Long-term outcomes of a course of deep TMS for treatment-resistant OCD

Journal: Brain Stimulation 15(1):226-228 (2022)

Authors: T Harmelech, A Tendler, MK Arikan, HL çetin, MT Esmeray, R Ilhan, R Vidrine, O Muir, C MacMillan, R Sinclair, S Shakir, D Kent, N Evangelidis, Y Roth

Background:

The Deep TMS H7 Coil for treatment-resistant OCD has demonstrated 38% response rate that was sustained for at least a month in a multicenter randomized controlled trial. In real-world clinical practice settings 52.4% of patients achieved at least one month sustained response. Yet, the question of the long-term durability of response to Deep TMS for OCD has remained unanswered.   

Objective:

To shed some light on the potential durability of Deep TMS treatment for OCD.

Methods:

Clinical sites that participated in the OCD multicenter trial as well as those that contributed the post marketing data were contacted (n=16). All sites were provided with a list of their patients who met response criteria at their last Y-BOCS evaluation following the Deep TMS treatment course (overall N=108) and requested to report whether each of them had, since the end of their treatment, any medication change/CBT/hospitalization/Deep TMS re-treatment. If so, on what date did the change in treatment occur and what was the reason (e.g., OCD exacerbation, desire for greater improvement, etc.). Sites were also requested to inquire about functional disability (days lost and days unproductive per week).

The potential durability of response to Deep TMS was defined as the elapsed time from the end of the Deep TMS treatment course until a change in treatment occurred.

Results:

The analysis set included 60 patients from 7 centers for whom there was durability data. Of those, only 8 patients (13.3%) had durability of <1 year, while 52 patients (86.7%) had durability of >1 year. Half of the patients who had at least 1 year durability (n=26), who represent 43.3% of the analysis set, had durability of >2 years. The average durability of Deep TMS for OCD was >1.98(±0.13) years. Importantly, 37/60 (62%) of patients were still considered to have Deep TMS durability at the time of the survey.

Almost half of the analysis set (n=28) had functional disability data as well. A significant reduction on disability was reported by patients following Deep TMS treatment (mean reduction in unproductive days per week:  3.8(±0.4; p<5-9); mean reduction in lost days per week1.8(±0.5; p<0.001)). A significant correlation was found between the improvement in symptom severity to the functional improvement following Deep TMS treatment (r=0.45, p=0.018). 

Conclusions:

It has been previously demonstrated that Deep TMS is an effective treatment for OCD patients who have failed multiple medications, alluding to a different mechanism of action. The durability results demonstrated here reaffirm that the mechanism of Deep TMS treatment in OCD is different from that of medications that necessitate chronic use.

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