Page 101 - IDF Journal 2023

Obsessive Compulsive Disorder
We collected the data of 99 patients diagnosed with OCD, with an average Yale-Brown Obsessive Compulsive Scale (YBOCS) baseline of 27/40. We found
a 28% remission rate (YBOCS score of <16/40) for OCD patients treated with rTMS, with 57% of patients seeing at least a 20% reduction in OCD symptoms, and 42% of patients seeing at least a 30% reduction in symptoms. This final statistic from our audit shares similar results
with the literature, which found a 30% reduction of symptoms in YBOCS scores after rTMS treatment 7.
Moreover, we conducted a study comparing the differences in our two OCD protocols. Patients were either treated over the right dorsolateral prefrontal cortex and the supplementary motor area, or
the left medial orbito-frontal cortex. Our study found both treatment locations
to be equally effective in treating OCD symptoms 8. Finally, we also looked at how rTMS specifically affected obsessions and compulsions separately. Our data
REFERENCES
1. Singh H, Neil LA. Incidence of side
effects in patients receiving Repetitive Transcranial Magnetic Stimulation (rTMS). Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation. 2020 Nov 1;13(6):1847-8.
2. Milev RV, Giacobbe P, Kennedy SH, Blumberger DM, Daskalakis ZJ,
Downar J, Modirrousta M, Patry S, Vila-Rodriguez F, Lam RW, MacQueen GM. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management
of adults with major depressive disorder: section 4. Neurostimulation treatments. The Canadian Journal of Psychiatry. 2016 Sep;61(9):561-75.
3. Singh H, Neal LA, Kennedy E, Thangaraja A, Madan R, Wayman L-J (2022) Comparing the clinical outcomes of prolonged iTBS over F3 and 1hz over
FCz with 10hz over F3 and cTBS over F4. Brain Stimulation. Basic, Translational, and Clinical Research in Neuromodulation, 15. 5. 1323.
4. Alhelali A, Almheiri E, Abdelnaim M, Weber FC, Langguth B, Schecklmann M, Hebel T. Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Disorder in Comparison to the Treatment of Unipolar Depression in a Naturalistic Setting. Brain sciences. 2022 Feb 23;12(3):298.
5. Ceresa A, Esposito CM, Buoli M. How does borderline personality disorder affect management and treatment response of patients with major depressive disorder? A comprehensive review. Journal of affective disorders. 2021 Feb 15;281:581-9.
suggests that rTMS significantly reduces both the obsessions and compulsions associated with OCD, with the effect sizes indicating that rTMS may be most beneficial in treating the obsessional element of OCD.
Post-Traumatic Stress Disorder
Our audit on post-traumatic stress disorder (PTSD) patients had a small sample size (12). To measure PTSD symptoms, we used the Impact of Events Scale Revised (IES-R). Our results displayed that 50% of patients went into remission (IES-R <33), and 90% of our patients saw at least a 20% reduction
in symptoms – consistent with a recent meta-analysis of studies on rTMS and PTSD9.
Cocaine Craving
Using a self-report craving scale, 20 patients with cocaine addiction were examined for our audit, with a baseline craving score of 6.5. 18/20 patients had at least a 20% reduction in symptoms, with
6. Zimmerman M, Terrill D, Ward M, D’Avanzato C, Tirpak JW. Telehealth Partial Hospital Level of Care and Borderline Personality Disorder: Reply to Renn et al. The Journal of Clinical Psychiatry. 2021 Aug 17;82(5):36029.
7. Carmi L, Tendler A, Bystritsky A, Hollander E, Blumberger DM, Daskalakis J, Ward H, Lapidus K, Goodman W, Casuto L, Feifel D. Efficacy and safety of deep transcranial magnetic stimulation for obsessive- compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial. American Journal of Psychiatry. 2019 Nov 1;176(11):931-8.
8. Singh, H., Wyman, L.J., Shojaii, P. and Neal, L.A., 2021. A Comparison of final Yale-Brown Obsessive-Compulsive
Scale (YBOCS) in patients receiving
either Repetitive Transcranial Magnetic Stimulation (rTMS) to the Right Dorsolateral Prefrontal Cortex+ Supplementary Motor Area (rDLPFC+ SMA) or Left Medial Orbitofrontal Cortex (FP1) for the treatment of Obsessive-Compulsive Disorder (OCD). Brain Stimulation: Basic, Translational,
and Clinical Research in Neuromodulation, 14(5), p.1409.
9. Harris A, Reece J. Transcranial magnetic stimulation as a treatment for posttraumatic stress disorder: A meta- analysis. Journal of Affective Disorders. 2021 Jun 15;289:55-65.
10. Terraneo A, Leggio L, Saladini M, Ermani M, Bonci A, Gallimberti L. Transcranial magnetic stimulation of dorsolateral prefrontal cortex reduces cocaine use: a pilot study. European Neuropsychopharmacology. 2016 Jan 1;26(1):37-44.
8/20 patients reaching a craving score
of 0. Although the literature is relatively small on rTMS and cocaine addiction, a 2016 study appears to have found similar effectiveness for rTMS in the reduction of cocaine craving10.
Accelerated TMS
Accelerated TMS (aTMS) involves having more than one session of TMS in the same day. Many patients opt for aTMS due to the convenience it offers – such
as less trips to the clinic and a greater ability to work around their schedule. Our research compared 253 patients who received either rTMS or aTMS. We found no significant differences in outcomes between daily sessions and aTMS. Thus, either the option of daily sessions or aTMS can be utilised to best fit the schedule and lifestyle of the patient.
Conclusion
We have found rTMS to be a safe, effective treatment for various mental health conditions. Our patient data has contributed to several published studies, and we hope to further the literature, publishing more data to further understand the effectiveness of rTMS. For the future, the growing evidence base highlights the benefits of rTMS for a variety of conditions alongside depression. It is our expectation that more diseases will soon be treated with rTMS, including painful ones such
as fibromyalgia which we anticipate commencing treatment for in the spring of 2023. We continue to raise awareness of rTMS and offer free prescriber training to psychiatrists and GPs who would like to get more insight into this life changing treatment. See our website for further details.
Content written by
Ben Dunkerley,
BSc, MSc, TMS practitioner, Manchester
Dr Leigh Anthony Neal MB BCh MRCGP DRCOG FRCPsych MD
Consultant Psychiatrist,
Medical Director and co-founder of Smart TMS
W: www.smarttms.co.uk
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