Journal: Brain Stimulation
Authors: A Tendler, E Sisko, M DeLuca, S Garrison, D Mages, H Mayfield, R Gersner, J Sutton, N Rodriguez
Background:
dTMS for obsessive-compulsive disorder (OCD) with the H7 coil has been shown to be efficacious in pilot and multicenter double-blinded clinical trials. How do patients fair in a naturalistic setting?
Objective:
Retrospective patient chart review who received open label dTMS for OCD with the H7 coil.
Methods:
Twenty-one patients with severe medication resistant OCD who were ineligible for the double-blind placebo controlled (DBPC) study were administered dTMS with the H7 coil over the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC) five times weekly. Individualized OCD symptoms were provoked to a visual analogue scale (VAS) between 5-7; then, dTMS was administered at 100%MT, 20Hz, 2 second trains, 20 second intervals for 2000 total pulses. Yale-Brown Obsessive-Compulsive Scale (YBOCS) was measured at baseline, weekly, and endpoint; response was defined as ≥ 30% decrease from baseline, partial response defined as ≥ 20% decrease, and remission defined as a YBOCS ≤ 10.
Results:
Patients’ age ranged from 15 to 70 years old with a mean of 36. Of the 21 patients, 16 responded, 17 partially responded, 7 remitted, and 4 failed to respond. Of the 16 responders, 8 remitted. The four non-responders discontinued treatment due to either drug abuse, increase in depression, relocated, or felt improved. Efficacy was not dependent on age, gender or baseline YBOCS. The response had a strong non-significant dependence on number of treatments, suggesting that for best outcomes patients should receive at least 30 treatment sessions (38.2% response with < 30 treatments and 60.9% with ≥ 30 treatments). There were no serious adverse events, but some patients experienced transient mild to moderate headaches.
Conclusions:
dTMS with the H7 coil in a naturalistic setting is efficacious for OCD.
Link to Article:
https://www.brainstimjrnl.com/article/S1935-861X(18)30226-2/abstract
