A double blind randomized clinical trial of the effectiveness of low frequency rTMS over right DLPFC or OFC for treatment of obsessive-compulsive disorder

Khedr, Eman M.; Elbeh, Khaled; Saber, Mostafa; Abdelrady, Zeinab; Abdel-Warith, Abdel-Wahab A.

doi:10.1016/j.jpsychires.2022.10.025

Cited by 12 publications

(22 citation statements)

References 66 publications

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“…We included 110 studies, encompassing a total of 4820 participants . The majority of participants were male (2959 [61.4%] compared with 1861 females [38.6%]), and the mean (SD) age was 43 (8.8) years.…”

Section: Resultsmentioning

confidence: 99%

“…The details of all retained studies and the overall results for dose equivalents are reported in eTable 1 in Supplement 1 and the Table, respectively. Overall, considering the important heterogeneity found for borderline disorder and autism spectrum disorder, we included 33 studies on schizophrenia, 43 on mood disorders, 18 on OCD, 4 on posttraumatic stress disorder (PTSD), and 11 on substance use disorder (SUD) . We also included 32 studies on treatment-resistant depression .…”

Section: Resultsmentioning

confidence: 99%

“…B. The maximum improvement in Yale-Brown Obsessive-Compulsive Scale (Y-BCOS) scores (ED 95 ) was reached at 13 679 total pulses (95% CI, 7117-14 734 total pulses; mean [SD] duration, 2.0 [1.0] weeks; 3 studies68,86,99 ; 85 participants; χ 2 = 15.19; df = 2; P < .001; I 2 = 60%). C.…”

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confidence: 99%

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Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders

Sabé,

Hyde,

Cramer

et al. 2024

JAMA Netw Open

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ImportanceNoninvasive brain stimulation (NIBS) interventions have been shown to be efficacious in several mental disorders, but the optimal dose stimulation parameters for each disorder are unknown.ObjectiveTo define NIBS dose stimulation parameters associated with the greatest efficacy in symptom improvement across mental disorders.Data SourcesStudies were drawn from an updated (to April 30, 2023) previous systematic review based on a search of PubMed, OVID, and Web of Knowledge.Study SelectionRandomized clinical trials were selected that tested transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) for any mental disorder in adults aged 18 years or older.Data Extraction and SynthesisTwo authors independently extracted the data. A 1-stage dose-response meta-analysis using a random-effects model was performed. Sensitivity analyses were conducted to test robustness of the findings. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.Main Outcomes and MeasuresThe main outcome was the near-maximal effective doses of total pulses received for TMS and total current dose in coulombs for tDCS.ResultsA total of 110 studies with 4820 participants (2659 men [61.4%]; mean [SD] age, 42.3 [8.8] years) were included. The following significant dose-response associations emerged with bell-shaped curves: (1) in schizophrenia, high-frequency (HF) TMS on the left dorsolateral prefrontal cortex (LDLPFC) for negative symptoms (χ2 = 9.35; df = 2; P = .009) and TMS on the left temporoparietal junction for resistant hallucinations (χ2 = 36.52; df = 2; P &lt; .001); (2) in depression, HF-DLPFC TMS (χ2 = 14.49; df = 2; P &lt; .001); (3) in treatment-resistant depression, LDLPFC tDCS (χ2 = 14.56; df = 2; P &lt; .001); and (4) in substance use disorder, LDLPFC tDCS (χ2 = 33.63; df = 2; P &lt; .001). The following significant dose-response associations emerged with plateaued or ascending curves: (1) in depression, low-frequency (LF) TMS on the right DLPFC (RDLPFC) with ascending curve (χ2 = 25.67; df = 2; P = .001); (2) for treatment-resistant depression, LF TMS on the bilateral DLPFC with ascending curve (χ2 = 5.86; df = 2; P = .004); (3) in obsessive-compulsive disorder, LF-RDLPFC TMS with ascending curve (χ2 = 20.65; df = 2; P &lt; .001) and LF TMS on the orbitofrontal cortex with a plateaued curve (χ2 = 15.19; df = 2; P &lt; .001); and (4) in posttraumatic stress disorder, LF-RDLPFC TMS with ascending curve (χ2 = 54.15; df = 2; P &lt; .001). Sensitivity analyses confirmed the main findings.Conclusions and RelevanceThe study findings suggest that NIBS yields specific outcomes based on dose parameters across various mental disorders and brain regions. Clinicians should consider these dose parameters when prescribing NIBS. Additional research is needed to prospectively validate the findings in randomized, sham-controlled trials and explore how other parameters contribute to the observed dose-response association.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders

