Efficacy of repetitive transcranial magnetic stimulation in patients with obsessive–compulsive disorder: a pilot study
Tóm tắt
Obsessive–compulsive disorder (OCD) is a common disabling psychiatric disorder. Considering the lack of an acceptable treatment response in many patients, several efforts have been made to increase the efficacy of therapy. We aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) on the supplementary motor area in the treatment of patients with drug-resistant OCD and examine changes in brain function. This quasi-experimental study was performed on 12 patients who were referred to outpatient clinics of Ibn-e-Sina psychiatric hospital and were diagnosed with OCD according to the clinical and diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). All patients received 20 rTMS sessions in their right supplementary motor region. Main outcomes were assessed using quantitative electroencephalography (qEEG) and the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) before and after the intervention. In addition, Y‑BOCS was completed after 10 rTMS sessions and after the 6‑week follow-up. Data were analyzed with SPSS. Ten of 12 patients completed this study, of whom 7 (70%) were female. The mean age was 36.66 ± 10.28 years. Y‑BOCS overall score significantly decreased over time during the course of study compared to baseline (P < 0.05). A significant decrease in beta wave activity of the parietal and occipital regions was seen in posttreatment qEEG, compared with baseline (P < 0.05). rTMS over the supplementary motor area at 20 sessions could effectively improve Y‑BOCS score and decrease beta wave activity in parietal and occipital regions. Further studies are needed to approve these findings in a controlled design.
Tài liệu tham khảo
Sadock BJ, Sadock VA. Kaplan and Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry. : Lippincott Williams & Wilkins; 2011.
Alonso P, Pujol J, Cardoner N, Benlloch L, Deus J, Menchón JM, et al. Right prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a double-blind, placebo-controlled study. Am J Psychiatry. 2001;158(7):1143–5.
Berlim MT, Neufeld NH, Van den Eynde F. Repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD): an exploratory meta-analysis of randomized and sham-controlled trials. J Psychiatr Res. 2013;47(8):999–1006.
Ruffini C, Locatelli M, Lucca A, Benedetti F, Insacco C, Smeraldi E. Augmentation effect of repetitive transcranial magnetic stimulation over the orbitofrontal cortex in drug-resistant obsessive-compulsive disorder patients: a controlled investigation. Prim Care Companion J Clin Psychiatry. 2009;11(5):226.
Sarkhel S, Sinha VK, Praharaj SK. Adjunctive high-frequency right prefrontal repetitive transcranial magnetic stimulation (rTMS) was not effective in obsessive-compulsive disorder but improved secondary depression. J Anxiety Disord. 2010;24(5):535–9.
Ma Z‑R, Shi L‑J. Repetitive transcranial magnetic stimulation (rTMS) augmentation of selective serotonin reuptake inhibitors (SSRIs) for SSRI-resistant obsessive-compulsive disorder (OCD): a meta-analysis of randomized controlled trials. Int J Clin Exp Med. 2014;7(12):4897.
Hansen ES, Prichep LS, Bolwig TG, John ER. Quantitative electroencephalography in OCD patients treated with paroxetine. Clin Electroencephalogr. 2003;34(2):70–4.
Zhou D‑D, Wang W, Wang G‑M, Li D‑Q, Kuang L. An updated meta-analysis: short-term therapeutic effects of repeated transcranial magnetic stimulation in treating obsessive-compulsive disorder. J Affect Disord. 2017;215:187–96.
Kumar S, Gupta R. An update of the application of repetitive transcranial magnetic stimulation (rTMS) in patients with obsessive compulsive disorder. Neuropsychiatry. 2016;6(1):10–4.
Zaman R, Robbins TW. Is there potential for repetitive transcranial magnetic stimulation (RTMS) as a treatment of OCD. Psychiat Danub. 2017;29(3):672–8.
Marques RC, Vieira L, Marques D, Cantilino A. Transcranial magnetic stimulation of the medial prefrontal cortex for psychiatric disorders: a systematic review. Rev Bras Psiquiatr. 2019;41(5):447–57.
