Biol Psychiatry Cogn Neurosci Neuroimaging. 2021 Mar 25:S2451-9022(21)00087-2. doi: 10.1016/j.bpsc.2021.03.010. Online ahead of print.
ABSTRACT
BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic, disabling mental health condition with limited treatment options available to date. Numerous randomised controlled trials (RCT) have explored the efficacy of repetitive transcranial magnetic stimulation (rTMS) in OCD. This meta-analysis synthesized data from selected RCTs and examined the impact of different treatment parameters to generate hypotheses that would direct future RCTs.
METHODS: A database search was performed to identify studies published in English up to October 2020. Randomised, 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 (YBOCS) 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 YBOCS scores (Hedges’ g=0.77, 95% CI=0.41, 1.14; p<0.0001). The largest significant effect size was obtained by targeting the bilateral dorsolateral prefrontal cortex (BL-DLPFC). High and low frequency rTMS showed comparable effects. Studies with follow-up data suggested that effects of active rTMS remain significantly superior to sham 4 weeks post-treatment.
CONCLUSIONS: The therapeutic effects of rTMS are superior to sham in the treatment of OCD. Targeting the BL-DLPFC was the most favourable 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.
PMID:33775927 | DOI:10.1016/j.bpsc.2021.03.010
