Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Psychiatric Quarterly
Erschienen in: Psychiatric Quarterly 3/2018

09.02.2018 | Review Article

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)

verfasst von: Simone Rehn, Guy D. Eslick, Vlasios Brakoulias

Erschienen in: Psychiatric Quarterly | Ausgabe 3/2018

Einloggen, um Zugang zu erhalten

Abstract

Randomised and sham-controlled trials (RCTs) of repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) have yielded conflicting results, which may be due to the variability in rTMS parameters used. We performed an updated systematic review and meta-analysis on the effectiveness of rTMS for the treatment of OCD and aimed to determine whether certain rTMS parameters, such as cortical target, may be associated with higher treatment effectiveness. After conducting a systematic literature review for RCTs on rTMS for OCD through to 1 December 2016 using MEDLINE, PubMed, Web of Science, PsycINFO, Google, and Google Scholar, we performed a random-effects meta-analysis with the outcome measure as pre-post changes in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores. To determine whether rTMS parameters may have influenced treatment effectiveness, studies were further analysed according to cortical target, stimulation frequency, and length of follow-up. Data were obtained from 18 RCTs on rTMS in the treatment of OCD. Overall, rTMS yielded a modest effect in reducing Y-BOCS scores with Hedge’s g of 0.79 (95% CI = 0.43–1.15, p < 0.001). Stimulation of the supplementary motor area yielded the greatest reductions in Y-BOCS scores relative to other cortical targets. Subgroup analyses suggested that low frequency rTMS was more effective than high frequency rTMS. The effectiveness of rTMS was also greater at 12 weeks follow-up than at four weeks follow-up. Our meta-analysis implies that low frequency rTMS applied over the supplementary motor area may offer the greatest effectiveness in the treatment of OCD. The therapeutic effects of rTMS also appear to persist post-treatment and may offer beneficial long-term effectiveness. With our findings, it is suggested that future large-scale studies focus on the supplementary motor area and include follow-up periods of 12 weeks or more.
Literatur
1.
Ruscio A, Stein D, Chiu W, Kessler R. The epidemiology of obsessive-compulsive disorder in the national comorbidity survey replication. Mol Psychiatry. 2010;15(1):53–63.CrossRefPubMed
2.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association; 2013.CrossRef
3.
Skoog G, Skoog I. A 40-year follow-up of patients with obsessive-compulsive disorder. Arch Gen Psychiatry. 1999;56(2):121–7.CrossRefPubMed
4.
DuPont RL, Rice D, Shiraki S, Rowland C. Economic costs of obsessive-compulsive disorder. Med Interface. 1995;8(4):102–9.PubMed
5.
Fullana MA, Mataix-Cols D, Caspi A, Harrington H, Grisham JR, Moffitt TE, et al. Obsessions and compulsions in the community: prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions. Am J Psychiatr. 2009;166(3):329–36.CrossRefPubMed
6.
7.
Pallanti S, Hollander E, Bienstock C, Koran L, Leckman J, Marazziti D, et al. Treatment non-response in OCD: methodological issues and operational definitions. Int J Neuropsychopharmacol. 2002;5(2):181–91.CrossRefPubMed
8.
Abramowitz JS, Franklin ME, Foa EB. Empirical status of cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analytic review. Rom J Cogn Behav Psychother. 2002;2(2):89–104.
9.
Rauch SL, Jenike MA. Management of treatment resistant obsessive-compulsive disorder: concepts and strategies. In: Hollander E, Zohar J, Marazziti D, Olivier B, editors. Obsessive compulsive disorder. Chicester: Wiley; 1994. p. 227–44.
10.
Blom RM, Figee M, Vulink N, Denys D. Update on repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: different targets. Curr Psychiatry Rep. 2011;13(4):289–94.CrossRefPubMedPubMedCentral
11.
Saba G, Moukheiber A, Pelissolo A. Transcranial cortical stimulation in the treatment of obsessive-compulsive disorders: efficacy studies. Curr Psychiatry Rep. 2015;17(5):1–8.CrossRef
12.
Jaafari N, Rachid F, Rotge JY, Polosan M, El-Hage W, Belin D, et al. Safety and efficacy of repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder: a review. World J Biol Psychiatry. 2012;13(3):164–77.CrossRefPubMed
