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The Efficacy of Transcranial Magnetic Stimulation in the Treatment of Obsessive-Compulsive Disorder: An Umbrella Review of Meta-Analyses

Published online by Cambridge University Press:  06 December 2023

Sujita Kumar Kar Open the ORCID record for Sujita Kumar Kar [Opens in a new window] ,
Aditya Agrawal ,
Amílcar Silva-dos-Santos Open the ORCID record for Amílcar Silva-dos-Santos [Opens in a new window] ,
Yogesh Gupta  and
Zhi-De Deng
Sujita Kumar Kar*
Affiliation:
Department of Psychiatry, King George’s Medical University, Lucknow, India
Aditya Agrawal
Affiliation:
Department of Psychiatry, King George’s Medical University, Lucknow, India
Amílcar Silva-dos-Santos
Affiliation:
Neuroscience Unit, CUF Tejo Hospital, Lisbon, Portugal Mental Health Department, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal Department of Psychiatry, Universidade do Mindelo, Mindelo, Cape Verde Psychiatry Unit, Hospital de Cascais, Cascais, Portugal
Yogesh Gupta
Affiliation:
Department of Psychiatry, King George’s Medical University, Lucknow, India
Zhi-De Deng
Affiliation:
Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
*
Corresponding author: Sujita Kumar Kar; Email: sujitakumarkar@kgmcindia.edu
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Abstract

Background

Repetitive transcranial magnetic stimulation (rTMS) has been increasingly used for treating obsessive-compulsive disorder (OCD). Although several meta-analyses have explored its effectiveness and safety, there is no umbrella review specifically focused on rTMS for OCD. This umbrella review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and analyzed relevant meta-analyses on rTMS for OCD.

Methods

Twenty-three articles were identified from PubMed, and after screening, 12 meta-analyses were included in the review. The studies analyzed in the meta-analyses ranged from 10 to 27, with total participants ranging from 282 to 791. The most commonly studied regions were the dorsolateral prefrontal cortex (DLPFC), supplementary motor area (SMA), and orbito-frontal cortex (OFC).

Result

The majority of the meta-analyses consistently supported the effectiveness of rTMS in reducing OCD symptoms when applied to the DLPFC and SMA. Encouraging results were also observed when targeting the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC) through deep transcranial magnetic stimulation (dTMS). However, there was a high level of heterogeneity in the findings of nine out of 12 meta-analyses.

Conclusion

In conclusion, existing evidence suggests that rTMS targeting the DLPFC and SMA consistently reduces OCD symptoms, but targeting the mPFC and ACC through dTMS shows variable results. However, the high heterogeneity in the study findings indicates a need for further research and standardization in the field.

Keywords

Transcranial magnetic stimulationobsessive-compulsive disorderefficacyevidencemeta-analysis

Information

Type
Original Research
Information
CNS Spectrums , Volume 29 , Issue 2 , April 2024 , pp. 109 - 118
Copyright
© The Author(s), 2023. Published by Cambridge University Press

