{"id":790,"date":"2025-02-21T13:05:03","date_gmt":"2025-02-21T04:05:03","guid":{"rendered":"https:\/\/wako-psy-clinic.com\/kimoto\/?p=790"},"modified":"2025-02-21T13:05:03","modified_gmt":"2025-02-21T04:05:03","slug":"%e5%bc%b7%e8%bf%ab%e6%80%a7%e9%9a%9c%e5%ae%b3%e3%81%ab%e5%af%be%e3%81%99%e3%82%8b%e3%80%81tms%e6%b2%bb%e7%99%82%e3%80%81%e5%b7%a6%e5%89%8d%e9%a0%ad%e5%89%8d%e9%87%8e%e3%81%b8%e3%81%ae%e9%80%a3","status":"publish","type":"post","link":"https:\/\/wako-psy-clinic.com\/kimoto\/blog\/790.html","title":{"rendered":"\u5f37\u8feb\u6027\u969c\u5bb3\u306b\u5bfe\u3059\u308b\u3001TMS\u6cbb\u7642\u3001\u5de6\u524d\u982d\u524d\u91ce\u3078\u306e\u9023\u7d9a\u7167\u5c04\u306f\u52b9\u679c\u3092\u767a\u63ee\u3059\u308b\u304b\uff1f\u795e\u5948\u5ddd\u770c\u539a\u6728\u5e02\u306e\u5150\u7ae5\u7cbe\u795e\u79d1\u533b\u304c\u89e3\u8aac"},"content":{"rendered":"\n
\u5f37\u8feb\u6027\u969c\u5bb3\u306b\u5bfe\u3059\u308b\u3001TMS\u6cbb\u7642\u3001\u5de6\u524d\u982d\u524d\u91ce\u3078\u306e\u9023\u7d9a\u7167\u5c04\u306f\u52b9\u679c\u3092\u767a\u63ee\u3059\u308b\u304b\uff1f\u795e\u5948\u5ddd\u770c\u539a\u6728\u5e02\u306e\u5150\u7ae5\u7cbe\u795e\u79d1\u533b\u304c\u89e3\u8aac

\u3053\u3093\u306b\u3061\u306f\u3001\u795e\u5948\u5ddd\u770c\u539a\u6728\u5e02\u306e\u5150\u7ae5\u7cbe\u795e\u79d1\u5c02\u9580\u30af\u30ea\u30cb\u30c3\u30af\u3001\u304d\u3082\u3068\u30e1\u30f3\u30bf\u30eb\u30af\u30ea\u30cb\u30c3\u30af\u3067\u3059\u3002

\u4eca\u56de\u306f\u3001\u5f37\u8feb\u6027\u969c\u5bb3\u306b\u5bfe\u3059\u308b\u3001TMS\u6cbb\u7642\u3001\u5de6\u524d\u982d\u524d\u91ce\u3078\u306e\u9023\u7d9a\u7167\u5c04\u306f\u52b9\u679c\u3092\u767a\u63ee\u3059\u308b\u304b\uff1f\u306b\u3064\u3044\u3066\u89e3\u8aac\u3057\u307e\u3059\u3002


\u5f37\u8feb\u6027\u969c\u5bb3\uff08OCD\uff09\u306b\u5bfe\u3059\u308bTMS\u6cbb\u7642\uff1a\u5de6\u524d\u982d\u524d\u91ce\uff08\u5de6DLPFC\uff09\u3078\u306e\u9023\u7d9a\u523a\u6fc0\u306e\u6709\u52b9\u6027