13.
Husain F, Nandipati G, Braun A, Cohen L, Tagamets M, Horwitz B. Simulating transcranial magnetic stimulation during PET with a large-scale neural network model of the prefrontal cortex and the visual system. NeuroImage. 2002;15(1):58–73.CrossRefPubMed
14.
Pascual-Leone A, Keenan J, Freund S, Stinchfield Z, Tormos J, Parker A, et al. Repetitive transcranial magnetic stimulation trials in depression. Eur Neuropsychopharmacol. 1998;8:S123–S4.CrossRef
15.
Speer AM, Kimbrell TA, Wassermann EM, Repella JD, Willis MW, Herscovitch P, et al. Opposite effects of high and low frequency rTMS on regional brain activity in depressed patients. Biol Psychiatry. 2000;48(12):1133–41.CrossRefPubMed
16.
Fineberg N, Chamberlain S, Hollander E, Boulougouris V, Robbins T. Translational approaches to obsessive-compulsive disorder: from animal models to clinical treatment. Br J Pharmacol. 2011;164(4):1044–61.CrossRefPubMedPubMedCentral
17.
Milad MR, Rauch SL. Obsessive-compulsive disorder: beyond segregated cortico-striatal pathways. Trends Cogn Sci. 2012;16(1):43–51.CrossRefPubMed
18.
Del Casale A, Kotzalidis G, Rapinesi C, Serata D, Ambrosi E, Simonetti A, et al. Functional neuroimaging in obsessive-compulsive disorder. Neuropsychobiology. 2011;64(2):61–85.CrossRefPubMed
19.
Chamberlain SR, Menzies L, Hampshire A, Suckling J, Fineberg NA, del Campo N, et al. Orbitofrontal dysfunction in patients with obsessive-compulsive disorder and their unaffected relatives. Science. 2008;321(5887):421–2.CrossRefPubMed
20.
21.
van den Heuvel OA, Veltman DJ, Groenewegen HJ, Cath DC, van Balkom AJ, van Hartskamp J, et al. Frontal-striatal dysfunction during planning in obsessive-compulsive disorder. Arch Gen Psychiatry. 2005;62(3):301–9.CrossRefPubMed
22.
Yücel M, Harrison BJ, Wood SJ, Fornito A, Wellard RM, Pujol J, et al. Functional and biochemical alterations of the medial frontal cortex in obsessive-compulsive disorder. Arch Gen Psychiatry. 2007;64(8):946–55.CrossRefPubMed
23.
Nakao T, Nakagawa A, Nakatani E, Nabeyama M, Sanematsu H, Yoshiura T, et al. Working memory dysfunction in obsessive–compulsive disorder: a neuropsychological and functional MRI study. J Psychiatr Res. 2009;43(8):784–91.CrossRefPubMed
24.
Greenberg BD, George MS, Martin JD, Benjamin J, Schlaepfer TE, Altemus M, et al. Effect of prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a preliminary study. Am J Psychiatr. 1997;154(6):867–9.CrossRefPubMed
25.
Sachdev PS, McBride R, Loo CK, Mitchell PB, Malhi GS, Croker VM. Right versus left prefrontal transcranial magnetic stimulation for obsessive-compulsive disorder: a preliminary investigation. J Clin Psychiatry. 2001;62(12):981–4.CrossRefPubMed
26.
Alonso P, Pujol J, Cardoner N, Benlloch L, Deus J, Menchon JM, et al. Right prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a double-blind, placebo-controlled study. Am J Psychiatry. 2001;158(7):1143–5.CrossRefPubMed
27.
Sachdev PS, Loo CK, Mitchell PB, TF MF, Malhi GS. Repetitive transcranial magnetic stimulation for the treatment of obsessive compulsive disorder: a double-blind controlled investigation. Psychol Med. 2007;37(11):1645–9.CrossRefPubMed
28.
29.
30.
Gomes PO, Rosa MA, Allam N, de Souza ER, Brasil-Neto J. A randomized double-blind trial of repetitive transcranial magnetic stimulation in obsessive -compulsive disorder with three months follow-up. J ECT. 2012;28(2):149.
31.
32.
Mantovani A, Simpson HB, Fallon BA, Rossi S, Lisanby SH. Randomized sham-controlled trial of repetitive transcranial magnetic stimulation in treatment-resistant obsessive-compulsive disorder. Int J Neuropsychopharmacol. 2010;13(2):217–27.CrossRefPubMed
33.
Nauczyciel C, Le Jeune F, Naudet F, Douabin S, Esquevin A, Verin M, et al. Repetitive transcranial magnetic stimulation over the orbitofrontal cortex for obsessive-compulsive disorder: a double-blind, crossover study. Transcult Psychiatry. 2014;4:e436.CrossRef
34.
35.
Mantovani A, Rossi S, Bassi BD, Simpson HB, Fallon BA, Lisanby SH. Modulation of motor cortex excitability in obsessive-compulsive disorder: an exploratory study on the relations of neurophysiology measures with clinical outcome. Psychiatry Res. 2013;210(3):1026–32.CrossRefPubMed