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References

Mathews, C. Obsessive-compulsive disorders. Contin Minneap Minn. 2021;27(6):1764–1784. doi:10.1212/CON.0000000000001011.Google ScholarPubMed
Pampaloni, I, Marriott, S, Pessina, E, et al. The global assessment of OCD. Compr Psychiatry. 2022;118:152342 doi:10.1016/j.comppsych.2022.152342.CrossRefGoogle ScholarPubMed
Skapinakis, P, Caldwell, DM, Hollingworth, W, et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2016;3(8):730–739. doi:10.1016/S2215-0366(16)30069-4.CrossRefGoogle ScholarPubMed
Issari, Y, Jakubovski, E, Bartley, CA, et al. Early onset of response with selective serotonin reuptake inhibitors in obsessive-compulsive disorder: a meta-analysis. J Clin Psychiatry. 2016;77(5):e605–e611. doi:10.4088/JCP.14r09758.CrossRefGoogle ScholarPubMed
Ahmari, SE, Dougherty, DD. Dissecting OCD circuits: from animal models to targeted treatments. Depress Anxiety. 2015;32(8):550–562. doi:10.1002/da.22367.CrossRefGoogle ScholarPubMed
Jalal, B, Chamberlain, SR, Sahakian, BJ. Obsessive-compulsive disorder: etiology, neuropathology, and cognitive dysfunction. Brain Behav. 2023;3:e3000 doi:10.1002/brb3.3000.CrossRefGoogle Scholar
Pauls, DL, Abramovitch, A, Rauch, SL, et al. Obsessive-compulsive disorder: an integrative genetic and neurobiological perspective. Nat Rev Neurosci. 2014;15(6):410–424. doi:10.1038/nrn3746.CrossRefGoogle ScholarPubMed
Bais, M, Figee, M, Denys, D. Neuromodulation in obsessive-compulsive disorder. Psychiatr Clin North Am. 2014;37(3):393–413. doi:10.1016/j.psc.2014.06.003.CrossRefGoogle ScholarPubMed
Rapinesi, C, Bersani, FS, Kotzalidis, GD, et al. Maintenance deep transcranial magnetic stimulation sessions are associated with reduced depressive relapses in patients with unipolar or bipolar depression. Front Neurol. 2015;6:16. doi:10.3389/fneur.2015.00016.CrossRefGoogle ScholarPubMed
Bergfeld, IO, Dijkstra, E, Graat, I, et al. Invasive and non-invasive neurostimulation for OCD. Curr Top Behav Neurosci. 2021;49:399–436. doi:10.1007/7854_2020_206.CrossRefGoogle ScholarPubMed
Kammen, A, Cavaleri, J, Lam, J, et al. Neuromodulation of OCD: a review of invasive and non-invasive methods. Front Neurol. 2022;13:909264. doi:10.3389/fneur.2022.909264.CrossRefGoogle ScholarPubMed
Lefaucheur, J-P, Aleman, A, Baeken, C, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014–2018). Clin Neurophysiol. 2020;131(2):474–528. doi:10.1016/j.clinph.2019.11.002.CrossRefGoogle ScholarPubMed
Office of the Commissioner, FDA. FDA Permits Marketing of Transcranial Magnetic Stimulation for Treatment of Obsessive Compulsive Disorder. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder. Published March 24, 2020. Accessed May 1, 2023.Google Scholar
Voelker, R. Brain stimulation approved for obsessive-compulsive disorder. JAMA. 2018;320(11):1098. doi:10.1001/jama.2018.13301.Google ScholarPubMed
Acevedo, N, Bosanac, P, Pikoos, T, et al. Therapeutic neurostimulation in obsessive-compulsive and related disorders: a systematic review. Brain Sci. 2021;11(7):948. doi:10.3390/brainsci11070948.CrossRefGoogle ScholarPubMed
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. doi:10.1016/j.jpsychires.2013.03.022.CrossRefGoogle ScholarPubMed
Trevizol, AP, Shiozawa, P, Cook, IA, et al. Transcranial magnetic stimulation for obsessive-compulsive disorder: an updated systematic review and meta-analysis. J ECT. 2016;32(4):262–266. doi:10.1097/YCT.0000000000000335.CrossRefGoogle ScholarPubMed
Zhou, D-D, Wang, W, Wang, G-M, et al. An updated meta-analysis: short-term therapeutic effects of repeated transcranial magnetic stimulation in treating obsessive-compulsive disorder. J Affect Disord. 2017;215:187–196. doi:10.1016/j.jad.2017.03.033.CrossRefGoogle ScholarPubMed
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). Psychiatr Q. 2018;89(3):645–665. doi:10.1007/s11126-018-9566-7.CrossRefGoogle ScholarPubMed
Liang, K, Li, H, Bu, X, et al. Efficacy and tolerability of repetitive transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Transl Psychiatry. 2021;11(1):332. doi:10.1038/s41398-021-01453-0.CrossRefGoogle ScholarPubMed
