Adjunctive neuronavigated accelerated continuous theta-burst stimulation in obsessive-compulsive disorder: a randomized sham-controlled study

Abstract Background Approximately 40% of patients treated for obsessive-compulsive disorder (OCD) do not respond to standard and second-line augmentation treatments leading to the exploration of alternate biological treatments. Continuous theta burst stimulation (cTBS) is a form of repetitive transcranial magnetic stimulation inducing more rapid and longer-lasting effects on synaptic plasticity than the latter. To the best of our knowledge, only one recent study and a case report investigated the effect of cTBS at the supplementary motor area (SMA) in OCD. Objective This study aimed to examine the effect of accelerated robotized neuronavigated cTBS over SMA in patients with OCD. Methods A total of 32 patients with OCD were enrolled and randomized into active and sham cTBS groups. For active cTBS stimulation, an accelerated protocol was used. Bursts of three stimuli at 50 Hz, at 80% of MT, repeated at 5 Hz were used. Daily 2 sessions of 900 pulses each, for a total of 30 sessions over 3 wk (weekly 10 sessions), were given. Yale–Brown Obsessive-Compulsive Rating Scale (YBOCS), Clinical Global Impressions scale (CGI), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were administered at baseline and at end of weeks 3 and 8. Results A total of 26 patients completed the study. Active cTBS group showed significant group × time effect in YBOCS obsession ( P < .001, η 2 = 0.288), compulsion ( P = .004, η 2 = 0.207), YBOCS total ( P < .001, η 2 = 0.288), CGI-S ( P = .010, η 2 = 0.248), CGI-C ( P = .010, η 2 = 0.248), HAM-D ( P = .014, η 2 = 0.224) than sham cTBS group. Conclusions Findings from our study suggest that adjunctive accelerated cTBS significantly improves psychopathology, severity of illness, and depression among patients with OCD. Future studies with larger sample sizes will add to our knowledge.