Shivakumar V, Dinakaran D, Narayanaswamy JC, Venkatasubramanian G. Noninvasive brain stimulation in obsessive-compulsive disorder. Indian J Psychiatry. 2019;61(1):S66–s76.
Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–7.
Kaviani H, Mousavi A. Psychometric properties of the Persian version of beck anxiety inventory (BAI). Tehran Univ Med J. 2008;66(2):136–40.
Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the beck depression inventory—second edition: BDI-II-PERSIAN. Depress Anxiety. 2005;21(4):185–92.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4(6):561–71.
Beck AT, Steer RA, Brown GK. Beck depression inventory-II. Pearson. 1996;78(2):490–8.
Busner J, Targum SD. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont). 2007;4(7):28–37.
Esfahani SR, Motaghipour Y, Kamkari K, Zahiredin A, Janbozorgi M. Reliability and validity of the Persian version of the Yale-Brown obsessive-compulsive scale (Y-BOCS). Iran J Psychiatry Clin Psychol. 2012;17(4):297–303.
Stein DJ, Costa DL, Lochner C, Miguel EC, Reddy YJ, Shavitt RG, et al. Obsessive-compulsive disorder. Nat Rev Dis Primers. 2019;5(1):1–21.
Rehn S, Eslick GD, Brakoulias V. A meta-analysis of the effectiveness of different cortical targets used in repetitive transcranial magnetic stimulation (rTMS) for the treatment of obsessive-compulsive disorder (OCD). Psych Quar. 2018;89(3):645–65.
Singh S, Kumar S, Gupta A, Verma R, Kumar N. Effectiveness and predictors of response to 1‑Hz repetitive transcranial magnetic stimulation in patients with obsessive-compulsive disorder. J ECT. 2019;35(1):61–6.
Dhaliwal S, Meek B, Modirrousta M. Repetitive transcranial magnetic stimulation of the dorsal anterior cingulate cortex in the treatment of obsessive compulsive disorder: a double blind randomized clinical trial. Brain Stimul. 2019;12(2):472.
Verma R, Kumar N, Kuppili PP. Repetitive transcranial magnetic stimulation: the magic bullet for managing treatment-resistant obsessive-compulsive disorder in a congenitally deaf and mute woman. Prim Care Companion CNS Disord. 2018;20(4):17l02199.
Prichep LS, Mas F, Hollander E, Liebowitz M, John ER, Almas M, et al. Quantitative electroencephalographic subtyping of obsessive-compulsive disorder. Psychiatry Res Neuroimaging. 1993;50(1):25–32.
Simkin DR, Thatcher RW, Lubar J. Quantitative EEG and neurofeedback in children and adolescents: anxiety disorders, depressive disorders, comorbid addiction and attention-deficit/hyperactivity disorder, and brain injury. Child Adolesc Psychiatr Clin N Am. 2014;23(3):427–64.
Kwon JS, Kim J‑J, Lee DW, Lee JS, Lee DS, Kim M‑S, et al. Neural correlates of clinical symptoms and cognitive dysfunctions in obsessive-compulsive disorder. Psychiatry Res Neuroimaging. 2003;122(1):37–47.
Verfaillie SC, de Wit SJ, Vriend C, Remijnse PL, Veltman DJ, van den Heuvel OA. The course of the neural correlates of reversal learning in obsessive-compulsive disorder and major depression: a naturalistic follow-up fMRI study. J Obsessive Compuls Relat Disord. 2016;9:51–8.
Adler CM, McDonough-Ryan P, Sax KW, Holland SK, Arndt S, Strakowski SM. fMRI of neuronal activation with symptom provocation in unmedicated patients with obsessive compulsive disorder. J Psychiatr Res. 2000;34(4–5):317–24.
Garg H, Kumar S, Singh S, Kumar N, Verma R. New onset obsessive compulsive disorder following high frequency repetitive transcranial magnetic stimulation over left dorsolateral prefrontal cortex for treatment of negative symptoms in a patient with schizophrenia. Clin Psychopharmacol Neurosci. 2019;17(3):443–5.