A prospective, double-blind, placebo-controlled study by researchers at Baylor College of Medicine found that patients with a higher degree of symptom severity of obsessive-compulsive disorder (OCD) were more likely to respond to deep transcranial magnetic stimulation (dTMS). The results were published in the Journal of Psychiatric Research.
Patients (N = 100) with primary obsessive-compulsive disorder were recruited for this study at 11 locations between 2014 and 2017. Patients were randomized to receive 29 dTMS treatments over 6 weeks (5 per week for 5 weeks and 4 during week 6) or a dummy treatment. The dTMS had an H-shaped coil design that bilaterally stimulated the dorsal medial prefrontal cortex (mPFC) and the anterior cingulate cortex (ACC). The treatment group received 50 puffs and 2000 pulses (20 Hz) per session, the pulse trains being 2 seconds with an interval between puffs of 20 seconds.
The patients were 84% white, 59% men, and an average age of 39 years. Obsessive-compulsive disorder was moderate to severe (57%), moderate (35%), and severe (7%).
At the end of treatment, the model that included fixed and random effects for dTMS therapy on reducing OCD symptoms was significant (c2136.72; P <0.001), but was exceeded by a model with moderators (c250.54; P = 0.001). Significant cofactors associated with faster symptom reduction were older age (d, -0.62; P = 0.005), lower OCD severity (d, 0.50; P = 0.023) and lower basic disability (d , 0.47; P =). 034).
The significant moderator was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; d, -0.54; P = 0.017), patients in the treatment group had a 6.3-Y-BOCS reduction and patients in the sham group a reported 4.4 point reduction. In patients with a baseline Y-BOCS score of 28 points, they reported a reduction in the treatment cohort by 5.9 points and the mock group by 2.0 points.
4 weeks after treatment, the fixed and random effects model (c2156.88; P <0.001) exceeded the model with the moderators (c2)32.72; P = 0.11). Only the baseline severity remained significant (d, -0.45; P = 0.042), although older age tended to be significant (d, -0.43; P = 0.051).
Baseline Y-BOCS remained significant at 4 weeks, with those with baseline 28 points (d, -0.67; P = 0.047) a 7.1 point reduction in treatment arm and a 2.9 point reduction in sham arm Points reported.
The main limitation of this study was the lack of diversity among participants, which made it unclear whether these results were generalizable.
These results suggest that bilateral dTMS stimulation of the mPFC / ACC may be effective in treating patients with increased symptom severity. Patients with lower OCD severity would likely benefit more from other therapeutic agents.
Disclosure: Several authors have declared their affiliations with the industry. For a full list of the details, see the original article.
Storch EA, Tendler A, Schneider SC, Guzick AG, La Buissonniere-Ariza V, Goodman WK. Moderators and predictors of response to deep transcranial magnetic stimulation in obsessive-compulsive disorder. J Psychiatr Res. 2020; S0022-3956 (20) 31026-8. doi: 10.1016 / j.jpsychires.2020.10.023
This article originally appeared on Psychiatry Advisor