36.
37.
38.
Pelissolo A, Harika-Germaneau G, Rachid F, Gaudeau-Bosma C, Tanguy ML, BenAdhira R, et al. Repetitive transcranial magnetic stimulation to supplementary motor area in refractory obsessive-compulsive disorder treatment: a sham-controlled trial. Int J Neuropsychopharmacol. 2016;19(8) https://​doi.​org/​10.​1093/​ijnp/​pyw025.​
39.
Berlim MT, Van den Eynde F, Daskalakis ZJ. Clinically meaningful efficacy and acceptability of low-frequency repetitive transcranial magnetic stimulation (rTMS) for treating primary major depression: a meta-analysis of randomized, double-blind and sham-controlled trials. Neuropsychopharmacology. 2013;38(4):543–51.CrossRefPubMed
40.
Prasko J, Paskova B, Zalesky R, Novak T, Kopecek M, Bares M, et al. The effect of repetitive transcranial magnetic stimulation (rTMS) on symptoms in obsessive compulsive disorder. A randomized, double blind, sham controlled study. Neuroendocrinol Lett. 2006;27(3):327–32.PubMed
41.
Kang JI, Kim CH, Namkoong K, Lee CI, Kim SJ. A randomized controlled study of sequentially applied repetitive transcranial magnetic stimulation in obsessive-compulsive disorder. J Clin Psychiatry. 2009;70(12):1645–51.CrossRefPubMed
42.
Badawy AA, El Sawy H, El Hay MA. Efficacy of repetitive transcranial magnetic stimulation in the management of obsessive compulsive disorder. Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2010;47:393–7.
43.
Sarkhel S, Sinha VK, Praharaj SK. Adjunctive high-frequency right prefrontal repetitive transcranial magnetic stimulation (rTMS) was not effective in obsessive-compulsive disorder but improved secondary depression. J Anxiety Disord. 2010;24(5):535–9.CrossRefPubMed
44.
45.
Ma Z-R, Shi L-J. Repetitive transcranial magnetic stimulation (rTMS) augmentation of selective serotonin reuptake inhibitors (SSRIs) for SSRI-resistant obsessive-compulsive disorder (OCD): a meta-analysis of randomized controlled trials. Int J Clin Exp Med. 2014;7(12):4897.PubMedPubMedCentral
46.
Zhang XZ, Gu Y, Zhao EQ, Li YZ. Research on treating refractory obsessive compulsive disorder with combination of sitaplam and repetitive transcranial magnetic stimulation. Chin J Health Psychol. 2010;18:778–80.
47.
Cheng J, Li H, Shi YZ. The efficacy of repetitive transcranial magnetic stimulation on obsessive compulsive disorder. Journal of International Psychiatry. 2013;40:148–51.
48.
Ma X, Huang Y, Liao L, Jin Y. A randomized double-blinded sham-controlled trial of alpha electroencephalogram-guided transcranial magnetic stimulation for obsessive-compulsive disorder. Chin Med J. 2014;127(4):601–6.PubMed
49.
Haghighi M, Shayganfard M, Jahangard L, Ahmadpanah M, Bajoghli H, Pirdehghan A, et al. Repetitive transcranial magnetic stimulation (rTMS) improves symptoms and reduces clinical illness in patients suffering from OCD: results from a single-blind, randomized clinical trial with sham cross-over condition. J Psychiatr Res. 2015;68:238–44.CrossRefPubMed
50.
51.
Tang LY, Chu FC, Li YD, Xu ZP. Treating refractory obsessive compulsive disorder with combination of paroxetine and repetitive transcranial magnetic stimulation: a double-blind sham controlled study. Chinese Journal of Behavioral Medical and Brain Science. 2010;19(7):604–6.
52.
Han CF, Jiang DF. Effect of slow frequency repetitive Transcranial Magnetic Stimulation (rTMS) combined with fluvoxamine on obsessivecompulsive disorder in maintenance stage. J Psychiatry. 2015;28:446–48.
53.
Luo XF, Huang MI, Ye XJ. Controlled clinical study of sertraline alone or combined repetitive transcranial magnetic stimulation in patients with refractory obsessive-compulsive disorder. J Clin Psychiatry. 2015;25:238–240.
54.
55.
Jahangard L, Haghighi M, Shyayganfard M, Ahmadpanah M, Bahmani DS, Bajoghli H, et al. Repetitive transcranial magnetic stimulation improved symptoms of obsessive-compulsive disorder, but also cognitive performance: results from a randomized clinical trial with a cross-over design and sham condition. Neuropsychobiology. 2016;73(4):224–32. https://​doi.​org/​10.​1159/​000446287.CrossRefPubMed
56.
57.
Zhang ZM. A control study of sertraline plus rTMS in the treatment of refractory OCD. J Clin Psychosom Dis. 2016;22:41–3.
