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A randomized controlled study of sequentially applied repetitive transcranial magnetic stimulation in obsessive-compulsive disorder.

 Jee In Kang  ;  Chan-Hyung Kim  ;  Kee Namkoong  ;  Chang-il Lee  ;  Se Joo Kim 
 JOURNAL OF CLINICAL PSYCHIATRY, Vol.70(12) : 1645-1651, 2009 
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Adult ; Female ; Functional Laterality/physiology ; Humans ; Male ; Obsessive-Compulsive Disorder/diagnosis ; Obsessive-Compulsive Disorder/therapy* ; Outcome Assessment (Health Care) ; Prefrontal Cortex/physiology ; Psychiatric Status Rating Scales ; Transcranial Magnetic Stimulation/methods* ; Treatment Outcome
OBJECTIVE: The present study investigated possible therapeutic effects and safety of sequentially combined low-frequency repetitive transcranial magnetic stimulation (rTMS) to the right dorsolateral prefrontal cortex and supplementary motor area in patients with treatment-resistant obsessive-compulsive disorder. METHOD: Between February 2007 and January 2008, we carried out a study with a rater-blinded, sham-controlled design in which 20 patients with treatment-resistant obsessive-compulsive disorder, confirmed by a psychiatrist after use of the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version, were randomly assigned to either active rTMS (n = 10) or sham treatment (n = 10). Over 10 days, rTMS of 1 Hz was given at 110% of the motor threshold for 20 minutes over the right dorsolateral prefrontal cortex and sequentially at 1 Hz at 100% of the motor threshold for 20 minutes over the supplementary motor area. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS) score. RESULTS: For the between-group analyses, there were no significant differences over 4 weeks between the active and sham groups on the YBOCS (F = 0.01, P = .92) and the Montgomery-Asberg Depression Rating Scale (MADRS; F = 0.39, P = .54). In repeated-measures analyses on all subjects, there was a significant effect of time on the YBOCS (F = 5.48, P = .009) and the MADRS (F = 6.55, P = .004). There were no significant group-by-time interactions for the YBOCS (F = 0.03, P = .94) or the MADRS (F = 0.09, P = .67). CONCLUSIONS: These findings suggest that 10 sessions of sequential rTMS of the right dorsolateral prefrontal cortex and the supplementary motor area at low frequency had no therapeutic effect on obsessive-compulsive symptoms. However, rTMS was a safe method of treatment, and there was no significant change in cognitive function after rTMS. Further controlled studies using a more sophisticated sham system in larger samples are required to confirm the effect of rTMS in obsessive-compulsive disorder.
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1. College of Medicine (의과대학) > Dept. of Psychiatry (정신과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Jee In(강지인) ORCID logo https://orcid.org/0000-0002-2818-7183
Kim, Se Joo(김세주) ORCID logo https://orcid.org/0000-0002-5438-8210
Kim, Chan Hyung(김찬형)
Namkoong, Kee(남궁기) ORCID logo https://orcid.org/0000-0003-1400-8057
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