Randomized sham-controlled trial of repetitive transcranial magnetic stimulation in treatment-resistant obsessive-compulsive disorder.
In open trials, 1-Hz repetitive transcranial magnetic stimulation (rTMS) to the supplementary motor area (SMA) improved symptoms and normalized cortical hyper-excitability of patients with obsessive-compulsive disorder (OCD). Here we present the results of a randomized sham-controlled double-blind study. Medication-resistant OCD patients (n=21) were assigned 4 wk either active or sham rTMS to the SMA bilaterally. rTMS parameters consisted of 1200 pulses/d, at 1 Hz and 100% of motor threshold (MT). Eighteen patients completed the study. Response to treatment was defined as a > or = 25% decrease on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Non-responders to sham and responders to active or sham rTMS were offered four additional weeks of open active rTMS. After 4 wk, the response rate in the completer sample was 67% (6/9) with active and 22% (2/9) with sham rTMS. At 4 wk, patients receiving active rTMS showed on average a 25% reduction in the YBOCS compared to a 12% reduction in those receiving sham. In those who received 8-wk active rTMS, OCD symptoms improved from 28.2+/-5.8 to 14.5+/-3.6. In patients randomized to active rTMS, MT measures on the right hemisphere increased significantly over time. At the end of 4-wk rTMS the abnormal hemispheric laterality found in the group randomized to active rTMS normalized. The results of the first randomized sham-controlled trial of SMA stimulation in the treatment of resistant OCD support further investigation into the potential therapeutic applications of rTMS in this disabling condition.
Mantovani
Antonio
A
Division of Brain Stimulation and Therapeutic Modulation, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY 10032, USA. AM2518@columbia.edu
Simpson
Helen B
HB
Fallon
Brian A
BA
Rossi
Simone
S
Lisanby
Sarah H
SH
D000328:Adult; D004311:Double-Blind Method; D004351:Drug Resistance; D004576:Electromyography; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000502:physiology; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000523:psychology*; D016896:Treatment Outcome