Background: Application of repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been promising and approved by the Food and Drug Administration in 2018, but effects differ between patients. Knowledge about clinical predictors of rTMS response may help to increase clinical efficacy but is not available so far. Methods: In a retrospective study, we investigated the efficacy of rTMS over the dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA) in 65 pharmaco-resistant OCD outpatients recruited for rTMS treatment from July 2015 to May 2017. Patients received either SMA rTMS (n = 38) or bilateral DLPFC rTMS (n = 27) in case of reporting higher affective and depressive symptoms in addition to the primary OCD symptoms. OCD symptoms and depression/anxiety states were measured at baseline (before the 1st session) and after the 20th session of rTMS. Additionally, we performed a binary logistic regression analysis on the demographic and clinical variables based on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) 3-factor and 2-factor models and individual items to investigate potential predictors of rTMS response. Results: Patients' scores in Y-BOCS and Beck anxiety/depression inventories were significantly decreased following rTMS treatment. 46.2% of all patients responded to rTMS, based on the criterion of at least a 30% reduction in Y-BOCS scores. There was no significant difference between response rates of patients in DLPFC and SMA groups. No significant demographic predictors of rTMS efficacy were identified. The factors "obsession severity", "resistance" and "disturbance" and the "interference due to obsessions" and "resistance against compulsions" items of the Y-BOCS significantly predicted response to rTMS.

Background: Application of the repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been promising but effects differ between patients. Knowledge about clinical predictors of rTMS response may help to increase clinical efficacy but is not available so far. Methods: In a retrospective study, we investigated the efficacy of rTMS over the dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA) in 65 pharamcoresistant OCD outpatients recruited for the rTMS treatment from July 2015 to May 2017. Patients received either SMA rTMS or bilateral DLPFC rTMS based on their symptoms and OCD symptoms and depression/anxiety states were measured at baseline (before the 1st session) and after the 20th session of rTMS. Additionally, we performed a binary logistic regression analysis on the demographic variables and clinical variables based on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) items and factors to investigate demographic and clinical predictors for rTMS response in the rTMS responders and non-responders. Results: Patients’ scores in Y-BOCS and Beck anxiety/depression inventories were significantly decreased following rTMS treatment. 46.2% of all patients responded to rTMS, based on at least a 30% reduction in Y-BOCS scores. The stimulation target (DLPFC vs. SMA) did not significantly differ in rTMS efficacy. No significant demographic predictors were found. “Interference due to obsessions”, “resistance against compulsions” and “disturbance” factor could significantly predict response failure to rTMS. Conclusions: Patients with less intrusive/interfering thoughts and low scores in the “disturbance” factor might benefit more from rTMS treatment. Identifying clinical and non-clinical predictors of response are needed to personalize and adapt rTMS protocols in pharmaco-resistant OCD patients. Interpretation of rTMS efficacy should be cautious due to the Lack of sham condition.

Background: Application of repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been promising, but effects differ between patients. Knowledge about clinical predictors of rTMS response may help to increase clinical efficacy but is not available so far. Methods: In a retrospective study, we investigated the efficacy of rTMS over the dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA) in 65 pharmaco-resistant OCD outpatients recruited for rTMS treatment from July 2015 to May 2017. Patients received either SMA rTMS or bilateral DLPFC rTMS in case of reporting higher affective and depressive symptoms in addition to the primary OCD symptoms. OCD symptoms and depression/anxiety states were measured at baseline (before the 1 st session) and after the 20th session of rTMS. Additionally, we performed a binary logistic regression analysis on the demographic and clinical variables based on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) 3-factor and 2-factor models and individual items to investigate potential predictors of rTMS response. Results: Patients’ scores in Y-BOCS and Beck anxiety/depression inventories were significantly decreased following rTMS treatment. 46.2% of all patients responded to rTMS, based on the criterion of at least a 30% reduction in Y-BOCS scores. Both stimulation protocols had similar effects in patients with similar baseline clinical-demographic characteristics. No significant demographic predictors of rTMS efficacy were identified. The factors “Obsession severity”, “resistance” and “disturbance” and the “Interference due to obsessions” and “resistance against compulsions” items of the Y-BOCS significantly predicted response to rTMS. Conclusions: In patients with less intrusive/interfering thoughts, and low scores in the “obsession severity”, “disturbance”, and “resistance factors, rTMS might have superior effects. Identification of clinical and non-clinical predictors of response is relevant to personalize and adapt rTMS protocols in pharmaco-resistant OCD patients. Interpretation of rTMS efficacy should be done with caution due to the lack of a sham intervention condition.

