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Deep brain stimulation improves OCD symptoms

High-frequency deep transcranial magnetic stimulation, or dTMS, over the medial prefrontal cortex and anterior cingulate cortex safely improved symptoms in patients with obsessive-compulsive disorder, study findings published in American Journal of Psychiatry revealed.

“In recent years, several attempts to treat OCD with repetitive transcranial magnetic stimulation (rTMS) have been documented, and a recent meta-analysis found active rTMS to be clinically and statistically superior to sham treatment,” Lior Carmi, PhD, from the School of Psychological Science, Tel Aviv University, Israel, and colleagues wrote. “However, no consensus protocol has yet emerged with respect to stimulation target, frequency, and intensity.”

Researchers examined the therapeutic effect of dTMS in a multicenter double-blind sham-controlled study among 99 patients with OCD who failed to respond adequately to maintenance treatment of a serotonin reuptake inhibitor or .

Participants were randomly assigned to receive treatment with either high-frequency (20 Hz) or sham dTMS for 6 weeks. Before each treatment, participants received a 5-minute individualized obsessive-compulsive symptom provocation to activate the relevant neuronal circuit.

Carmi and colleagues examined clinical response to treatment and change from baseline to posttreatment assessment using the Yale-Brown Obsessive-Compulsive Scale (YBOCS) as well as response rates at the posttreatment assessment and month after follow-up.

At the 6-week, posttreatment assessment, the researchers observed a greater reduction in YBOCS score among patients who received active dTMS treatment than among those who received sham treatment (reductions of 6 points vs. 3.3 points), according to the results. The response rates were higher in the active group compared with the sham group after 6 weeks (38.1% vs. 11.1%) and after the 1-month follow-up (45.2% vs. 17.8%).

Overall, 73% of participants in the active treatment group and 69% in the sham treatment group reported adverse events, but the difference between groups was not statistically significant. The most frequent adverse event was headache (37.5 and 35.3% in the active and sham groups) and the dropout rate was about 12% for both groups.

“The intriguing finding of an additional benefit for OCD patients who did not respond adequately to pharmacological or psychological treatment suggests that dTMS may involve a different mechanism,” Carmi and colleagues wrote. “Accordingly, we recommend considering the option of adding dTMS to treatment when the response to a proper psychological or pharmacological intervention is inadequate.” – by Savannah Demko

Disclosure: Carmi reports research and travel support from Brainsway. Please see the study for all other authors’ relevant financial disclosures.