Sabé,

Hyde,

Cramer

et al. 2024

JAMA Netw Open

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“…Although rTMS has been widely investigated as a neuromodulatory tool for numerous neuropsychiatric disorders, its neurophysiological mechanisms remain unclear (Carpenter et al, 2012 ; Anderson et al, 2016 ; Zandvakili et al, 2019 ; Alyagon et al, 2020 ; Cosmo et al, 2021 ; McIntyre et al, 2021 ; Khedr et al, 2022 ). The use of the FCN model in this study is innovative as it offers a novel approach to understanding the acute effects of rTMS on dynamic patterns of brain connectivity over time.…”

Section: Discussionmentioning

confidence: 99%

“…Since its initial clearance, rTMS has been increasingly utilized in TRD (Carpenter et al, 2012 ; Gaynes et al, 2014 ; Anderson et al, 2016 ; Cosmo et al, 2021 ), with emerging data supporting its use in a broad range of neuropsychiatric disorders (Carpenter et al, 2012 ; Anderson et al, 2016 ; Zandvakili et al, 2019 ; Alyagon et al, 2020 ; Cosmo et al, 2021 ; McIntyre et al, 2021 ; Khedr et al, 2022 ). Despite its clinical successes, the mechanism of action of rTMS and its effects during treatment have yet to be fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depression

Cosmo

Zandvakili

Petrosino

et al. 2023

Front. Neural Circuits

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IntroductionPrevious studies have demonstrated the effectiveness of therapeutic repetitive transcranial magnetic stimulation (rTMS) to treat pharmacoresistant depression. Nevertheless, these trials have primarily focused on the therapeutic and neurophysiological effects of rTMS following a long-term treatment course. Identifying brain-based biomarkers of early rTMS therapeutic response remains an important unanswered question. In this pilot study, we examined the effects of rTMS on individuals with pharmacoresistant depression using a graph-based method, called Functional Cortical Networks (FCN), and serial electroencephalography (EEG). We hypothesized that changes in brain activity would occur early in treatment course.MethodsA total of 15 patients with pharmacoresistant depression underwent five rTMS sessions (5Hz over the left dorsolateral prefrontal cortex, 120%MT, up to 4,000 pulses/session). Five participants received additional rTMS treatment, up to 40 sessions. Resting EEG activity was measured at baseline and following every five sessions, using 64-channel EEG, for 10 minutes with eyes closed. An FCN model was constructed using time-varying graphs and motif synchronization. The primary outcome was acute changes in weighted-node degree. Secondary outcomes included serial FFT-based power spectral analysis and changes in depressive symptoms measured by the 9-Item Patient Health Questionnaire (PHQ-9) and the 30-item Inventory of Depressive Symptoms-Self Report (IDS-SR).ResultsWe found a significant acute effect over the left posterior area after five sessions, as evidenced by an increase in weighted-node degree of 37,824.59 (95% CI, 468.20 to 75,180.98) and a marginal enhancement in the left frontal region (t (14) = 2.0820, p = 0.056). One-way repeated measures ANOVA indicated a significant decrease in absolute beta power over the left prefrontal cortex (F (7, 28) = 2.37, p = 0.048) following ten rTMS sessions. Furthermore, a significant clinical improvement was observed following five rTMS sessions on both PHQ-9 (t (14) = 2.7093, p = 0.017) and IDS-SR (t (14) = 2.5278, p = 0.024) and progressed along the treatment course.DiscussionOur findings suggest that FCN models and serial EEG may contribute to a deeper understanding of mechanisms underlying rTMS treatment. Additional research is required to investigate the acute and serial effects of rTMS in pharmacoresistant depression and assess whether early EEG changes could serve as predictors of therapeutic rTMS response.

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Comparative efficacy of repetitive transcranial magnetic stimulation protocols for obsessive-compulsive disorder: A network meta-analysis

Vinod,

Thatikonda,

Malo

et al. 2024

Asian Journal of Psychiatry

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A double blind randomized clinical trial of the effectiveness of low frequency rTMS over right DLPFC or OFC for treatment of obsessive-compulsive disorder

Cited by 12 publications

References 66 publications

Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders

Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders

Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depression

Comparative efficacy of repetitive transcranial magnetic stimulation protocols for obsessive-compulsive disorder: A network meta-analysis

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