Abstract
Objective: Obsessive-compulsive disorder (OCD) is a chronic and disabling condition that often responds unsatisfactorily to pharmacological and psychological treatments. Converging evidence suggests a dysfunction of the cortical-striatalthalamic-cortical circuit in OCD, and a previous feasibility study indicated beneficial effects of deep transcranial magnetic stimulation (dTMS) targeting the medial prefrontal cortex and the anterior cingulate cortex. The authors examined the therapeutic effect of dTMS in a multicenter double-blind sham-controlled study. Methods: At 11 centers, 99 OCD patients were randomly allocated to treatment with either high-frequency (20 Hz) or sham dTMS and received daily treatments following individualized symptom provocation, for 6 weeks. Clinical response to treatment was determined using the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the primary efficacy endpoint was the change in score from baseline to posttreatment assessment. Additional measures were response rates (defined as a reduction of $30% in YBOCS score) at the posttreatment assessment and after another month of follow-up. Results: Eighty-nine percent of the active treatment group and 96% of the sham treatment group completed the study. The reduction in YBOCS score among patients who received active dTMS treatment was significantly greater than among patients who received sham treatment (reductions of 6.0 points and 3.3 points, respectively), with response rates of 38.1% and 11.1%, respectively. At the 1-month followup, the response rates were 45.2% in the active treatment group and 17.8% in the sham treatment group. Significant differences between the groups were maintained at follow-up. Conclusions: High-frequency dTMS over the medial prefrontal cortex and anterior cingulate cortex significantly improved OCD symptoms and may be considered as a potential intervention for patients who do not respond adequately to pharmacological and psychological interventions.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 931-938 |
| Number of pages | 8 |
| Journal | American Journal of Psychiatry |
| Volume | 176 |
| Issue number | 11 |
| DOIs | |
| State | Published - Jan 1 2019 |
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ASJC Scopus subject areas
- Psychiatry and Mental health
Cite this
Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder : A prospective multicenter randomized double-blind placebo-controlled trial. / Carmi, Lior; Tendler, Aron; Bystritsky, Alexander; Hollander, Eric; Blumberger, Daniel M.; Daskalakis, Jeff; Ward, Herbert; Lapidus, Kyle; Goodman, Wayne; Casuto, Leah; Feifel, David; Barnea-Ygael, Noam; Roth, Yiftach; Zangen, Abraham; Zohar, Joseph.
In: American Journal of Psychiatry, Vol. 176, No. 11, 01.01.2019, p. 931-938.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder
T2 - A prospective multicenter randomized double-blind placebo-controlled trial
AU - Carmi, Lior
AU - Tendler, Aron
AU - Bystritsky, Alexander
AU - Hollander, Eric
AU - Blumberger, Daniel M.
AU - Daskalakis, Jeff
AU - Ward, Herbert
AU - Lapidus, Kyle
AU - Goodman, Wayne
AU - Casuto, Leah
AU - Feifel, David
AU - Barnea-Ygael, Noam
AU - Roth, Yiftach
AU - Zangen, Abraham
AU - Zohar, Joseph
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Objective: Obsessive-compulsive disorder (OCD) is a chronic and disabling condition that often responds unsatisfactorily to pharmacological and psychological treatments. Converging evidence suggests a dysfunction of the cortical-striatalthalamic-cortical circuit in OCD, and a previous feasibility study indicated beneficial effects of deep transcranial magnetic stimulation (dTMS) targeting the medial prefrontal cortex and the anterior cingulate cortex. The authors examined the therapeutic effect of dTMS in a multicenter double-blind sham-controlled study. Methods: At 11 centers, 99 OCD patients were randomly allocated to treatment with either high-frequency (20 Hz) or sham dTMS and received daily treatments following individualized symptom provocation, for 6 weeks. Clinical response to treatment was determined using the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the primary efficacy endpoint was the change in score from baseline to posttreatment assessment. Additional measures were response rates (defined as a reduction of $30% in YBOCS score) at the posttreatment assessment and after another month of follow-up. Results: Eighty-nine percent of the active treatment group and 96% of the sham treatment group completed the study. The reduction in YBOCS score among patients who received active dTMS treatment was significantly greater than among patients who received sham treatment (reductions of 6.0 points and 3.3 points, respectively), with response rates of 38.1% and 11.1%, respectively. At the 1-month followup, the response rates were 45.2% in the active treatment group and 17.8% in the sham treatment group. Significant differences between the groups were maintained at follow-up. Conclusions: High-frequency dTMS over the medial prefrontal cortex and anterior cingulate cortex significantly improved OCD symptoms and may be considered as a potential intervention for patients who do not respond adequately to pharmacological and psychological interventions.
AB - Objective: Obsessive-compulsive disorder (OCD) is a chronic and disabling condition that often responds unsatisfactorily to pharmacological and psychological treatments. Converging evidence suggests a dysfunction of the cortical-striatalthalamic-cortical circuit in OCD, and a previous feasibility study indicated beneficial effects of deep transcranial magnetic stimulation (dTMS) targeting the medial prefrontal cortex and the anterior cingulate cortex. The authors examined the therapeutic effect of dTMS in a multicenter double-blind sham-controlled study. Methods: At 11 centers, 99 OCD patients were randomly allocated to treatment with either high-frequency (20 Hz) or sham dTMS and received daily treatments following individualized symptom provocation, for 6 weeks. Clinical response to treatment was determined using the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the primary efficacy endpoint was the change in score from baseline to posttreatment assessment. Additional measures were response rates (defined as a reduction of $30% in YBOCS score) at the posttreatment assessment and after another month of follow-up. Results: Eighty-nine percent of the active treatment group and 96% of the sham treatment group completed the study. The reduction in YBOCS score among patients who received active dTMS treatment was significantly greater than among patients who received sham treatment (reductions of 6.0 points and 3.3 points, respectively), with response rates of 38.1% and 11.1%, respectively. At the 1-month followup, the response rates were 45.2% in the active treatment group and 17.8% in the sham treatment group. Significant differences between the groups were maintained at follow-up. Conclusions: High-frequency dTMS over the medial prefrontal cortex and anterior cingulate cortex significantly improved OCD symptoms and may be considered as a potential intervention for patients who do not respond adequately to pharmacological and psychological interventions.
UR - http://www.scopus.com/inward/record.url?scp=85074379975&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85074379975&partnerID=8YFLogxK
U2 - 10.1176/appi.ajp.2019.18101180
DO - 10.1176/appi.ajp.2019.18101180
M3 - Article
C2 - 31109199
AN - SCOPUS:85074379975
VL - 176
SP - 931
EP - 938
JO - American Journal of Psychiatry
JF - American Journal of Psychiatry
SN - 0002-953X
IS - 11
ER -