Transcranial Magnetic Stimulation for the Treatment of Obsessive-Compulsive Disorder

Transcranial Magnetic Stimulation for the Treatment of Obsessive-Compulsive Disorder

Rikinkumar S. Patel, MD, MPHa; Saher Kamil, MDb; Hema Mekala, MDa; and Steven Lippmann, MDc,*

About 10% of patients diagnosed with obsessive-compulsive disorder (OCD) remain symptomatic despite standard pharmaceutical and psychotherapy treatments.1 Many suffer treatment resistance despite optimal care. For such individuals, the US Food and Drug Administration approved transcranial magnetic stimulation (TMS) in 2018 as a potentially effective intervention.2

Deep TMS (dTMS) employs a H7 coil and targets deep brain areas of the anterior cingulate and medial prefrontal cortex. It can induce improved clinical results.3,4

One randomized study3 involved 100 subjects with OCD. The treatment group received 29 dTMS sessions over 6 weeks, while a sham coil was applied for the control set. The dTMS patients evidenced a 38% reduction in OCD symptoms compared to 11% for controls. Improvement for the dTMS group was maintained at 10-week follow-up.3

Another trial4 evaluated the effectiveness of dTMS in 99 treatment-resistant individuals with OCD. Subjects were randomized to 20-Hz high-frequency and sham groups. Nearly 45% of participants who received high-frequency dTMS showed clinical improvement compared to those in the sham group. High-frequency exposure modulates neural activity and sustained inhibited compulsions in patients with OCD.4

More TMS research5 documented that targeting other brain areas also attenuated OCD symptoms. The effect of repetitive TMS (rTMS) over the right dorsolateral prefrontal cortex was tested among 45 subjects. Groups were divided into low-frequency, high-frequency, and sham exposures. Application of low-frequency rTMS yielded the best response rates.5

An investigation6 comparing α-electroencephalograph TMS with a sham intervention bilaterally in 46 patients with OCD resulted in less obsessions, anxiety, and depression following TMS treatment. Administration of rTMS over a supplemental motor area in 2 trials6,7 yielded fewer OCD symptoms. Another study8 monitored low-frequency, double-cone rTMS over the right orbitofrontal cortex; time-limited improvement was significant but only briefly sustained.

With clinical benefit safely documented, dTMS can be a reasonable adjunctive treatment option for OCD-diagnosed patients. Metallic objects or implanted devices in or near the head are the contraindication against administering dTMS. Further research is ongoing.2

Published online: October 22, 2020.

Potential conflicts of interest: None.

Funding/support: None.

References

1.Denys D. Pharmacotherapy of obsessive-compulsive disorder and obsessive-compulsive spectrum disorders. Psychiatr Clin North Am. 2006;29(2):553-584, xi. PubMed CrossRef

2.FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. US Food & Drug Administration website. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder. 2018. Accessed August 24, 2020.

3.Brainsway announces positive final results of its deep-TMS multicenter study in obsessive compulsive disorder (OCD) patients. Brainsway website. https://www.brainsway.com/news_events/brainsway-announces-positive-final-results-deep-tms-multicenter-study-obsessive-compulsive-disorder-ocd-patients/. 2017. Accessed August 24, 2020.

4.Carmi L, Tendler A, Bystritsky A, et al. Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial. Am J Psychiatry. 2019;176(11):931-938. PubMed CrossRef

5.Elbeh KAM, Elserogy YMB, Khalifa HE, et al. Repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorders: double blind randomized clinical trial. Psychiatry Res. 2016;238:264-269. PubMed CrossRef

6.Ma X, Huang Y, Liao L, et al. A randomized double-blinded sham-controlled trial of α electroencephalogram-guided transcranial magnetic stimulation for obsessive-compulsive disorder. Chin Med J (Engl). 2014;127(4):601-606. PubMed

7.Gomes PV, Brasil-Neto JP, Allam N, et al. A randomized, double-blind trial of repetitive transcranial magnetic stimulation in obsessive-compulsive disorder with three-month follow-up. J Neuropsychiatry Clin Neurosci. 2012;24(4):437-443. PubMed CrossRef

8.Nauczyciel C, Le Jeune F, Naudet F, et al. Repetitive transcranial magnetic stimulation over the orbitofrontal cortex for obsessive-compulsive disorder: a double-blind, crossover study. Transl Psychiatry. 2014;4(9):e436. PubMed CrossRef

aDepartment of Psychiatry, Griffin Memorial Hospital, Norman, Oklahoma

bDepartment of Psychiatry, Austin State Hospital, Austin, Texas

cDepartment of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky

*Corresponding author: Steven Lippmann, MD, 401 East Chestnut St, Ste 610, Louisville, KY 40202 ([email protected]).

Prim Care Companion CNS Disord 2020;22(5):19br02583

To cite: Patel RS, Kamil S, Mekala H, et al. Transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder. Prim Care Companion CNS Disord. 2020;22(5):19br02583.

To share: https://doi.org/10.4088/PCC.19br02583

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