ReviewRepetitive transcranial magnetic stimulation (rTMS) for obsessive–compulsive disorder (OCD): An exploratory meta-analysis of randomized and sham-controlled trials
Section snippets
Search strategy
We identified articles for inclusion in this meta-analysis by:
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Screening the bibliography of the previous general reviews on rTMS for OCD (Blom et al., 2011; Jaafari et al., 2012; Pigot et al., 2008), of the meta-analysis by Slotema et al. (2010), and of all included RCTs;
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Searching MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), and SCOPUS from January 1, 1995 until December 3, 2012;
The search procedures (including syntax, parameters, and results) are
Literature search
We retrieved 59 references (after discarding duplicates) from MEDLINE, PsycINFO, EMBASE, CENTRAL and SCOPUS. Of these, 10 met the eligibility criteria (Alonso et al., 2001; Badawy et al., 2010; Gomes et al., 2012; Kang et al., 2009; Mansur et al., 2011; Mantovani et al., 2010; Prasko et al., 2006; Ruffini et al., 2009; Sachdev et al., 2007; Sarkhel et al., 2010). Please refer to the Supplementary Material for a detailed description of the study selection procedure.
Included RCTs: main characteristics
Overall, 10 RCTs were included
Discussion
This is the first meta-analysis assessing the efficacy and acceptability of rTMS for OCD. Our findings show that active rTMS significantly reduced overall OCD-related anxiety and depressive symptomatology following a mean of 14 sessions. Furthermore, active and sham rTMS groups did not differ in terms of depression scores at baseline or dropout rates at study end, although baseline Y-BOCS scores for the active rTMS group were significantly higher. Thus, active rTMS efficacy for OCD might have
Conclusion
In contrast with rTMS trials for major depression, in which a small number of brain regions were investigated while demographic/clinical and/or stimulation parameters were manipulated (Daskalakis et al., 2008), the lack of such repeated studies for OCD and their overall heterogeneity limit our ability to conclusively synthesize the literature. We therefore cannot draw definitive conclusions about the clinical utility of rTMS for OCD. With this said, LF-rTMS (particularly targeting the SMA or
Role of the funding source
We received no funding for this study.
Contributors
None.
Conflicts of interest
Dr. Berlim has received a researcher-initiated grant from Brainsway Inc. Dr Van den Eynde and Mr Nicholas Neufeld report no potential conflicts of interest.
Acknowledgment
None.
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