Accelerated neuromodulation therapy for Obsessive-Compulsive Disorder

Williams, Nolan; Sudheimer, Keith; Cole, Eleanor; Varias, Andrea; Goldstein-Piekarski, Andrea N.; Stetz, Patrick; Lombardi, Anthony; Filippou-Frye, Maria; Roessel, Peter van; Anderson, Kelley P.; McCarthy, Elizabeth; Wright, Brianna; Sandhu, Thasveen; Menon, Sindu; Jo, Booil; Koran, Lorrin M.; Williams, Leanne M.; Rodriguez, Carolyn I.

doi:10.1016/j.brs.2021.02.013

Cited by 29 publications

(22 citation statements)

References 10 publications

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“…Alternatively, it is possible that 20 sessions of bilateral TBS delivered over 10 days was an insufficient dose, in view of the notion that TRD non-responsive to rTMS may be attributable to under-dosing [61] and that patients with highly refractory depression may benefit from more TMS pulses per day [30] and/or more total pulses per course [74]. In contrast to the bilateral cTBS600 and iTBS600 we applied over 20 sessions (equating to a total of 24,000 TBS pulses), Williams et al reported favourable treatment response rates in both TRD [45,61] and obsessivecompulsive disorder [75] when 50 sessions of iTBS1800 were applied (totalling 90,000 pulses). Further, Nettekoven et al found increased motor cortical excitability of iTBS1800 over iTBS600 and iTBS1200 protocols in healthy controls [37].…”

Section: Discussionmentioning

confidence: 97%

Accelerated theta burst stimulation for the treatment of depression: A randomised controlled trial

Chen¹,

Thomas²,

Kaewpijit³

et al. 2021

Brain Stimulation

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Introduction: Theta burst pattern repetitive transcranial magnetic stimulation (TBS) is increasingly applied to treat depression. TBS's brevity is well-suited to application in accelerated schedules. Sizeable trials of accelerated TBS are lacking; and optimal TBS parameters such as stimulation intensity are not established. Methods: We conducted a three arm, single blind, randomised, controlled, multi-site trial comparing accelerated bilateral TBS applied at 80 % or 120 % of the resting motor threshold and left unilateral 10 Hz rTMS. 300 patients with treatment-resistant depression (TRD) were recruited. TBS arms applied 20 bilateral prefrontal TBS sessions over 10 days, while the rTMS arm applied 20 daily sessions of 10 Hz rTMS to the left prefrontal cortex over 4 weeks. Primary outcome was depression treatment response at week 4. Results: The overall treatment response rate was 43.7 % and the remission rate was 28.2 %. There were no significant differences for response (p ¼ 0.180) or remission (p ¼ 0.316) across the three groups. Response rates between accelerated bilateral TBS applied at sub-and supra-threshold intensities were not significantly different (p ¼ 0.319). Linear mixed model analysis showed a significant effect of time (p < 0.01), but not rTMS type (p ¼ 0.680). Conclusion: This is the largest accelerated bilateral TBS study to date and provides evidence that it is effective and safe in treating TRD. The accelerated application of TBS was not associated with more rapid antidepressant effects. Bilateral sequential TBS did not have superior antidepressant effect to unilateral 10 Hz rTMS. There was no significant difference in antidepressant efficacy between sub-and suprathreshold accelerated bilateral TBS.

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Section: Discussionmentioning

confidence: 97%

Accelerated theta burst stimulation for the treatment of depression: A randomised controlled trial

Chen¹,

Thomas²,

Kaewpijit³

et al. 2021

Brain Stimulation

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“…In the future, targets for rTMS should be no more anatomical but should look at the functional connections of the target. In this sense, the target should be chosen depending on its connectivity (49). Our study points in this direction.…”

Section: Discussionmentioning

confidence: 99%

rTMS investigation of resistant Obsessive-Compulsive Related Disorders: Efficacy of targeting the reward system

