title: A randomized controlled study of sequentially applied repetitive transcranial magnetic stimulation in obsessive-compulsive disorder.
abstract: OBJECTIVE
  The present study investigated possible therapeutic effects and safety of sequentially combined low-frequency repetitive transcranial magnetic stimulation (rTMS) to the right dorsolateral prefrontal cortex and supplementary motor area in patients with treatment-resistant obsessive-compulsive disorder.
  
  
  METHODS
  Between February 2007 and January 2008, we carried out a study with a rater-blinded, sham-controlled design in which 20 patients with treatment-resistant obsessive-compulsive disorder, confirmed by a psychiatrist after use of the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version, were randomly assigned to either active rTMS (n = 10) or sham treatment (n = 10). Over 10 days, rTMS of 1 Hz was given at 110% of the motor threshold for 20 minutes over the right dorsolateral prefrontal cortex and sequentially at 1 Hz at 100% of the motor threshold for 20 minutes over the supplementary motor area. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS) score.
  
  
  RESULTS
  For the between-group analyses, there were no significant differences over 4 weeks between the active and sham groups on the YBOCS (F = 0.01, P = .92) and the Montgomery-Asberg Depression Rating Scale (MADRS; F = 0.39, P = .54). In repeated-measures analyses on all subjects, there was a significant effect of time on the YBOCS (F = 5.48, P = .009) and the MADRS (F = 6.55, P = .004). There were no significant group-by-time interactions for the YBOCS (F = 0.03, P = .94) or the MADRS (F = 0.09, P = .67).
  
  
  CONCLUSIONS
  These findings suggest that 10 sessions of sequential rTMS of the right dorsolateral prefrontal cortex and the supplementary motor area at low frequency had no therapeutic effect on obsessive-compulsive symptoms. However, rTMS was a safe method of treatment, and there was no significant change in cognitive function after rTMS. Further controlled studies using a more sophisticated sham system in larger samples are required to confirm the effect of rTMS in obsessive-compulsive disorder.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00932204.
authors.affiliation: Department of Psychiatry, Ilsan Hospital, National Health Insurance Corporation, Gyeonggi-do, South Korea.
authors.forename: Jee In
authors.initials: JI
authors.lastname: Kang
authors.forename: Chan-Hyung
authors.initials: CH
authors.lastname: Kim
authors.forename: Kee
authors.initials: K
authors.lastname: Namkoong
authors.forename: Chang-Il
authors.initials: CI
authors.lastname: Lee
authors.forename: Se Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D017397:Prefrontal Cortex / Q000502:physiology; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome