Efficacy and clinical predictors of response to rTMS treatment in pharmacoresistant obsessive-compulsive disorder (OCD): a retrospective study

• Published in: BMC psychiatry Vol. 20; no. 1; p. 372
• Main Authors: Rostami, Reza, Kazemi, Reza, Jabbari, Arezoo, Madani, Azam Sadat, Rostami, Hosseinreza, Taherpour, Mohammad Amin, Molavi, Parviz, Jaafari, Nematollah, Kuo, Min-Fang, Vicario, Carmelo M, Nitsche, Michael A, Salehinejad, Mohammad Ali
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.07.2020; BioMed Central; BMC
• Subjects: Anxiety; Clinical predictors; Cortex (motor); Demographic predictors; Drug approval; Drug therapy; Human health and pathology; Humans; Life Sciences; Magnetic fields; Medical research; Mental depression; Mental disorders; Motor Cortex; Neuroses; Obsessive compulsive disorder; Obsessive-compulsive disorder (OCD); Obsessive-Compulsive Disorder - therapy; Pathophysiology; Patients; Prefrontal Cortex; Psychiatrics and mental health; Psychiatry; Psychotherapy; Repetitive transcranial magnetic stimulation (rTMS); Response rates; Retrospective Studies; Suicides & suicide attempts; Supplementary motor area; Transcranial Magnetic Stimulation; Treatment Outcome; Yale-Brown obsessive-compulsive scale (Y-BOCS); Clinical predictors; Obsessive-compulsive disorder (OCD); Repetitive transcranial magnetic stimulation (rTMS); Yale-Brown obsessive-compulsive scale (Y-BOCS); Demographic predictors
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-020-02769-9

Application of repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been promising and approved by the Food and Drug Administration in 2018, but effects differ between patients. Knowledge about clinical predictors of rTMS response may help to increase clinical efficacy but is not available so far. In a retrospective study, we investigated the efficacy of rTMS over the dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA) in 65 pharmaco-resistant OCD outpatients recruited for rTMS treatment from July 2015 to May 2017. Patients received either SMA rTMS (n = 38) or bilateral DLPFC rTMS (n = 27) in case of reporting higher affective and depressive symptoms in addition to the primary OCD symptoms. OCD symptoms and depression/anxiety states were measured at baseline (before the 1st session) and after the 20th session of rTMS. Additionally, we performed a binary logistic regression analysis on the demographic and clinical variables based on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) 3-factor and 2-factor models and individual items to investigate potential predictors of rTMS response. Patients' scores in Y-BOCS and Beck anxiety/depression inventories were significantly decreased following rTMS treatment. 46.2% of all patients responded to rTMS, based on the criterion of at least a 30% reduction in Y-BOCS scores. There was no significant difference between response rates of patients in DLPFC and SMA groups. No significant demographic predictors of rTMS efficacy were identified. The factors "obsession severity", "resistance" and "disturbance" and the "interference due to obsessions" and "resistance against compulsions" items of the Y-BOCS significantly predicted response to rTMS. In patients with less intrusive/interfering thoughts, and low scores in the "obsession severity", "disturbance", and "resistance" factors, rTMS might have superior effects. Identifying clinical and non-clinical predictors of response is relevant to personalize and adapt rTMS protocols in pharmaco-resistant OCD patients. Interpretation of rTMS efficacy should be done with caution due to the lack of a sham intervention condition.