1. \u5f37\u8feb\u6027\u969c\u5bb3\uff08OCD\uff09\u306e\u795e\u7d4c\u30e1\u30ab\u30cb\u30ba\u30e0
\u2460 OCD\u306f\u795e\u7d4c\u56de\u8def\u306e\u7570\u5e38\u304c\u95a2\u4e0e
\u524d\u982d\u76ae\u8cea\uff0d\u57fa\u5e95\u6838\uff0d\u8996\u5e8a\u56de\u8def\uff08CSTC\u56de\u8def\uff09\u304c\u904e\u6d3b\u52d5\u3092\u8d77\u3053\u3057\u3066\u3044\u308b\u3002
\u7279\u306b\u88dc\u8db3\u904b\u52d5\u91ce\uff08SMA\uff09\u3001\u524d\u982d\u524d\u91ce\uff08DLPFC\uff09\u3001\u773c\u7aa9\u524d\u982d\u76ae\u8cea\uff08OFC\uff09\u306e\u7570\u5e38\u304c\u95a2\u4fc2\u3002
\u53f3DLPFC\u306e\u904e\u6d3b\u52d5\u304c\u5f37\u8feb\u89b3\u5ff5\u306e\u6301\u7d9a\u306b\u95a2\u4e0e\u3057\u3066\u3044\u308b\u3068\u3055\u308c\u308b\u3002

\u2461 TMS\u306e\u4e3b\u8981\u306a\u30bf\u30fc\u30b2\u30c3\u30c8
OCD\u306b\u5bfe\u3059\u308bTMS\u306e\u6a19\u6e96\u7684\u306a\u30bf\u30fc\u30b2\u30c3\u30c8\u306f\u4ee5\u4e0b\u306e\u901a\u308a\uff1a

\u88dc\u8db3\u904b\u52d5\u91ce\uff08SMA\uff09 \u2192 \u9ad8\u983b\u5ea6\u523a\u6fc0\uff08\u8208\u596e\uff09
\u6700\u3082\u30a8\u30d3\u30c7\u30f3\u30b9\u304c\u78ba\u7acb\u3055\u308c\u3066\u3044\u308b\u30bf\u30fc\u30b2\u30c3\u30c8
\u5f37\u8feb\u884c\u70ba\uff08\u5100\u5f0f\u884c\u52d5\uff09\u3092\u6291\u3048\u308b\u52b9\u679c\u304c\u671f\u5f85\u3055\u308c\u308b
\u53f3DLPFC\uff08\u80cc\u5916\u5074\u524d\u982d\u524d\u91ce\uff09 \u2192 \u4f4e\u983b\u5ea6\u523a\u6fc0\uff08\u6291\u5236\uff09
\u5f37\u8feb\u89b3\u5ff5\u306e\u6291\u5236\u306b\u6709\u52b9\u3068\u3055\u308c\u308b
\u5de6DLPFC\uff08\u80cc\u5916\u5074\u524d\u982d\u524d\u91ce\uff09 \u2192 \u9ad8\u983b\u5ea6\u523a\u6fc0\uff08\u8208\u596e\uff09
\u6a19\u6e96\u7684\u306a\u30bf\u30fc\u30b2\u30c3\u30c8\u3067\u306f\u306a\u3044\u304c\u3001\u3046\u3064\u75c7\u72b6\u3092\u4f34\u3046OCD\u60a3\u8005\u306b\u306f\u6709\u7528\u306a\u53ef\u80fd\u6027

2. \u5de6DLPFC\u3078\u306e\u9023\u7d9a\u523a\u6fc0\uff08\u9ad8\u983b\u5ea6rTMS\uff09\u306eOCD\u3078\u306e\u5f71\u97ff
\u2460 \u5de6DLPFC\u306e\u5f79\u5272
\u5de6DLPFC\u306f\u3001\u5b9f\u884c\u6a5f\u80fd\u3084\u8a8d\u77e5\u5236\u5fa1\u3092\u62c5\u3044\u3001\u611f\u60c5\u306e\u8abf\u6574\u306b\u3082\u95a2\u4e0e\u3002
TMS\u3067\u6d3b\u6027\u5316\u3059\u308b\u3068\u3001\u524d\u982d\u524d\u91ce\u5168\u4f53\u306e\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u304c\u5909\u5316\u3057\u3001\u5f37\u8feb\u75c7\u72b6\u306e\u6539\u5584\u306b\u3064\u306a\u304c\u308b\u53ef\u80fd\u6027\u304c\u3042\u308b\u3002
\u3046\u3064\u75c5\u3067\u306f\u6a19\u6e96\u6cbb\u7642\u30bf\u30fc\u30b2\u30c3\u30c8\u3060\u304c\u3001OCD\u306b\u5bfe\u3059\u308b\u76f4\u63a5\u7684\u306a\u52b9\u679c\u306f\u307e\u3060\u9650\u5b9a\u7684\u3002

