School of Psychology, The University of Sydney, Sydney, NSW, Australia.
Department of Psychiatry, Nepean Hospital, Level 5 South Block, PO Box 63, Penrith/Sydney, NSW, 2751, Australia.
Psychiatr Q. 2018 Sep;89(3):645-665. doi: 10.1007/s11126-018-9566-7.
Randomised and sham-controlled trials (RCTs) of repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) have yielded conflicting results, which may be due to the variability in rTMS parameters used. We performed an updated systematic review and meta-analysis on the effectiveness of rTMS for the treatment of OCD and aimed to determine whether certain rTMS parameters, such as cortical target, may be associated with higher treatment effectiveness. After conducting a systematic literature review for RCTs on rTMS for OCD through to 1 December 2016 using MEDLINE, PubMed, Web of Science, PsycINFO, Google, and Google Scholar, we performed a random-effects meta-analysis with the outcome measure as pre-post changes in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores. To determine whether rTMS parameters may have influenced treatment effectiveness, studies were further analysed according to cortical target, stimulation frequency, and length of follow-up. Data were obtained from 18 RCTs on rTMS in the treatment of OCD. Overall, rTMS yielded a modest effect in reducing Y-BOCS scores with Hedge's g of 0.79 (95% CI = 0.43-1.15, p < 0.001). Stimulation of the supplementary motor area yielded the greatest reductions in Y-BOCS scores relative to other cortical targets. Subgroup analyses suggested that low frequency rTMS was more effective than high frequency rTMS. The effectiveness of rTMS was also greater at 12 weeks follow-up than at four weeks follow-up. Our meta-analysis implies that low frequency rTMS applied over the supplementary motor area may offer the greatest effectiveness in the treatment of OCD. The therapeutic effects of rTMS also appear to persist post-treatment and may offer beneficial long-term effectiveness. With our findings, it is suggested that future large-scale studies focus on the supplementary motor area and include follow-up periods of 12 weeks or more.
重复经颅磁刺激（rTMS）治疗强迫症（OCD）的随机对照试验（RCT）结果相互矛盾，这可能是由于 rTMS 参数的变异性所致。我们对 rTMS 治疗 OCD 的有效性进行了更新的系统评价和荟萃分析，旨在确定皮质目标等某些 rTMS 参数是否与更高的治疗效果相关。通过对截至 2016 年 12 月 1 日的 MEDLINE、PubMed、Web of Science、PsycINFO、Google 和 Google Scholar 上关于 rTMS 治疗 OCD 的 RCT 进行系统文献检索，我们使用耶鲁-布朗强迫症量表（Y-BOCS）评分的前后变化作为结局指标进行了随机效应荟萃分析。为了确定 rTMS 参数是否可能影响治疗效果，我们还根据皮质目标、刺激频率和随访时间进一步分析了研究。共有 18 项 rTMS 治疗 OCD 的 RCT 数据纳入分析。总体而言，rTMS 可降低 Y-BOCS 评分，效应量为 Hedge's g 0.79（95%CI：0.43-1.15，p<0.001）。与其他皮质目标相比，刺激运动辅助区可使 Y-BOCS 评分降低最大。亚组分析表明，低频 rTMS 比高频 rTMS 更有效。12 周随访时 rTMS 的有效性大于 4 周随访时。我们的荟萃分析表明，低频 rTMS 作用于运动辅助区可能是治疗 OCD 的最佳方法。rTMS 的治疗效果在治疗后仍然存在，可能具有有益的长期效果。根据我们的发现，建议未来的大型研究集中在运动辅助区，并包括 12 周或更长的随访期。
