Locating the Orbitofrontal cortex
Dr. Rustin Berlow locates the orbitofrontal cortex for TMS stimulation indicated for the treatment of obsessive-compulsive disorder.
Dr. Rustin Berlow demonstrates how to find the right orbitofrontal cortex for OCD and how to place the coil.
If you imagine that there are three aspects of the frontal lobe; the medial, the lateral and the orbital. If you imagine right underneath the eyes, there’s sort of a shelf, called the cribriform plate, and on that, the frontal lobe sits. That orbitofrontal cortex has direct projections to the nucleus accumbens and is involved with anxiety and addiction. So for obsessive-compulsive disorder, the right orbitofrontal cortex is used. Finding the location is very easy since you take 5% up from the nasion, then 5% of the circumference over and you always end up right above the center of the eye.
Placing the coil there is made less convenient by the fact that the person’s nose is there and it’s sometimes almost impossible to get it to rest against the skin. If necessary, you can just make sure that it angles in the correct direction but isn’t touching or you can bring it down from the top, which has a very different effect. But when you do so, make sure that you have it stimulating in the plane of the cribriform plate and the left side similarly like this (demonstrates by showing the handle pointing upwards) but if possible, always use from the side, like that (handle pointing outwards), very gently so you don’t injure the person’s nose.