\u2461 \u7814\u7a76\u3067\u306e\u5831\u544a
OCD\u60a3\u8005\u306e\u4e00\u90e8\u306b\u3001\u5de6DLPFC\u3078\u306e\u9ad8\u983b\u5ea6TMS\u304c\u6709\u52b9\u3067\u3042\u3063\u305f\u3068\u3059\u308b\u7814\u7a76\u5831\u544a\u306f\u3042\u308b\u3002
\u7279\u306b\u3001\u3046\u3064\u75c7\u72b6\u3092\u4f34\u3046OCD\u3067\u306f\u3001\u5de6DLPFC\u306e\u6d3b\u6027\u5316\u304c\u6c17\u5206\u6539\u5584\u306b\u5bc4\u4e0e\u3057\u3001\u7d50\u679c\u3068\u3057\u3066\u5f37\u8feb\u75c7\u72b6\u304c\u8efd\u6e1b\u3059\u308b\u30b1\u30fc\u30b9\u304c\u3042\u308b\u3002
\u305f\u3060\u3057\u3001\u6a19\u6e96\u7684\u306a\u30bf\u30fc\u30b2\u30c3\u30c8\u3067\u306f\u306a\u3044\u305f\u3081\u3001\u4ed6\u306e\u90e8\u4f4d\uff08\u53f3DLPFC\u3084SMA\uff09\u3068\u7d44\u307f\u5408\u308f\u305b\u3066\u7528\u3044\u3089\u308c\u308b\u3053\u3068\u304c\u591a\u3044\u3002

3. \u5de6DLPFC\u3078\u306eTMS\u304c\u6709\u52b9\u306a\u30b1\u30fc\u30b9
\u2460 \u3046\u3064\u75c7\u72b6\u3092\u4f34\u3046OCD
OCD\u60a3\u8005\u306e\u7d0430\uff5e50%\u304c\u3046\u3064\u75c7\u72b6\u3092\u4f75\u767a \u3059\u308b\u3068\u3055\u308c\u308b\u3002
\u5de6DLPFC\u3078\u306e\u9ad8\u983b\u5ea6\u523a\u6fc0\u306f\u3001\u6297\u3046\u3064\u52b9\u679c\u304c\u3042\u308a\u3001OCD\u75c7\u72b6\u306e\u9593\u63a5\u7684\u306a\u6539\u5584\u304c\u671f\u5f85\u3067\u304d\u308b\u3002

\u2461 \u53f3DLPFC\u3084SMA\u3078\u306eTMS\u3067\u52b9\u679c\u304c\u4e0d\u5341\u5206\u306a\u5834\u5408
OCD\u306b\u5bfe\u3059\u308b\u53f3DLPFC\u306e\u4f4e\u983b\u5ea6TMS\u3084SMA\u306e\u9ad8\u983b\u5ea6TMS\u3067\u52b9\u679c\u304c\u9650\u5b9a\u7684\u306a\u5834\u5408\u3001\u5de6DLPFC\u3078\u306eTMS\u3092\u8ffd\u52a0\u3059\u308b\u30b1\u30fc\u30b9\u304c\u3042\u308b\u3002
\u88dc\u52a9\u7684\u306a\u6cbb\u7642\u6226\u7565\u3068\u3057\u3066\u691c\u8a0e\u3055\u308c\u308b\u3053\u3068\u304c\u3042\u308b\u3002

