Journal
INTERNATIONAL JOURNAL OF NEUROPSYCHOPHARMACOLOGY
Volume 13, Issue 2, Pages 217-227Publisher
OXFORD UNIV PRESS
DOI: 10.1017/S1461145709990435
Keywords
Obsessive-compulsive disorder; SMA; transcranial magnetic stimulation; treatment
Funding
- Division of Brain Stimulation and Therapeutic Modulation
- Anxiety Disorders Clinic, Department of Psychiatry
- Columbia University/New York State Psychiatric Institute
- Department of Neuroscience, Siena University
- Magstim Company
- Neuronetics
- Cyberonics
- NIH
- AFAR
- NARSAD
- Stanley Medical Research Foundation
- DARPA
- NYSTAR
- Janssen Pharmaceutica
- Neuropharm Ltd
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In open trials, 1-Hz repetitive transcranial magnetic stimulation (rTMS) to the supplementary motor area (SMA) improved symptoms and normalized cortical hyper-excitability of patients with obsessive-compulsive disorder (OCD). Here we present the results of a randomized sham-controlled double-blind study. Medication-resistant OCD patients (n = 21) were assigned 4 wk either active or sham rTMS to the SMA bilaterally. rTMS parameters consisted of 1200 pulses/d, at I Hz and 100% of motor threshold (MT). Eighteen patients completed the Study. Response to treatment was defined as a >= 25% decrease on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Non-responders to sham and responders to active or sham rTMS were offered four additional weeks of open active rTMS. After 4 wk, the response rate in the completer sample was 67% (6/9) with active and 22% (2/9) with sham rTMS. At 4 wk, patients receiving active rTMS showed on average a 25% reduction in the YBOCS compared to a 12% reduction in those receiving sham. In those who received 8-wk active rTMS, OCD symptoms improved from 28.2+/-5.8 to 14.5+/-3.6. In patients randomized to active rTMS, MT measures on the right hemisphere increased significantly over time. At the end of 4-wk rTMS the abnormal hemispheric laterality found in the group randomized to active rTMS normalized. The results of the first randomized sham-controlled trial of SMA stimulation in the treatment of resistant OCD support further investigation into the potential therapeutic applications of rTMS in this disabling condition.
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