58.
59.
Moher D, Liberati A, Tetzlaff J, Altman DG. Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral
60.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000.
61.
Organization WH. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: World Health Organization. 1993. Report No.: 9789241544559;9241544554; Contract No.: Report.
62.
Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46(11):1006–11.CrossRefPubMed
63.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.CrossRefPubMed
64.
Higgins J, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses [journal article as teaching resource, deposited by John Flynn]. Br Med J. 2003;327:557–60.CrossRef
65.
66.
Orwin RG. A fail-safe N for effect size in meta-analysis. J Educ Stat. 1983;8(2):157–9.
67.
Borenstein M, Hedges LV, Higgins J, Rothstein HR. Multiple comparisons within a study. Introduction to meta-analysis. Chichester: John Wiley & Sons, Ltd.; 2009. p. 239–42.CrossRef
68.
de Wit SJ, de Vries FE, van der Werf YD, Cath DC, Heslenfeld DJ, Veltman EM, et al. Presupplementary motor area hyperactivity during response inhibition: a candidate endophenotype of obsessive-compulsive disorder. Am J Psychiatr. 2012;169(10):1100–8.CrossRefPubMed
69.
Oliveri M, Babiloni C, Filippi M, Caltagirone C, Babiloni F, Cicinelli P, et al. Influence of the supplementary motor area on primary motor cortex excitability during movements triggered by neutral or emotionally unpleasant visual cues. Exp Brain Res. 2003;149(2):214–21.CrossRefPubMed
70.
71.
Rossi S, Bartalini S, Ulivelli M, Mantovani A, Di Muro A, Goracci A, et al. Hypofunctioning of sensory gating mechanisms in patients with obsessive-compulsive disorder. Biol Psychiatry. 2005;57(1):16–20.CrossRefPubMed
72.
van den Heuvel OA, Remijnse PL, Mataix-cols D, Vrenken H, Groenewegen HJ, HBM U, et al. The major symptom dimensions of obsessive-compulsive disorder are mediated by partially distinct neural systems. Brain. 2009;132(Pt 4):853–68.PubMed
73.
Kedzior KK, Azorina V, Reitz SK. More female patients and fewer stimuli per session are associated with the short-term antidepressant properties of repetitive transcranial magnetic stimulation (rTMS): a meta-analysis of 54 sham-controlled studies published between 1997–2013. Neuropsychiatr Dis Treat. 2014;10:727–56.CrossRefPubMedPubMedCentral
74.
Berlim M, Van den Eynde F, Tovar-Perdomo S, Daskalakis Z. Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. Psychol Med. 2014;44(02):225–39.CrossRefPubMed
75.
76.
Angst J, Gamma A, Endrass J, Goodwin R, Ajdacic V, Eich D, et al. Obsessive-compulsive severity spectrum in the community: prevalence, comorbidity, and course. Eur Arch Psychiatry Clin Neurosci. 2004;254(3):156–64.CrossRefPubMed
77.
Ridding MC, Rothwell JC. Is there a future for therapeutic use of transcranial magnetic stimulation? Nat Rev Neurosci. 2007;8(7):559–67.CrossRefPubMed
78.
Stein DJ, Carey PD, Lochner C, Seedat S, Fineberg N, Andersen EW. Escitalopram in obsessive-compulsive disorder: response of symptom dimensions to pharmacotherapy. CNS Spectr. 2008;13(6):492–8.CrossRefPubMed
79.
Rasmussen S, Hackett E, DuBoff E, Greist J, Halaris A, Koran L, et al. A 2-year study of sertraline in the treatment of obsessive-compulsive disorder. Int Clin Psychopharmacol. 1997;12(6):309–16.CrossRefPubMed
80.
Clomipramine Collaborative Study Group. Clomipramine in the treatment of patients with obsessive-compulsive disorder. Arch Gen Psychiatry. 1991;48(8):730.CrossRef
81.
Montgomery S, Kasper S, Stein D, Hedegaard KB, Lemming O. Citalopram 20 mg, 40 mg and 60 mg are all effective and well tolerated compared with placebo in obsessive-compulsive disorder. Int Clin Psychopharmacol. 2001;16(2):75–86.CrossRefPubMed
82.
83.
Lefaucheur J-P, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol. 2014;125(11):2150–206.CrossRefPubMed
84.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association; 1994.
Metadaten
Titel
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)
verfasst von
Simone Rehn
Guy D. Eslick
Vlasios Brakoulias
Publikationsdatum
09.02.2018
Verlag
Springer US
Erschienen in
Psychiatric Quarterly / Ausgabe 3/2018
Print ISSN: 0033-2720
Elektronische ISSN: 1573-6709
DOI
https://doi.org/10.1007/s11126-018-9566-7