Background: Application of the repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been promising but effects differ between patients. Knowledge about clinical predictors of rTMS response would help to increase clinical efficacy but is not available so far. Methods: In a retrospective study, we investigated the efficacy of rTMS over the dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA) in 65 OCD outpatients recruited for the rTMS treatment from July 2015 to May 2017. Patients were divided into two groups and received either SMA rTMS or bilateral DLPFC rTMS. OCD symptoms and depression/anxiety states were measured before and after the 20th session of rTMS. Additionally, we performed a binary logistic regression analysis on the demographic variables and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) items to investigate demographic and clinical predictors for rTMS response in responders and non-responders. Results: Patients’ scores in Y-BOCS and Beck anxiety/depression inventories were significantly decreased following rTMS treatment. Specifically, 46.2% of all patients responded to rTMS, based on at least 30% reduction of the Y-BOCS scores. Stimulation target (DLPFC vs. SMA) did not significantly differ in rTMS efficacy. No significant demographic predictors were found. Interference due to obsessions and resistance against compulsions were the only two clinical predictors of rTMS treatment response that could significantly predict response failure to rTMS. Conclusions: rTMS treatment should be adapted to the clinical profile of OCD patients including the symptoms. Patients with less intrusive and interfering thoughts might benefit more from rTMS treatment. Identifying clinical and non-clinical predictors of response are needed to personalize and adapt rTMS protocols in pharmaco-resistant OCD patients.

Background: Application of repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been promising and approved by the Food and Drug Administration in 2018, but effects differ between patients. Knowledge about clinical predictors of rTMS response may help to increase clinical efficacy but is not available so far. Methods: In a retrospective study, we investigated the efficacy of rTMS over the dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA) in 65 pharmaco-resistant OCD outpatients recruited for rTMS treatment from July 2015 to May 2017. Patients received either SMA rTMS (n = 38) or bilateral DLPFC rTMS (n = 27) in case of reporting higher affective and depressive symptoms in addition to the primary OCD symptoms. OCD symptoms and depression/anxiety states were measured at baseline (before the 1st session) and after the 20th session of rTMS. Additionally, we performed a binary logistic regression analysis on the demographic and clinical variables based on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) 3-factor and 2-factor models and individual items to investigate potential predictors of rTMS response. Results: Patients’ scores in Y-BOCS and Beck anxiety/depression inventories were significantly decreased following rTMS treatment. 46.2% of all patients responded to rTMS, based on the criterion of at least a 30% reduction in Y-BOCS scores. There was no significant difference between response rates of patients in DLPFC and SMA groups. No significant demographic predictors of rTMS efficacy were identified. The factors “Obsession severity”, “resistance” and “disturbance” and the “Interference due to obsessions” and “resistance against compulsions” items of the Y-BOCS significantly predicted response to rTMS. Conclusions: In patients with less intrusive/interfering thoughts, and low scores in the “obsession severity”, “disturbance”, and “resistance factors, rTMS might have superior effects. Identification of clinical and non-clinical predictors of response is relevant to personalize and adapt rTMS protocols in pharmaco-resistant OCD patients. Interpretation of rTMS efficacy should be done with caution due to the lack of a sham intervention condition.