Tseng Ping-Tao, Hsu Chih-Wei, Hung Chao-Ming, Liang Chih-Sung, Wang Hung-Yu, Stubbs Brendon, Carvalho Andre F, Brunoni Andre R, Su Kuan-Pin, Tu Yu-Kang, Wu Yi-Cheng, Chen Tien-Yu, Li Dian-Jeng, Lin Pao-Yen, Chen Yen-Wen, Hung Kuo-Chuan, Chen Jiann-Jy, Zeng Bing-Syuan, Li Cheng-Ta
Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan.
Acta Psychiatr Scand. 2025 Mar 31. doi: 10.1111/acps.13809.
Despite the high lifetime prevalence and elevated disability rates, treatments for obsessive-compulsive disorder (OCD) have limited efficacy. Considering the abnormal connectivity in the cortical-striatal-thalamic-cortical loop circuits in OCD, several randomized controlled trials (RCTs) have addressed the efficacy of different non-invasive brain stimulation (NIBS) modalities for the management of OCD. However, these RCTs yielded inconclusive results.
This network meta-analysis (NMA) included RCTs of NIBS interventions, such as transcranial direct current stimulation (tDCS) and various repetitive transcranial magnetic stimulation (rTMS), in OCD patients. The primary outcomes were changes in the overall severity of OCD and acceptability (i.e., dropout rates).
This NMA of 34 eligible RCTs (1089 participants) and 24 different NIBS interventions revealed that three NIBS interventions significantly improved overall OCD severity compared with sham controls, which were high-frequency rTMS over the dorsolateral prefrontal cortex (DLPFC) [mean difference (MD) = -10.81, 95% confidence intervals (95% CIs) = -20.80 to -0.82], high-frequency deep TMS over the dorsal medial prefrontal cortex/anterior cingulate cortex (dmPFC/ACC) (MD = -9.74, 95% CIs = -16.42 to -3.06), and low-frequency rTMS over the right DLPFC (MD = -4.70, 95% CIs = -8.84 to -0.57).
This study highlighted that excitatory stimulation over the dmPFC/ACC and bilateral DLPFC, or inhibitory stimulation over the right DLPFC, was associated with significant improvements in overall OCD severity. Further large-scale RCTs with longer follow-up periods are needed to investigate the true impact of NIBS-based intervention to manage OCD.
PROSPERO: CRD42023394953.
尽管强迫症（OCD）的终生患病率很高且致残率也有所上升，但其治疗效果有限。考虑到强迫症患者皮质-纹状体-丘脑-皮质环路的连接异常，多项随机对照试验（RCT）探讨了不同的非侵入性脑刺激（NIBS）方式对强迫症治疗的疗效。然而，这些RCT的结果并不确定。
本网络荟萃分析（NMA）纳入了强迫症患者接受NIBS干预（如经颅直流电刺激（tDCS）和各种重复经颅磁刺激（rTMS））的RCT。主要结局是强迫症总体严重程度的变化和可接受性（即脱落率）。
这项对34项符合条件的RCT（1089名参与者）和24种不同NIBS干预措施的NMA显示，与假对照相比，三种NIBS干预措施显著改善了强迫症的总体严重程度，分别是背外侧前额叶皮质（DLPFC）高频rTMS（平均差（MD）=-10.81，95%置信区间（95% CIs）=-20.80至-0.82）、背内侧前额叶皮质/前扣带回皮质（dmPFC/ACC）高频深部TMS（MD=-9.74，95% CIs=-16.42至-3.06）以及右侧DLPFC低频rTMS（MD=-4.70，95% CIs=-8.84至-0.57）。
本研究强调，对dmPFC/ACC和双侧DLPFC进行兴奋性刺激，或对右侧DLPFC进行抑制性刺激，与强迫症总体严重程度的显著改善相关。需要进一步开展随访期更长的大规模RCT，以研究基于NIBS的干预措施对强迫症治疗的真正影响。
PROSPERO：CRD42023394953。
