HIGH FREQUENCY DEEP REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (dTMS) OF MEDIAL PREFRONTAL AND ANTERIOR CINGULATE CORTICES IN PATIENTS WITH OCD: A DOUBLE-BLIND, PLACEBO CONTROLLED, PERSPECTIVE MULTI-CENTER STUDY

Introduction Obsessive compulsive disorder (OCD) is a disabling disease with an annual prevalence of 1.2%. Currently approved medications only result in a reduction of symptoms for 40-60% of patients leaving most patients significantly affected. Symptom severity is correlated to the degree of hyperconnectivity in the cortico-stiriato-thalamic circuit and increased glucose metabolism in the anterior cingulate cortex during symptom provocation and at rest. Methods Ninety-four OCD patients who met inclusion/exclusion criteria (age 22-68, YBOCS≥20 despite SSRI treatment and/or CBT, stable on medications or therapy for at least two months) were randomized to receive active or sham treatment for twenty-nine sessions over six weeks. Deep transcranial magnetic stimulation(dTMS) was applied over the medial prefrontal(mPFC) and anterior cingulate cortices(ACC) using the H7 dTMS coil. Once the coil was in the treatment position, the patient’s symptoms were provoked using an individualized script tailored to the patient’s obsessions and compulsions. Subsequently, dTMS was administered for eighteen minutes at 100% resting motor threshold of the foot, 20HZ pulse frequency, in 2 second trains, with a 20 second inter-train interval totaling 2000 pulses. The sham coil was designed to have the same sound, scalp and facial sensation of the real coil without stimulating the brain directly. Results The mean age of the subjects was 38.7 (±11.75), 58.7%male, 78.8% Caucasian, mean age of onset was 13, 98% had failed medications approved for OCD and 68.7% had failed CBT. At the end of week 6 (the primary endpoint) the YBOCS decreased by 5.7 points (95% CI: [3.3;8.2]) in the dTMS arm and by 3.0 points (95% CI: [0.7;5.4]) in the control arm (p-value: 0.0157). Response (≥30% decrease/20% decrease in the YBOCS) rates were dTMS 38.10% in the dTMS arm and 11.11% in the sham arm (p-value:0.0033). Partial response rates were (≥20% decrease in the YBOCS) 54.76 in the dTMS arm and 26.67% in the sham arm (p-value: 0.0076). At week 10 (follow up) the YBOCS decreased by 6.2 points (95% CI: [3.6;8.7]) in the dTMS arm and by 3.8 points (95% CI: [1.4;6.2]) in the control arm (p-value: 0.0459). There were no serious adverse events related to the treatment. The most frequent adverse event, headache, did not differ in frequency between the two arms. Conclusions High frequency dTMS of the ACC was found to be an effective treatment for OCD. This approach is an additional intervention in the toolbox for treating OCD.