People with Obsessive-Compulsive Disorder Have a New Treatment Option at MUSC Health

E. Baron Short, M.D. MSCR

Patients diagnosed with debilitating obsessive-compulsive disorder have access to a revolutionary new treatment at MUSC Health – deep transcranial magnetic stimulation or dTMS.  

MUSC Health began offering dTMS in early 2020, according to E. Baron Short, M.D., MSCR, director of the MUSC Health’s Brain Stimulation Service, and it is the only place in the state and one of few in the region to offer it.

DTMS is the first new therapy in more than 10 years to receive FDA approval for the treatment of OCD and is one more treatment tool in MUSC’s internationally recognized brain stimulation program. 

“We’re just beginning to learn about the circuitry of the brain and ways of modifying pathways to treat neuropsychiatric conditions,” Short says. “The ability to provide dTMS gives us – and our patients -- another treatment focused on the brain, rather than medications alone.”

OCD is a neuropsychiatric disorder marked by uncontrollable thoughts, images or urges and the behaviors to overcome them. Onset occurs in late adolescence and affects approximately 2.3% of the population.

“OCD can be extremely debilitating,” Short says. “These people can’t function. Checking doors, washing hands repeatedly until they bleed, the fear that something terrible is about to happen and the compulsion to resolve the thing that has upset them are typical OCD behaviors.”

This disorder has several different manifestations: checking, an urge to rearrange objects, cleaning and fear of contamination, forbidden or harmful thoughts and impulses, and compulsive actions done to relieve the anxiety that can take hours a day.

While OCD obsessions may seem like to family and friends just a peculiar habit, it originates in a part of the brain called the cortical-striatal-thalamic-cortical (CSTC) circuit.

“In people with OCD, the anterior cingulate cortex, which is located in the CSTC circuit, is hyperactive,” Short says. “This hyperactivity occurs when the individual is provoked, experiencing an OCD episode or at rest.”

DTMS is designed to directly target that part of the brain according to Short. By using a magnet that produces electromagnetic pulses, dTMS regulates the neural activity of the anterior cingulate cortex and the medial prefrontal cortex, which is part of the CSTC circuit.

Treatment, which is designed for patients 18 and up, consists of 29 dTMS sessions over a six-week period. Before treatment, Short schedules a 90-minute session to establish specific provocations based on the patient’s symptoms. These can include internal provocations like thoughts and external provocations such as photos and images.

Each session lasts 30 minutes and includes the administration of provocations, followed by 18 minutes of dTMS. No anesthesia is required, and the treatment is painless Short says.

“Patients may feel the pulses on top of their head, and their facial muscles may contract during the treatment, but cognition is not impaired and there is no loss of memory,” Short says.

Short is optimistic about initial outcomes and enthusiastic over the potential for dTMS and the advances that MUSC is making in brain stimulation therapy.

“For me it’s gratifying to provide relief to patients when nothing else has helped them,” he says. “People have experienced limited benefits from medications and other therapies. DTMS helps them get their lives back.”

MUSC has been a leader in brain stimulation for more than three decades. The program has been at the forefront internationally for its pioneering research, clinical work and outreach in brain stimulation therapy, treating more than 15,000 patients for depression and a host of neuropsychiatric disorders.

“We’re one more example of how MUSC fulfills the tripartite mission of research, education and innovative clinical services,” Short says.