TY - JOUR
T1 - Repetitive transcranial magnetic stimulation for obsessive-compulsive disorder
T2 - A systematic review and pairwise/network meta-analysis
AU - Fitzsimmons, Sophie M. D. D.
AU - van der Werf, Ysbrand D.
AU - van Campen, A. Dilene
AU - Arns, Martijn
AU - Sack, Alexander T.
AU - Hoogendoorn, Adriaan W.
AU - van Balkom, Anton J. L. M.
AU - Batelaan, Neeltje M.
AU - Eijndhoven, Philip van
AU - Hendriks, Gert-Jan
AU - Oostrom, Iris van
AU - Oppena, Patricia van
AU - other members of the TETRO Consortium
AU - Schruers, Koen R. J.
AU - Tendolkar, Indira
AU - Vriend, Chris
AU - van den Heuvel, Odile A.
N1 - Funding Information: We thank Kirsten Rupert and Caroline Planting for help with the search terms and literature search, Ralph Wientjens for help with article screening, and Karolina Brzozowska (KB) for help with article screening, quality ratings, figures and tables Funding Information: This work was supported by a NWO-ZonMw VIDI grant (no. 91717306), awarded to OAvdH. NWO-ZonMw had no involvement in the study design, the collection, analysis and interpretation of data, the writing of the report; or in the decision to submit the article for publication. Funding Information: Financial disclosures: PvE and IT have recieved an NWO Doelmatigheid grant for rTMS in Major Depressive Disorder; YDvdW has received an ENIGMA World aging center Subcontract under NIA Award No. 1R01AG058854–01A1, and an ENIGMA Parkinson's Initiative: A Global Initiative for Parkinson's Disease, Subcontract under NINDS award 1RO1NS107513–01A1. Publisher Copyright: © 2022 The Author(s)
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Background We evaluated the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD), and ranked the relative efficacy of different stimulation protocols. Methods We performed a search for randomised, sham-controlled trials of rTMS for OCD. The primary analysis included both a pairwise meta-analysis and a series of frequentist network meta-analyses (NMA) of OCD symptom severity. Secondary analyses were carried out on relevant clinical factors and safety. Results 21 studies involving 662 patients were included. The pairwise meta-analysis showed that rTMS for OCD is efficacious across all protocols (Hedges’ g=-0.502 [95%CI= -0.708, -0.296]). The first NMA, with stimulation protocols clustered only by anatomical location, showed that both dorsolateral prefrontal cortex (dlPFC) stimulation and medial frontal cortex stimulation were efficacious. In the second NMA, considering each unique combination of frequency and location separately, low frequency (LF) pre-supplementary motor area (preSMA) stimulation, high frequency (HF) bilateral dlPFC stimulation, and LF right dlPFC stimulation were all efficacious. LF right dlPFC was ranked highest in terms of efficacy, although the corresponding confidence intervals overlapped with the other two protocols. Limitations Evidence base included mostly small studies, with only a few studies using similar protocols, giving a sparse network. Studies were heterogeneous, and a risk of publication bias was found. Conclusions rTMS for OCD was efficacious compared with sham stimulation. LF right dlPFC, HF bilateral dlPFC and LF preSMA stimulation were all efficacious protocols with significant and comparable clinical improvements. Future studies should further investigate the relative merits of these three protocols.
AB - Background We evaluated the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD), and ranked the relative efficacy of different stimulation protocols. Methods We performed a search for randomised, sham-controlled trials of rTMS for OCD. The primary analysis included both a pairwise meta-analysis and a series of frequentist network meta-analyses (NMA) of OCD symptom severity. Secondary analyses were carried out on relevant clinical factors and safety. Results 21 studies involving 662 patients were included. The pairwise meta-analysis showed that rTMS for OCD is efficacious across all protocols (Hedges’ g=-0.502 [95%CI= -0.708, -0.296]). The first NMA, with stimulation protocols clustered only by anatomical location, showed that both dorsolateral prefrontal cortex (dlPFC) stimulation and medial frontal cortex stimulation were efficacious. In the second NMA, considering each unique combination of frequency and location separately, low frequency (LF) pre-supplementary motor area (preSMA) stimulation, high frequency (HF) bilateral dlPFC stimulation, and LF right dlPFC stimulation were all efficacious. LF right dlPFC was ranked highest in terms of efficacy, although the corresponding confidence intervals overlapped with the other two protocols. Limitations Evidence base included mostly small studies, with only a few studies using similar protocols, giving a sparse network. Studies were heterogeneous, and a risk of publication bias was found. Conclusions rTMS for OCD was efficacious compared with sham stimulation. LF right dlPFC, HF bilateral dlPFC and LF preSMA stimulation were all efficacious protocols with significant and comparable clinical improvements. Future studies should further investigate the relative merits of these three protocols.
KW - Network meta-analysis
KW - Obsessive-compulsive disorder
KW - Repetitive transcranial magnetic stimulation
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85123787258&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/35041869
UR - http://www.scopus.com/inward/record.url?scp=85123787258&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jad.2022.01.048
DO - https://doi.org/10.1016/j.jad.2022.01.048
M3 - Review article
C2 - 35041869
SN - 0165-0327
VL - 302
SP - 302
EP - 312
JO - Journal of affective disorders
JF - Journal of affective disorders
ER -