HIGH-DEFINITION TRANSCRANIAL DIRECT CURRENT STIMULATION IN HOARDING DISORDER: A CASE REPORT

Abstract Background Hoarding disorder, characterized by excessive acquisition of possessions and difficulty in discarding them, is a major treatment challenge. At the brain level, hoarding disorder has been associated with increased activity in the right dorsolateral prefrontal cortex (DLPFC). Aims & Objectives In a case report, we explored a therapeutic strategy using high-definition transcranial direct current stimulation (HD-tDCS) to alleviate symptoms in a patient with hoarding disorder. HD-tDCS is an emerging neuromodulation technique for patients with treatment-resistant psychiatric symptoms. Method A 63-year-old patient with severe, treatment-resistant hoarding disorder received 15 sessions of 20-min HD-tDCS (3 sessions per day for 5 consecutive days), with the cathode placed over the right DLPFC using a 4x1 ring electrode montage. Hoarding symptoms were assessed before at baseline, after HD-tDCS, and at 1 and 3 months follow-up using the Saving Inventory-Revised (SI-R) scale. Mood was assessed using the Montgomery-Å sberg Depression Rating Scale (MADRS). Results The treatment was well tolerated with no adverse events. We observed a reduction in the SI-R total score from 80 to 66 at 1-month follow-up (-18.5 %). This improvement was mainly in the excessive acquisition subscale (-50%), while the difficulty discarding subscale showed a modest decrease (-22%), and there was no change in the clutter subscale. Depressive symptoms decreased by 27% (MADRS) at 1 month, but returned to baseline at 3 months. Nevertheless, a 38% decrease in the SI-R acquisition subscale persisted at 3-month follow-up (-12.5% for the SI-R total score). Discussion & Conclusion Cathodal HD-tDCS over the right DLPFC appears to be a safe and promising intervention for hoarding disorder. Further validation through randomized, sham-controlled trials is needed to confirm these encouraging findings.