Efficacy and clinical predictors of response to rTMS treatment in obsessive-compulsive disorder (OCD): A retrospective study
Abstract Background: Application of the repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been promising but effects differ between patients. Knowledge about clinical predictors of rTMS response would help to increase clinical efficacy but is not available so far. Methods: In a retrospective study, we investigated the efficacy of rTMS over the dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA) in 65 OCD outpatients recruited for the rTMS treatment from July 2015 to May 2017. Patients were divided into two groups and received either SMA rTMS or bilateral DLPFC rTMS. OCD symptoms and depression/anxiety states were measured before and after the 20th session of rTMS. Additionally, we performed a binary logistic regression analysis on the demographic variables and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) items to investigate demographic and clinical predictors for rTMS response in responders and non-responders. Results: Patients’ scores in Y-BOCS and Beck anxiety/depression inventories were significantly decreased following rTMS treatment. Specifically, 46.2% of all patients responded to rTMS, based on at least 30% reduction of the Y-BOCS scores. Stimulation target (DLPFC vs. SMA) did not significantly differ in rTMS efficacy. No significant demographic predictors were found. Interference due to obsessions and resistance against compulsions were the only two clinical predictors of rTMS treatment response that could significantly predict response failure to rTMS. Conclusions: rTMS treatment should be adapted to the clinical profile of OCD patients including the symptoms. Patients with less intrusive and interfering thoughts might benefit more from rTMS treatment. Identifying clinical and non-clinical predictors of response are needed to personalize and adapt rTMS protocols in pharmaco-resistant OCD patients.