Repetitive Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Meta-analysis of Randomized, Sham-Controlled Trials

M Prabhavi N Perera; Sudaraka Mallawaarachchi; Aleksandra Miljevic; Neil W Bailey; Sally E Herring; Paul B Fitzgerald

doi:10.1016/j.bpsc.2021.03.010

Repetitive Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Meta-analysis of Randomized, Sham-Controlled Trials

Biol Psychiatry Cogn Neurosci Neuroimaging. 2021 Oct;6(10):947-960. doi: 10.1016/j.bpsc.2021.03.010. Epub 2021 Mar 26.

Authors

M Prabhavi N Perera¹, Sudaraka Mallawaarachchi², Aleksandra Miljevic³, Neil W Bailey³, Sally E Herring³, Paul B Fitzgerald³

Affiliations

¹ Epworth Centre for Innovation in Mental Health, Department of Psychiatry, Central Clinical School, Monash University, Epworth HealthCare, Melbourne, Victoria, Australia. Electronic address: magelage.perera@monash.edu.
² Melbourne Integrative Genomics, School of Mathematics & Statistics, University of Melbourne, Melbourne, Victoria, Australia.
³ Epworth Centre for Innovation in Mental Health, Department of Psychiatry, Central Clinical School, Monash University, Epworth HealthCare, Melbourne, Victoria, Australia.

PMID: 33775927
DOI: 10.1016/j.bpsc.2021.03.010

Abstract

Background: Obsessive-compulsive disorder (OCD) is a chronic, disabling mental health condition with limited treatment options available to date. Numerous randomized controlled trials have explored the efficacy of repetitive transcranial magnetic stimulation (rTMS) in OCD. This meta-analysis synthesized data from selected randomized controlled trials and examined the impact of different treatment parameters to generate hypotheses that would direct future randomized controlled trials.

Methods: A database search was performed to identify studies published in English up to October 2020. Randomized, 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 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 Yale-Brown Obsessive Compulsive Scale scores (Hedges' g = 0.64, 95% confidence interval = 0.39-0.89; p < .0001). The largest significant effect size was obtained by targeting the bilateral dorsolateral prefrontal cortex. High- and low-frequency rTMS showed comparable effects. Studies with follow-up data suggested that the effects of active rTMS remain significantly superior to those of sham 4 weeks after treatment.

Conclusions: The therapeutic effects of rTMS are superior to those of sham in the treatment of OCD. Targeting the bilateral dorsolateral prefrontal cortex was the most favorable 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.

Keywords: Cortical target; Meta-analysis; Noninvasive brain stimulation; Obsessive-compulsive disorder; Repetitive transcranial magnetic stimulation; Subgroup analysis.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Obsessive-Compulsive Disorder* / therapy
Prefrontal Cortex
Randomized Controlled Trials as Topic
Transcranial Magnetic Stimulation*