\u307e\u3068\u3081
\u2705 \u5de6DLPFC\u3078\u306e\u9ad8\u983b\u5ea6TMS\u306f\u3001OCD\u60a3\u8005\u306e\u3046\u3064\u75c7\u72b6\u3092\u6539\u5584\u3057\u3001\u9593\u63a5\u7684\u306b\u5f37\u8feb\u75c7\u72b6\u306e\u8efd\u6e1b\u306b\u3064\u306a\u304c\u308b\u53ef\u80fd\u6027\u304c\u3042\u308b\u3002
\u2705 \u3057\u304b\u3057\u3001OCD\u306b\u5bfe\u3059\u308b\u7b2c\u4e00\u9078\u629e\u306eTMS\u30bf\u30fc\u30b2\u30c3\u30c8\u3067\u306f\u306a\u304f\u3001\u6a19\u6e96\u6cbb\u7642\u306f\u53f3DLPFC\uff08\u4f4e\u983b\u5ea6\uff09\u3084SMA\uff08\u9ad8\u983b\u5ea6\uff09\u3078\u306e\u523a\u6fc0\u3002
\u2705 \u53f3DLPFC\u3084SMA\u3078\u306eTMS\u3068\u7d44\u307f\u5408\u308f\u305b\u308b\u3053\u3068\u3067\u3001\u6cbb\u7642\u52b9\u679c\u304c\u9ad8\u307e\u308b\u53ef\u80fd\u6027\u304c\u3042\u308b\u3002
\u2705 OCD\u75c7\u72b6\u304c\u5f37\u3044\u304c\u3001\u3046\u3064\u75c7\u72b6\u3082\u4f75\u767a\u3057\u3066\u3044\u308b\u30b1\u30fc\u30b9\u3067\u306f\u3001\u5de6DLPFC\u3078\u306eTMS\u304c\u6709\u7528\u306a\u5834\u5408\u304c\u3042\u308b\u3002

\u5de6DLPFC\u3078\u306eTMS\uff08\u9ad8\u983b\u5ea6\u9023\u7d9a\u523a\u6fc0\uff09\u306f\u3001OCD\u306b\u5bfe\u3059\u308b\u7b2c\u4e00\u9078\u629e\u306e\u6cbb\u7642\u30bf\u30fc\u30b2\u30c3\u30c8\u3067\u306f\u306a\u3044\u304c\u3001\u3046\u3064\u75c7\u72b6\u3092\u4f34\u3046OCD\u60a3\u8005\u306b\u306f\u88dc\u52a9\u7684\u306b\u6709\u52b9\u306a\u53ef\u80fd\u6027\u304c\u3042\u308b\u3002

OCD\u3082\u30b7\u30f3\u30d7\u30eb\u306b\u5f37\u8feb\u75c7\u72b6\u3060\u3051\u304c\u3042\u308b\u30b1\u30fc\u30b9\u3088\u308a\u3082\u3001\u3046\u3064\u75c7\u72b6\u306e\u5408\u4f75\u3001ADHD\u3084ASD\u306e\u5408\u4f75\u3092\u8a8d\u3081\u308b\u30b1\u30fc\u30b9\u306e\u65b9\u304c\u591a\u3044\u3088\u3046\u306b\u601d\u3044\u307e\u3059\u3002

\u305d\u3046\u3059\u308b\u3068\u3001\u7dcf\u5408\u7684\u306b\u306fTMS\u3092\u5de6\u524d\u982d\u524d\u91ce\u3078\u306e\u9ad8\u983b\u5ea6\u523a\u6fc0\u306f\u6709\u52b9\u3067\u3042\u308b\u3068\u601d\u3044\u307e\u3059\u3057\u3001\u5b9f\u969b\u306e\u6cbb\u7642\u3067\u3082\u6709\u52b9\u3060\u3063\u305f\u65b9\u304c\u591a\u3044\u3067\u3059\u3002

\u85ac\u304c\u52b9\u679c\u4e0d\u5341\u5206\u3001\u85ac\u306f\u4f7f\u308f\u305a\u6cbb\u7642\u3057\u305f\u3044\u3001\u4eca\u4f7f\u3063\u3066\u3044\u308b\u85ac\u3092\u6e1b\u3089\u3057\u305f\u3044\u3001\u65b9\u306b\u306f\u6709\u52b9\u306a\u6cbb\u7642\u9078\u629e\u80a2\u3068\u306a\u308b\u3067\u3057\u3087\u3046\u3002

\u30e2\u30cb\u30bf\u30fc\u3082\u968f\u6642\u52df\u96c6\u3057\u3066\u304a\u308a\u307e\u3059\u306e\u3067\u3001\u3054\u8208\u5473\u306e\u3042\u308b\u65b9\u306f\u30af\u30ea\u30cb\u30c3\u30af\u307e\u3067\u304a\u554f\u5408\u305b\u304f\u3060\u3055\u3044\u3002




Today, I will explain whether repetitive TMS (rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC) is effective in treating obsessive-compulsive disorder (OCD).

