Repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive–compulsive disorder (OCD) and Tourette's syndrome (TS)

TLDR

Motor and premotor cortices are hyperexcitable in obsessive–compulsive disorder and Tourette's syndrome. The study examined whether low‑frequency repetitive transcranial magnetic stimulation could normalize these overactive motor cortical regions and alleviate symptoms. Participants received 10 consecutive daily sessions of 1‑Hz rTMS at 100 % motor threshold to the supplementary motor area, delivering 1 200 stimuli per day. Slow rTMS to the SMA produced significant clinical improvement in OCD and TS, with marked reductions in YBOCS, YGTSS, CGI, HARS, HDRS, SAD, BDI, SCL‑90, and SASS scores, correlated with increased right resting motor threshold, sustained at 3‑month follow‑up, and restored right‑hemisphere motor threshold symmetry.

Abstract

There is evidence that motor and premotor cortex are hyperexcitable in obsessive–compulsive disorder (OCD) and Tourette's syndrome (TS). We tested whether low-frequency repetitive transcranial magnetic stimulation (rTMS) could normalize overactive motor cortical regions and thereby improve symptoms. Subjects with OCD or TS were treated with active rTMS to the supplementary motor area (SMA) for 10 daily sessions at 1 Hz, 100% of motor threshold, 1200 stimuli/day. Suggestions of clinical improvement were apparent as early as the first week of rTMS. At the second week of treatment, statistically significant reductions were seen in the YBOCS, YGTSS, CGI, HARS, HDRS, SAD, BDI, SCL-90, and SASS. Symptoms improvement was correlated with a significant increase of the right resting motor threshold and was stable at 3 months follow-up. Slow rTMS to SMA resulted in a significant clinical improvement and a normalization of the right hemisphere hyperexcitability, thereby restoring hemispheric symmetry in motor threshold.