Repetitive Transcranial Magnetic Stimulation to Supplementary Motor Area in Refractory Obsessive-Compulsive Disorder Treatment: a Sham-Controlled Trial

Abstract

Background:Repetitive transcranial magnetic stimulation has been explored in patients with obsessive-compulsive disorder, but with negative or conflicting results. This randomized double-blind study was designed to assess the efficacy of 1-Hz repetitive transcranial magnetic stimulation over the presupplementary area.Methods:Forty medication-resistant patients were assigned to 4 weeks of either active or sham repetitive transcranial magnetic stimulation targeting the presupplementary area with the help of a neuronavigation system.Results:According to the Yale-Brown obsessive-compulsive scale, the baseline-week 4 evolution showed no significant differences between groups. Responder rates at week 4 were not different between groups (repetitive transcranial magnetic stimulation 10.5% vs sham 20%; P=.63).Conclusion:Low-frequency repetitive transcranial magnetic stimulation applied to the presupplementary area seems ineffective for the treatment of obsessive-compulsive disorder patients, at least in severe and drug-refractory cases such as those included in this study. Further research is required to determine profiles of responder patients and appropriate repetitive transcranial magnetic stimulation parameters for obsessive-compulsive disorder.

Continuous theta burst stimulation over the supplementary motor area in refractory obsessive-compulsive disorder treatment: A randomized sham-controlled trial

“…In 2006, Mantovani et al (10) demonstrated that inhibition of the SMA successfully reduced OCD symptoms. Following this pioneering study, 5 randomized trials in OCD using low frequency rTMS over the SMA (11)(12)(13)(14)(15) reported inconsistent results. In the current trial, we used cTBS, known to induce larger and longer-lasting modulation of cortical excitability than standard rTMS (16), thus offering the promise of a potentially greater clinical efficacy.…”

“…The coil was positioned to target the pre-SMA as described in Pelissolo et al (14). All patients underwent a baseline and weekly evaluation of the motor cortex excitability by measuring the resting motor threshold (RMT).…”

“…According to Rehn et al's meta-analysis (6) the SMA is the most relevant cortical target for brain stimulation in OCD patients. To date, five randomized, sham-controlled studies using repeated low-frequency (1Hz) stimulation of the SMA in treatment resistant OCD (11)(12)(13)(14)(15) have been reported. In these prior studies, low frequency rTMS applied over the SMA showed varying rates of clinical effectiveness.…”

TMS for OCD

“…The sham coil utilized a mu-metal shield over the figure-8 coil. The active group did not have a significant reduction in YBOCS compared to sham [22].…”

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

“…Moreover, this study seems to be robust and with high statistical power, due to its considerable sample size of 36 patients (in comparison with the average sample size), a duration of treatment of four weeks (which is higher than the average) and, also, due to its use of a MRI-based neuronavigation system to target precisely the SMA [28]. Therefore, despite the high statistical power of the study performed by Pelissolo et al (2016), it is important to mention that the remaining four studies that targeted the SMA reached a different conclusion, specifically that TMS might be effective in treating OCD.…”