Ponzio

Makris²,

Tenerini³

et al. 2023

Front. Psychiatry

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IntroductionRepetitive Transcranial Magnetic Stimulation (rTMS) is not only a therapeutic option but also an investigational tool to explore circuits and subjective dimensions in pathological conditions. Obsessive-Compulsive Related Disorders (OCRDs) shared similarities with Substance Use Disorder (SUD), suggesting the involvement of the reward system. This study aimed to verify the efficacy of targeting the reward system with rTMS in OCRDs.MethodsPatients with trichotillomania, hoarding disorder and skin picking disorder were treated with rTMS over the left DorsoLateral PreFrontal Cortex (DLPFC) at 15 Hz, targeting the reward system via the connection with the nucleus accumbens and the ventral tegmental area. All patients were administered with psychometric scales assessing depression symptoms and severity of OCRDs symptoms at the baseline, at the end of the treatment and a 1-month follow-up.ResultsAnalysis of the results showed a reduction in symptom severity at the end of the treatment in all three groups (p < 0.0001) as well as a reduction in depression symptoms (p < 0.01). Improvements at 1-month follow-up were maintained only in younger patients. Indeed, when changes in scores at the follow-up were analyzed separately for younger (<30 years) and older patients (>60 years), the elderly showed again an increase in symptoms severity, suggesting that the stability of TMS effects over time reduces with age, possibly as an effect of age-related reduction in brain plasticity.DiscussionThis study adopted with promising results a protocol (15 Hz over the left DLPFC) targeting the reward system, typically employed in addictions. These results can be in line with the view of OCRDs as behavioral addictions, suggesting the implication of common circuits, such as the reward system, in the mechanisms at the basis of these disorders.

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“…For example, the pivotal non-inferiority trial for theta burst stimulation (TBS) [17] was published as this study was being designed and implemented. Since that time, TBS has likely become more prevalent in routine clinical practice as well as in clinical trials offering accelerated protocols [39,40]. Indeed, the most recent systematic review identified three seizures associated with TBS, including two with intermittent TBS and one with continuous TBS [16].…”

Section: Limitationsmentioning

confidence: 99%

Seizure risk with repetitive TMS: Survey results from over a half-million treatment sessions

et al. 2021

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Background: Seizures are rare during repetitive transcranial magnetic stimulation (rTMS) treatment, but estimating risk is difficult because of study heterogeneity and sampling limitations. Moreover, there are few studies comparing rates between device manufacturers. Objective: The objective of this study was to calculate rTMS seizure rates across various FDA-cleared devices in naturalistic clinical settings. Methods: In July and August 2018, approximately 500 members of the Clinical TMS Society (CTMSS) were electronically surveyed about seizures in their practices. Seizures were distinguished from non-seizures by a remote semi-structured interview with a Board-certified neurologist and Co-Chair of the CTMSS Standards Committee. Exact Poisson calculations were used to estimate seizure rates and confidence intervals across the four most widely used manufacturers. Results: The survey was completed by 134 members, with 9 responses excluded because of data inconsistencies. In total, 18 seizures were reported in 586,656 sessions and 25,526 patients across all device manufacturers. The overall seizure rate was 0.31 (95% CI: 0.18, 0.48) per 10,000 sessions, and 0.71 (95% CI: 0.42, 1.11) per 1000 patients. The Brainsway H-coil seizure rate of 5.56 per 1000 patients (95% CI: 2.77,9.95) was significantly higher (p < 0.001) than the three most widely used figure-8 coil devices' combined seizure rate of 0.14 per 1000 patients (95% CI: 0.01, 0.51). Conclusion:The absolute risk of a seizure with rTMS is low, but generic Brainsway H-coil treatment appears to be associated with a higher relative risk than generic figure-8 coil treatment. Well-designed prospective studies are warranted to further investigate this risk.

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Accelerated neuromodulation therapy for Obsessive-Compulsive Disorder

Cited by 29 publications

References 10 publications

Accelerated theta burst stimulation for the treatment of depression: A randomised controlled trial

Accelerated theta burst stimulation for the treatment of depression: A randomised controlled trial

rTMS investigation of resistant Obsessive-Compulsive Related Disorders: Efficacy of targeting the reward system

Seizure risk with repetitive TMS: Survey results from over a half-million treatment sessions

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