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Efficacy of repetitive transcranial magnetic stimulation in patients with obsessive–compulsive disorder: a pilot study

Wirksamkeit der repetitiven transkraniellen Magnetstimulation bei OCD(„obsessive–compulsive disorder“)-Patienten: eine Pilotstudie

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Summary

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Zusammenfassung

Grundlagen

Zwangsstörungen sind eine häufige, beeinträchtigende psychiatrische Störung. Viele Patienten sprechen nicht auf die Behandlung an. Daher wurden verschiedene Versuche unternommen, um die Therapieeffektivität zu erhöhen. Unser Ziel war die Evaluierung der Wirksamkeit einer repetitiven transkraniellen Magnetstimulation (rTMS) des supplementär-motorischen Areals bei der Behandlung von Patienten mit medikamentenresistenter Zwangsstörung und die Untersuchung von möglichen funktionellen Veränderungen im Gehirn.

Methodik

Diese quasi experimentelle Studie wurde an 12 Patienten durchgeführt, die in die Ambulanz des psychiatrischen Krankenhauses Ibn-e-Sina überwiesen wurden und bei denen eine Zwangsstörung gemäß den klinischen und diagnostischen Kriterien des DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) diagnostiziert wurde. Alle Patienten erhielten 20 rTMS-Sitzungen im rechten supplementär-motorischen Areal. Die wesentlichen Ergebnisse wurden anhand der quantitativen Elektroenzephalographie (qEEG) und der Yale-Brown Obsessive Compulsive Scale (Y-BOCS) vor und nach der Intervention bewertet. Darüber hinaus wurde die Y‑BOCS nach 10 rTMS-Sitzungen und nach dem 6‑Wochen-Follow-up erhoben. Die Daten wurden mit SPSS ausgewertet.

Ergebnisse

Zehn von 12 Patienten schlossen die Studie ab, 7 (70%) von ihnen waren weiblich. Das Durchschnittsalter betrug 36,66 ± 10,28 Jahre. Der Y‑BOCS-Gesamtscore verringerte sich im Studienverlauf signifikant im Vergleich zum Ausgangswert (p < 0,05). Im qEEG nach der Behandlung ließ sich im Vergleich zum Ausgangswert eine signifikante Abnahme der β‑Wellen-Aktivität in den parietalen und okzipitalen Regionen feststellen (p < 0,05).

Schlussfolgerungen

Zwanzig Sitzungen mit rTMS über dem supplementär-motorischen Areal konnten den Y‑BOCS-Score effektiv verbessern und die β‑Wellen-Aktivität in den parietalen wie in den okzipitalen Regionen verringern. Um diese Ergebnisse in einem kontrollierten Design zu bestätigen, sind weitere Studien erforderlich.

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Funding

This study was based on a thesis for MD degree in psychiatry specialty by Dr. Afsaneh Mohammadzadeh. The vice chancellor for research of Mashhad University of Medical Sciences provided funding for this study (grant number: 940560).

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Authors and Affiliations

  1. Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Farzad Akbarzadeh, Afsaneh Mohammadzadeh, Ebrahim Abdollahian, Ali Talaei &  Mahsa Nahidi

  2. Department of Biomedical Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran

    Majid Ghoshuni

  3. Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Bita Najjari

  4. Community Medicine Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Maliheh Dadgarmoghaddam

Authors
  1. Farzad Akbarzadeh
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  2. Afsaneh Mohammadzadeh
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  3. Majid Ghoshuni
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  4. Ebrahim Abdollahian
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  5. Ali Talaei
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  6. Bita Najjari
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  7. Maliheh Dadgarmoghaddam
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  8. Mahsa Nahidi
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Contributions

Farzad Akbarzadeh and Afsaneh Mohammadzadeh: methodology and wrote the protocol. Majid Ghoshuni and Ebrahim Abdollahian: contributed to acquisition and interpretation. Ali Talaei and Bita Najjari: conducted literature searches and provided summaries of previous research studies and contributed to analysis and interpretation. Maliheh Dadgarmoghaddam: conducted the statistical analysis and critically revised manuscript. Mahsa Nahidi: contributed to acquisition and interpretation, wrote the first draft of the manuscript. All authors contributed to and approved the final manuscript.

Corresponding author

Correspondence to Mahsa Nahidi.

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Conflict of interest

F. Akbarzadeh, A. Mohammadzadeh, M. Ghoshuni, E. Abdollahian, A. Talaei, B. Najjari, M. Dadgarmoghaddam and M. Nahidi declare that they have no competing interests.

Ethical standards

Ethics approval: The ethical codes of the Helsinki declaration on ethics in medical research were completely observed throughout the study. The Ethics Committee of the Medical School, Mashhad University of Medical Sciences approved this study (approval code IR.MUMS.fm.REC.1395.466). Consent to participate: Informed written consent was obtained from all subjects of the study.

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Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Akbarzadeh, F., Mohammadzadeh, A., Ghoshuni, M. et al. Efficacy of repetitive transcranial magnetic stimulation in patients with obsessive–compulsive disorder: a pilot study. Neuropsychiatr 35, 192–198 (2021). https://doi.org/10.1007/s40211-021-00403-y

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