Obsessive-Compulsive Disorder Responsive to Deep Transcranial Magnetic Stimulation

Deep transcranial magnetic stimulation (dTMS) improved symptoms of obsessive-compulsive disorder (OCD) compared with sham dTMS, according to a study published in the American Journal of Psychiatry.

Lior Carmi, PhD, of the School of Psychological Science, Tel Aviv University, Israel, and colleagues conducted a study at 11 centers and included 99 patients with OCD who were randomly assigned to treatment with either high-frequency (20 Hz) or sham dTMS. Participants received daily treatments following individualized symptom provocation for 6 weeks. They used the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to determine clinical response to treatment, and the primary efficacy end point was the change in score from baseline to posttreatment assessment. 

The intent-to-treat sample included 94 patients. For the primary efficacy analysis at the posttreatment assessment at 6 weeks, the Y-BOCS score had decreased significantly in both the active (-6.0) and sham (-3.3) groups. Secondary efficacy analysis showed the effect was also present at the 4-week posttreatment follow-up assessment, with a mean Y-BOCS score decrease of 6.5 points in the active treatment groups and a 4.1-point decrease in the sham treatment group. The effect size was 0.62.

A full response, defined as a reduction ≥30% in Y-BOCS score at the posttreatment assessment occurred in 38.1% of the active treatment group and 11.1% of the sham group. At the follow-up assessment, the rate of full response for the 2 groups was 45.2% and 17.8%, respectively (P =.006). Partial response at that time was 59.5% in the active treatment group and 42.2% for the sham treatment group. Adverse events were reported by 73% of active treatment patients and 69% of sham treatment patients, but this difference did not reach statistical significance. The dropout rate was approximately 12% in both groups.

“High-frequency dTMS over the medial prefrontal cortex and anterior cingulate cortex significantly improved OCD symptoms and may be considered as a potential intervention for patients who do not respond adequately to pharmacological and psychological interventions,” researchers concluded.

Reference

Carmi L, Tendler A, Bystritsky A et al. Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial [published online May 21, 2019]. Am J Psychiatry. doi:10.1176/appi.ajp.2019.18101180