Repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorders: Double blind randomized clinical trial

Elbeh, Khaled; Elserogy, Yasser M.; Khalifa, Hosam; Ahmed, Mohamed A.; Hafez, Mahmoud H.; Khedr, Eman M.

doi:10.1016/j.psychres.2016.02.031

Cited by 64 publications

(50 citation statements)

References 23 publications

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“…Interestingly, positive findings on LF stimulation over the right dlPFC 39 , 40 were associated with a reduction in depressive and anxiety scores, an effect previously shown in LF rTMS stimulation over the right dlPFC in depression. Neurobio-logically, there is insufficient understanding of deficits in the dorsal cognitive loop in OCD to guide the targeting of this circuitry in treatment.…”

Section: Methodssupporting

confidence: 58%

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Transcranial magnetic stimulation in the treatment of obsessive–compulsive disorder: current perspectives

Lusicic¹,

Schruers²,

Pallanti³

et al. 2018

NDT

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Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neurostimulation technique receiving increasing attention in the treatment of different psychiatric disorders. Evidence for rTMS use in obsessive–compulsive disorder (OCD) is accumulating and informing further developments in the neurostimulation field, the latest being deep transcranial magnetic stimulation (dTMS). dTMS allows direct stimulation of deeper subcortical structures and larger brain volume than conventional rTMS. Underlying neurobiological mechanisms related to transcranial magnetic stimulation are still under evaluation, but appear to offer a novel “third” way of addressing symptoms via localized electrical stimulation compared to pharmacotherapy and psychotherapy approaches. This systematic review focuses on the effects of rTMS and dTMS stimulation on different brain targets in OCD. Brain areas included are the dorsolateral prefrontal cortex, supplementary motor area, orbitofrontal cortex/medial prefrontal cortex, and anterior cingulate cortex (ACC). Improved understanding of the therapeutic effects of rTMS in OCD will support fine-tuning of the method and help determine how we can best optimize the approach via rTMS or dTMS to achieve clinically relevant results.

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Section: Methodssupporting

confidence: 58%

“…In a separate study, Elbeh et al 40 examined the effects of 1 Hz, 10 Hz, or sham treatment applied to the right dlPFC in 45 OCD patients with a mean duration of illness of 19.2±11.5 months. Stimulation was applied over 10 sessions, with a follow-up of 3 months.…”

Section: Methodsmentioning

confidence: 99%

Transcranial magnetic stimulation in the treatment of obsessive–compulsive disorder: current perspectives

Lusicic¹,

Schruers²,

Pallanti³

et al. 2018

NDT

View full text Add to dashboard Cite

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“…Despite the lack of understanding regarding the exact nature of the relationship between OCD and depression, there is an agreement that depression is an important factor that must be assessed in patients with OCD. Despite this notion, some studies in this review did not assess depression: Shayganfard et al [23]. As a result, it is difficult to know the impact that depression could have had in these trials' results.…”

Section: Discussionmentioning

confidence: 92%

“…Considering that low-frequency TMS has inhibitory effects, reducing cortical excitability, and that high-frequency TMS has excitatory effects, increasing cortical excitability [7,24], a preferential use of low-frequency TMS might have been expected, due to the aforementioned hyperactivity in certain cerebral areas in OCD. In fact, only one study compared simultaneously high-frequency and low-frequency TMS (Elbeh et al (2016)), and that study suggested that low-frequency TMS might cause long-term effects, since the reduction in Y-BOCS was maintained in the 3-months follow-up period, while high-frequency TMS might cause short-term effects, since such reduction was only maintained for two weeks in the high-frequency group [23]. It is worth noting that it is difficult to generalise the results of just one study.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the clinical variables, the presence of major depression was most noticeable in the studies that targeted the SMA (4/5 studies), in comparison to the studies that targeted the DLPFC (1/9 studies). Information regarding the average duration of the disease was also missing in 7/16 studies and, furthermore, amongst the studies that assessed it, Elbeh et al (2016) presented an average disease duration much lower than the rest (18.7 months, in comparison to the average of 12.2 years) [23], which can predispose to more favourable responses to treatment. Finally, regarding the treatment parameters, the duration of treatment and number of sessions were higher in the studies that targeted the SMA, which might predispose to better results since a longer duration of stimulation induces effects that persist for longer [7].…”

Section: Study Namementioning

confidence: 99%

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Efficacy of transcranial magnetic stimulation in the treatment of Obsessive-compulsive disorder

Sousa¹,

Moreira²

2018

IJCNMH

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Background: Obsessive-compulsive disorder (OCD) is a chronic and debilitating disease characterised by obsessions and compulsions that cause anxiety to the patient and his family. Its prevalence is around 2 to 3% in the general population, and despite being responsive to treatment, 40-60% of patients are not full responders and remain refractory. Therefore, new therapeutic options like transcranial magnetic stimulation (TMS) have been gaining interest recently due to their non-invasive nature and potentially promising results. However, there is not yet a consensus about its efficacy in this disease. The aim of this review is to assess the efficacy of TMS in the treatment of OCD, discussing some of the clinical trials available. Methods: A search was made in MEDLINE, through Pubmed, using the query: "Obsessive-Compulsive Disorder"[Mesh] AND "Transcranial Magnetic Stimulation"[Mesh]. Results: Several demographic, clinical and technique-related variables of 16 clinical trials were analysed, along with their outcome. Most of the trials revealed promising results in three cortical areas: dorsolateral pre-frontal cortex, supplementary motor area and orbitofrontal cortex. However, their statistical power is affected by their small sample size and heterogeneity of parameters, which limits critical analysis and comparison of results. Depression was also identified as a possible confounding factor, which could predispose to positive results. Conclusion: The distinct characteristics of the clinical trials make it impossible to generalise the effects of this technique in OCD. More robust studies, preferably without comorbid psychiatric disorders, are necessary to better evaluate the efficacy of this technique.

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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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Repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorders: Double blind randomized clinical trial

Cited by 64 publications

References 23 publications

Transcranial magnetic stimulation in the treatment of obsessive–compulsive disorder: current perspectives

Transcranial magnetic stimulation in the treatment of obsessive–compulsive disorder: current perspectives

Efficacy of transcranial magnetic stimulation in the treatment of Obsessive-compulsive disorder

Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders

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Repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorders: Double blind randomized clinical trial

Cited by 64 publications

References 23 publications

Transcranial magnetic stimulation in the treatment of obsessive&ndash;compulsive disorder: current perspectives

Transcranial magnetic stimulation in the treatment of obsessive&ndash;compulsive disorder: current perspectives

Efficacy of transcranial magnetic stimulation in the treatment of Obsessive-compulsive disorder

Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders

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Product

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Transcranial magnetic stimulation in the treatment of obsessive–compulsive disorder: current perspectives

Transcranial magnetic stimulation in the treatment of obsessive–compulsive disorder: current perspectives