Perera, MPN, Mallawaarachchi, S, Miljevic, A, et al. Repetitive transcranial magnetic stimulation for obsessive-compulsive disorder: a meta-analysis of randomized, sham-controlled trials. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021;6(10):947–960. doi:10.1016/j.bpsc.2021.03.010.Google ScholarPubMed
Fitzsimmons, SMDD, van der Werf, YD, van Campen, AD, et al. Repetitive transcranial magnetic stimulation for obsessive-compulsive disorder: a systematic review and pairwise/network meta-analysis. J Affect Disord. 2022;302:302–312. doi:10.1016/j.jad.2022.01.048.CrossRefGoogle ScholarPubMed
Pellegrini, L, Garg, K, Enara, A, et al. Repetitive transcranial magnetic stimulation (r-TMS) and selective serotonin reuptake inhibitor-resistance in obsessive-compulsive disorder: a meta-analysis and clinical implications. Compr Psychiatry. 2022;118:152339. doi:10.1016/j.comppsych.2022.152339.CrossRefGoogle ScholarPubMed
Gao, T, Du, J, Tian, S, et al. A meta-analysis of the effects of non-invasive brain stimulation on obsessive-compulsive disorder. Psychiatry Res. 2022;312:114530. doi:10.1016/j.psychres.2022.114530.CrossRefGoogle ScholarPubMed
Hyde, J, Carr, H, Kelley, N, et al. Efficacy of neurostimulation across mental disorders: systematic review and meta-analysis of 208 randomized controlled trials. Mol Psychiatry. 2022;27(6):2709–2719. doi:10.1038/s41380-022-01524-8.CrossRefGoogle ScholarPubMed
Suhas, S, Malo, PK, Kumar, V, et al. Treatment strategies for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: a network meta-analysis of randomised controlled trials. World J Biol Psychiatry Off J World Fed Soc Biol Psychiatry. 2023;24(2):162–177. doi:10.1080/15622975.2022.2082525.CrossRefGoogle ScholarPubMed
Thatikonda, NS, Vinod, P, Balachander, S, et al. Efficacy of repetitive transcranial magnetic stimulation on comorbid anxiety and depression symptoms in obsessive-compulsive disorder: a meta-analysis of randomized sham-controlled trials. Can J Psychiatry Rev Can Psychiatr. 2023;68(6):407–417. doi:10.1177/07067437221121112.CrossRefGoogle ScholarPubMed
Carmi, L, Tendler, A, Bystritsky, A, et al. Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial. Am J Psychiatry. 2019;176(11):931–938. doi:10.1176/appi.ajp.2019.18101180.CrossRefGoogle ScholarPubMed
Silva-Dos-Santos, A, Bruno Sales, M, Venda, D. Symptomatic improvement of acute mania associated with a single session of electroconvulsive therapy: a proposed concept of neuroversion. Bipolar Disord. 2021;23(8):844–846. doi:10.1111/bdi.13107.CrossRefGoogle ScholarPubMed
Silva-Dos-Santos, A, Sales, M, Sebastião, A, et al. A new viewpoint on the etiopathogenesis of depression: insights from the neurophysiology of deep brain stimulation in Parkinson’s disease and treatment-resistant depression. Front Psychiatry. 2021;12:607339. doi:10.3389/fpsyt.2021.607339.CrossRefGoogle ScholarPubMed
Carmi, L, Alyagon, U, Barnea-Ygael, N, et al. Clinical and electrophysiological outcomes of deep TMS over the medial prefrontal and anterior cingulate cortices in OCD patients. Brain Stimulat. 2018;11(1):158–165. doi:10.1016/j.brs.2017.09.004.CrossRefGoogle ScholarPubMed
Silva-Dos-Santos, A. The hypothesis of connecting two spinal cords as a way of sharing information between two brains and nervous systems. Front Psychol. 2017;8:105. doi:10.3389/fpsyg.2017.00105.CrossRefGoogle ScholarPubMed
Pais-Vieira, M, Yadav, AP, Moreira, D, et al. A closed loop brain-machine interface for epilepsy control using dorsal column electrical stimulation. Sci Rep. 2016;6(1):32814. doi:10.1038/srep32814.CrossRefGoogle ScholarPubMed
Harika-Germaneau, G, Rachid, F, Chatard, A, et al. Continuous theta burst stimulation over the supplementary motor area in refractory obsessive-compulsive disorder treatment: a randomized sham-controlled trial. Brain Stimulat. 2019;12(6):1565–1571. doi:10.1016/j.brs.2019.07.019.CrossRefGoogle ScholarPubMed
Liu, W, Shao, H, Liao, J, et al. Continuous theta-burst stimulation over the right orbitofrontal cortex in treatment-resistant obsessive-compulsive disorder treatment: a randomized sham-controlled trial. Int J Gen Med. 2021;14:3109–3118. doi:10.2147/IJGM.S318069.CrossRefGoogle ScholarPubMed