Impaired trial-by-trial adjustment of cognitive control in obsessive compulsive disorder improves after deep repetitive transcranial magnetic stimulation

Mandana Modirrousta, Benjamin P. Meek, Jitender Sareen, Murray W. Enns

Adaptive decision making requires the adjustment of behaviour following an error. Some theories suggest that repetitive thoughts and behaviours in obsessive compulsive disorder (OCD) are driven by malfunctioning error monitoring. This malfunction may relate to demonstrated hyperactivity in the medial prefrontal cortex (mPFC), including the dorsal anterior cingulate cortex. In this study, we measured aspects of error monitoring in individuals with OCD and administered deep low frequency repetitive transcranial magnetic stimulation (rTMS) in an attempt to modulate error monitoring capacity. For this pilot study, ten OCD patients and 10 aged-matched healthy controls completed modified versions of the Eriksen Flanker task before and after one session of deep 1 Hz rTMS (1200 pulses) over the mPFC (Brodmann areas 24 and 32). OCD patients received nine additional sessions of daily rTMS to assess their clinical response. Flanker tasks were repeated with patients post-treatment. Overall error rates were higher for patients compared to controls. When subjects were asked to report their errors, OCD patients were able to report fewer of their errors than the control group. In contrast to controls, patients did not demonstrate a normal post-error slowing (PES) phenomenon. This abnormal PES was mainly driven by abnormally slow response times (RTs) following correct responses rather than a failure to slow down after errors. Patients' symptoms and slowed RTs following correct responses improved after ten sessions of rTMS. Certain aspects of error monitoring, namely conscious error report and post error slowing, are impaired in OCD. These impairments can at least be partly corrected by 1 Hz deep rTMS over the mPFC. Simultaneous improvement of OCD symptoms by this method might suggest a correlation between error monitoring impairment and OCD pathophysiology. ClinicalTrials.gov NCT02541812; 09/02/2015.