Weitere Artikel der Ausgabe 3/2018

Psychiatric Quarterly 3/2018 Zur Ausgabe

Original Paper

Listening to the Patient Perspective: Psychiatric Inpatients’ Attitudes Towards Physical Restraint

Original Paper

Eye Gaze Patterns Associated with Aggressive Tendencies in Adolescence

Original Paper

Development of a Questionnaire to Assess Nursing Competencies for the Care of People with Psychiatric Disabilities in a Hospital Environment

Original Paper

Development and Preliminary Psychometric Properties of an Instrument for the Measurement of Obsessional Dissociative Experiences: The Van Obsessional Dissociation Questionnaire (VOD-Q)

Original Paper

Indirect Self-Destructiveness in Women who Experience Domestic Violence

Original Paper

A Survey of Online and Mobile Technology Use at Peer Support Agencies

Neu im Fachgebiet Psychiatrie

Mehr Zeit in den sozialen Medien kann zu Angststörungen führen

05.06.2024 Prävention und Gesundheitsförderung in der Pädiatrie Nachrichten

Eine Studie aus Finnland hat die Social-Media-Nutzung unter 16-jährigen Mädchen genauer unter die Lupe genommen. Lange Nutzdauer von Instagram & Co. war mit höheren Raten an Angststörungen assoziiert. Insgesamt waren rund 17% der Mädchen abhängig von Social Media.

Intoxikation ohne Alkoholaufnahme: An das Eigenbrauer-Syndrom denken!

05.06.2024 Internistische Diagnostik Nachrichten

Betrunken trotz Alkoholabstinenz? Der Fall einer 50-jährigen Patientin zeigt, dass dies möglich ist. Denn die Frau litt unter dem Eigenbrauer-Syndrom, bei dem durch Darmpilze eine alkoholische Gärung in Gang gesetzt wird.

Prämenstruelle Beschwerden mit Suizidrisiko assoziiert

04.06.2024 Suizidalität Nachrichten

Manche Frauen, die regelmäßig psychische und körperliche Symptome vor ihrer Menstruation erleben, haben ein deutlich erhöhtes Suizidrisiko. Jüngere Frauen sind besonders gefährdet.

Bei seelischem Stress sind Checkpoint-Hemmer weniger wirksam

03.06.2024 NSCLC Nachrichten

Wie stark Menschen mit fortgeschrittenem NSCLC von einer Therapie mit Immun-Checkpoint-Hemmern profitieren, hängt offenbar auch davon ab, wie sehr die Diagnose ihre psychische Verfassung erschüttert

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise