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Title: Repetitive transcranial magnetic stimulation for obsessive-compulsive disorder: A meta-analysis of randomized, sham-controlled trials.
Epworth Authors: Perera, M.
Miljevic, Aleksandra
Bailey, Neil W.
Herring, Sally E.
Fitzgerald, Paul B.
Prabhavi, N.
Other Authors: Mallawaarachchi, Sudaraka
Keywords: Obsessive-Compulsive Disorder
Repetitive Transcranial Magnetic Stimulation
Cortical Target
Noninvasive Brain Stimulation
Subgroup Analysis
Mental Health
Hedges' g
Yale-Brown Obsessive Compulsive Scale Scores
Epworth Centre for Innovation in Mental Health, Epworth HealthCare and Monash University Department of Psychiatry, Victoria
Epworth Rehabilitation, Mental Health and Chronic Pain Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: 2021
Publisher: Elsevier
Citation: Biol Psychiatry Cogn Neurosci Neuroimaging . 2021 Mar 26;S2451-9022(21)00087-2.
Abstract: Background: Obsessive-compulsive disorder (OCD) is a chronic, disabling mental health condition with limited treatment options available to date. Numerous randomized controlled trials have explored the efficacy of repetitive transcranial magnetic stimulation (rTMS) in OCD. This meta-analysis synthesized data from selected randomized controlled trials and examined the impact of different treatment parameters to generate hypotheses that would direct future randomized controlled trials. Methods: A database search was performed to identify studies published in English up to October 2020. Randomized, sham-controlled studies that used rTMS to treat OCD were included. Effect sizes were calculated using Hedges' g for pre- to post-treatment Yale-Brown Obsessive Compulsive Scale scores. Subgroup analyses were conducted to assess the effects of variations in rTMS treatment parameters. Results: A total of 26 studies with 781 participants were included. Overall, rTMS demonstrated a modest effect on reduction of Yale-Brown Obsessive Compulsive Scale scores (Hedges' g = 0.64, 95% confidence interval = 0.39-0.89; p < .0001). The largest significant effect size was obtained by targeting the bilateral dorsolateral prefrontal cortex. High- and low-frequency rTMS showed comparable effects. Studies with follow-up data suggested that the effects of active rTMS remain significantly superior to those of sham 4 weeks after treatment. Conclusions: The therapeutic effects of rTMS are superior to those of sham in the treatment of OCD. Targeting the bilateral dorsolateral prefrontal cortex was the most favorable approach in administering rTMS. Further research is required to determine the optimal frequency, total pulses per session, and duration of treatment with rTMS for OCD.
DOI: 10.1016/j.bpsc.2021.03.010
PubMed URL:
ISSN: 2451-9022
Journal Title: Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
Type: Journal Article
Affiliated Organisations: Melbourne Integrative Genomics, School of Mathematics & Statistics, University of Melbourne, Melbourne, Victoria, Australia.
Type of Clinical Study or Trial: Meta-Analysis
Appears in Collections:Mental Health

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