TY - JOUR
T1 - Repetitive Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder
T2 - A Meta-analysis of Randomized, Sham-Controlled Trials
AU - Perera, M. Prabhavi N.
AU - Mallawaarachchi, Sudaraka
AU - Miljevic, Aleksandra
AU - Bailey, Neil W.
AU - Herring, Sally E.
AU - Fitzgerald, Paul B.
N1 - Funding Information:
This work is supported by the Monash University Institute of Graduate Research (to MPNP, AM) and NHMRC Investigator Grant No. 1193596 (to PBF).
Funding Information:
This work is supported by the Monash University Institute of Graduate Research (to MPNP, AM) and NHMRC Investigator Grant No. 1193596 (to PBF). We would like to thank members of the Epworth Centre for Innovation in Mental Health for encouragement and insightful discussions. PBF has received equipment for research from MagVenture A/S, Nexstim, Neuronetics, and Brainsway Ltd. and funding for research from Neuronetics. He is a founder of TMS Clinics Australia. All other authors report no biomedical financial interests or potential conflicts of interest.
Publisher Copyright:
© 2021 Society of Biological Psychiatry
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - Background: Obsessive-compulsive disorder (OCD) is a chronic, disabling mental health condition with limited treatment options available to date. Numerous randomized controlled trials have explored the efficacy of repetitive transcranial magnetic stimulation (rTMS) in OCD. This meta-analysis synthesized data from selected randomized controlled trials and examined the impact of different treatment parameters to generate hypotheses that would direct future randomized controlled trials. Methods: A database search was performed to identify studies published in English up to October 2020. Randomized, sham-controlled studies that used rTMS to treat OCD were included. Effect sizes were calculated using Hedges’ g for pre- to post-treatment Yale-Brown Obsessive Compulsive Scale scores. Subgroup analyses were conducted to assess the effects of variations in rTMS treatment parameters. Results: A total of 26 studies with 781 participants were included. Overall, rTMS demonstrated a modest effect on reduction of Yale-Brown Obsessive Compulsive Scale scores (Hedges’ g = 0.64, 95% confidence interval = 0.39–0.89; p < .0001). The largest significant effect size was obtained by targeting the bilateral dorsolateral prefrontal cortex. High- and low-frequency rTMS showed comparable effects. Studies with follow-up data suggested that the effects of active rTMS remain significantly superior to those of sham 4 weeks after treatment. Conclusions: The therapeutic effects of rTMS are superior to those of sham in the treatment of OCD. Targeting the bilateral dorsolateral prefrontal cortex was the most favorable approach in administering rTMS. Further research is required to determine the optimal frequency, total pulses per session, and duration of treatment with rTMS for OCD.
AB - Background: Obsessive-compulsive disorder (OCD) is a chronic, disabling mental health condition with limited treatment options available to date. Numerous randomized controlled trials have explored the efficacy of repetitive transcranial magnetic stimulation (rTMS) in OCD. This meta-analysis synthesized data from selected randomized controlled trials and examined the impact of different treatment parameters to generate hypotheses that would direct future randomized controlled trials. Methods: A database search was performed to identify studies published in English up to October 2020. Randomized, sham-controlled studies that used rTMS to treat OCD were included. Effect sizes were calculated using Hedges’ g for pre- to post-treatment Yale-Brown Obsessive Compulsive Scale scores. Subgroup analyses were conducted to assess the effects of variations in rTMS treatment parameters. Results: A total of 26 studies with 781 participants were included. Overall, rTMS demonstrated a modest effect on reduction of Yale-Brown Obsessive Compulsive Scale scores (Hedges’ g = 0.64, 95% confidence interval = 0.39–0.89; p < .0001). The largest significant effect size was obtained by targeting the bilateral dorsolateral prefrontal cortex. High- and low-frequency rTMS showed comparable effects. Studies with follow-up data suggested that the effects of active rTMS remain significantly superior to those of sham 4 weeks after treatment. Conclusions: The therapeutic effects of rTMS are superior to those of sham in the treatment of OCD. Targeting the bilateral dorsolateral prefrontal cortex was the most favorable approach in administering rTMS. Further research is required to determine the optimal frequency, total pulses per session, and duration of treatment with rTMS for OCD.
KW - Cortical target
KW - Meta-analysis
KW - Noninvasive brain stimulation
KW - Obsessive-compulsive disorder
KW - Repetitive transcranial magnetic stimulation
KW - Subgroup analysis
UR - http://www.scopus.com/inward/record.url?scp=85109105606&partnerID=8YFLogxK
U2 - 10.1016/j.bpsc.2021.03.010
DO - 10.1016/j.bpsc.2021.03.010
M3 - Article
C2 - 33775927
AN - SCOPUS:85109105606
SN - 2451-9022
VL - 6
SP - 947
EP - 960
JO - Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
JF - Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
IS - 10
ER -