1. The Neurological Mechanism of OCD
OCD is associated with dysfunction in the cortico-striato-thalamo-cortical (CSTC) circuit, which regulates cognitive control and habitual behaviors.

Hyperactivity in the CSTC loop, particularly in the supplementary motor area (SMA), dorsolateral prefrontal cortex (DLPFC), and orbitofrontal cortex (OFC), contributes to OCD symptoms.
The right DLPFC is often overactive, which is linked to the persistence of obsessive thoughts.
2. Common TMS Targets for OCD
TMS treatment for OCD typically focuses on modulating brain activity in key regions:

Supplementary Motor Area (SMA): High-frequency stimulation

Most evidence-based target for OCD treatment.
Helps reduce compulsive behaviors (ritualistic actions).
Right DLPFC: Low-frequency stimulation

Suppresses overactivity in this area, reducing obsessive thoughts.
Left DLPFC: High-frequency stimulation

Typically not the primary target for OCD.
Used mainly for comorbid depression, which often accompanies OCD.
3. How High-Frequency rTMS to the Left DLPFC Affects OCD
\u2460 Role of the Left DLPFC
The left DLPFC plays a crucial role in cognitive control, emotional regulation, and executive function.
Activating this region with high-frequency rTMS can positively affect prefrontal network connectivity, which may help alleviate OCD symptoms.
Although left DLPFC TMS is a standard treatment for depression, its direct impact on OCD is less established.
\u2461 Research Findings on Left DLPFC rTMS for OCD
Some studies have reported that high-frequency TMS to the left DLPFC improves symptoms in OCD patients, particularly those with comorbid depression.
Left DLPFC stimulation may boost mood and executive function, leading to a secondary reduction in OCD symptoms.
However, right DLPFC suppression and SMA activation remain the primary strategies for treating OCD.
Left DLPFC stimulation is often used in combination with other targets rather than as a standalone treatment.
4. When Is Left DLPFC rTMS Effective for OCD?
\u2460 OCD with Comorbid Depression
30\u201350% of OCD patients experience depressive symptoms, making treatment more complex.
High-frequency TMS to the left DLPFC is an effective antidepressant strategy, which may indirectly reduce OCD symptoms by improving mood stability.
\u2461 Cases Where Right DLPFC or SMA TMS Alone Is Not Effective
When low-frequency right DLPFC TMS or high-frequency SMA TMS fails to yield significant improvement, adding high-frequency left DLPFC stimulation may provide additional benefits.
Some treatment-resistant cases of OCD have shown better response with a combination approach.
5. Summary: Effectiveness of Left DLPFC TMS for OCD
High-frequency TMS to the left DLPFC is not the first-line TMS treatment for OCD.
It is most effective for OCD patients with comorbid depression, as it enhances mood stability and cognitive function.
For primary OCD symptoms (obsessions and compulsions), right DLPFC suppression and SMA activation remain the main treatment targets.
Combining left DLPFC stimulation with right DLPFC or SMA TMS may enhance overall treatment response.
Patients with medication-resistant OCD or those seeking to reduce medication use may benefit from this approach.
Final Thoughts
Although OCD often presents with pure compulsive symptoms, many patients also experience comorbid depression, ADHD, or ASD, making their condition more complex.

From my clinical experience, high-frequency TMS to the left DLPFC has been effective in many OCD patients, particularly those with emotional instability or cognitive dysfunction.

For patients who:
\u2705 Do not respond well to medication
\u2705 Want a drug-free treatment option
\u2705 Wish to reduce their current medication

TMS therapy\u2014especially a combination approach involving the left DLPFC\u2014is a promising alternative.

\ud83d\udccc We are currently recruiting TMS treatment study participants.
If you are interested, please contact our clinic for more details! \ud83d\ude80
<\/pre>\n","protected":false},"excerpt":{"rendered":"
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