with transcranial direct current stimulation (tDCS): challenges and future directions. Brain Stimul. 2012;5(3):175-95
Brunoni AR, Valiengo L, Baccaro A, et al. The sertraline vs. electrical current therapy for treating depression clinical study: results from a factorial, randomized, controlled trial. JAMA Psychiatry. 2013;70(4):383-91.
Mondino M, Haesebaert F, Poulet E, Suaud-Chagny MF, Brunelin J. Fronto-temporal transcranial Direct Current Stimulation (tDCS) reduces source-monitoring deficits and auditory hallucinations in patients with schizophrenia. Schizophr Res. 2015;161(2-3):515-6.
Narayanaswamy JC, Jose D, Chhabra H, et al. Successful Application of Add-on Transcranial Direct Current Stimulation (tDCS) for Treatment of SSRI Resistant OCD. Brain Stimul. 2015;8(3):655-7.
Bation R, Poulet E, Haesebaert F, Saoud M, Brunelin J. Transcranial direct current stimulation in treatment-resistant obsessive-compulsive disorder: An open-label pilot study. Prog Neuropsychopharmacol Biol Psychiatry. 2016;65:153-7.
Goodman W, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46(11):1006-11.
Berlim MT, Neufeld NH, Van den Eynde F. Repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD): an exploratory meta-analysis of randomized and sham-controlled trials. J Psychiatr Res. 2013;47(8):999-1006.
American Psychiatry Association. Diagnostic and Statistical Manual of Mental disorders (DSM-5). 5th ed. Washington: American Psychiatric Association; 2013.
Associação Brasileira dos Institutos de Pesquisa de Mercado (ABIPEME). Proposição para um novo critério de classificação socioeconômica. São Paulo: Mímeo; 1978.
Rosario-Campos MC, Miguel EC, Quatrano S, et al. The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS): an instrument for assessing obsessive-compulsive symptom dimensions. Mol Psychiatry. 2006;11(5):495-504.
Rosario MC, Prado HS, Borcato S, et al. Validation of the University of São Paulo Sensory Phenomena Scale: initial psychometric properties. CNS Spectr. 2009;14(6):315-23.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893-7.
Eisen JL, Phillips KA, Baer L, et al. The Brown Assessment of Beliefs Scale: reliability and validity. Am J Psychiatry. 1998;155(1):102-8.
Guy W. ECDEU Assessment Manual for Psychopharmacology. Revised, 1976. Rockville: National Institute of Mental Health; 1976. Available from: https://archive.org/stream/ecdeuassessmentm1933guyw#page/n1/mode/2up. Accessed in 2016 (Sep 9).
Fleck MPA, Fachel OF, Louzada S, et al. Desenvolvimento da versão em português do instrumento de avaliação de qualidade de vida da OMS (WHOQOL-100) [Development of the Portuguese version of the OMS evaluation instrument of quality of life]. Rev Bras Psiquiatr. 1999;21(1):19-28.
First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington: American Psychiatric Press, Inc.; 1996.
Senço NM, Huang Y, D’Urso G, et al. Transcranial direct current stimulation in obsessive-compulsive disorder: emerging clinical evidence and considerations for optimal montage of electrodes. Expert Rev Med Devices. 2015;12(4):381-91.
Brunoni AR, Valiengo L, Baccaro A, et al. The sertraline vs. electrical current therapy for treating depression clinical study: results from a factorial, randomized, controlled trial. JAMA Psychiatry. 2013;70(4):383-91.
Rabkin JG, Markowitz JS, Ocepek-Welikson K, Wager SS. General versus systematic inquiry about emergent clinical events with SAFTEE: implications for clinical research. J Clin Psychopharmacol. 1992;12(1):3-10.
Brunoni AR, Sampaio-Junior B, Moffa AH, et al. The Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS): rationale and study design of a non-inferiority, triple-arm, placebo-controlled clinical trial. Sao Paulo Med J. 2015;133(3):252-63.
D’Urso G, Brunoni AR, Anastasia A, et al. Polarity-dependent effects of transcranial direct current stimulation in obsessive-compulsive disorder. Neurocase. 2016;22(1):60-4.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
