title: Repetitive Transcranial Magnetic Stimulation Over Presupplementary Motor Area May Not Be Helpful in Treatment-Refractory Obsessive-Compulsive Disorder: A Case Series.
abstract: BACKGROUND
  A significant proportion of patients with obsessive-compulsive disorder (OCD) fail to improve with standard medication and cognitive behavior therapy. Repetitive transcranial magnetic stimulation (rTMS) has been investigated for its role in treating OCD. Low-frequency rTMS over the presupplementary motor area (pre-SMA) has shown mixed results. Moreover, it has not been studied in highly treatment refractory OCD. We analyzed the outcome of low-frequency rTMS over pre-SMA in OCD patients refractory to multiple serotonin reuptake inhibitors (SRIs), augmenting agents, and cognitive behavior therapy.
  
  
  METHODS
  Low-frequency (1-Hz stimulus at 100% motor threshold) rTMS was delivered over the pre-SMA using a previously described protocol. At least 25% reduction Yale-Brown Obsessive Compulsive Scale scores and 2-point reduction in Clinical Global Impression-Severity of Illness scores were used to assess treatment response.
  
  
  RESULTS
  Seventeen patients were initiated on rTMS. Three of them dropped out within 9 sittings. Only 1 patient met the criteria for response after 1 month of treatment initiation. No major adverse effects were observed in any of them.
  
  
  CONCLUSIONS
  The study is a retrospective analysis of outcomes when rTMS was administered as part of routine clinical care. Assessments of the patients were done by trained but different raters, and interrater reliability was not measured.
  
  
  CONCLUSIONS
  Low-frequency rTMS over the pre-SMA may not be effective in treatment refractory OCD. Further studies, taking note of the possible reasons for ineffectiveness discussed in the study, may help elucidate the role of rTMS in OCD.
authors.affiliation: From the Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Aditya
authors.initials: A
authors.lastname: Hegde
authors.forename: Malvika
authors.initials: M
authors.lastname: Ravi
authors.forename: Subhasini
authors.initials: S
authors.lastname: V S
authors.forename: Shyam Sundar
authors.initials: SS
authors.lastname: Arumugham
authors.forename: Jagadisha
authors.initials: J
authors.lastname: Thirthalli
authors.forename: Y C
authors.initials: YC
authors.lastname: Janardhan Reddy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex; D009771:Obsessive-Compulsive Disorder / Q000523:psychology* / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors