| Objectives:OCD is usually characterized by recurrent obsessive thoughts and uncontrollable compulsive behaviors,and is clinically difficult to cure.Although the currently accepted first-line therapies are selective serotonin reuptake inhibitors and cognitive behavioral therapy,approximately 40-60%of OCD still has poor outcomes after these treatments.Research on painless non-invasive transcranial magnetic stimulation(TMS)for the treatment of OCD has been increasing in recent years,while conventional TMS treatment protocols have long treatment cycles(usually taking weeks to months)and less consistent efficacy,so there is a need for protocols with shorter onset of action and better treatment outcomes.Accelerated high-dose theta burst stimulation(ah TBS)has optimized existing stimulation protocols by increasing the single-day treatment frequency and increasing the total number of pulses stimulated,achieving impressive short-term efficacy in other disorders.The present study investigated whether the ah TBS protocol significantly improved the efficacy of OCD compared to conventional 1Hz rTMS.It also further explored the demographic and clinical variables that may predict the response to TMS in patients with OCD,providing a reference for exploring more optimal TMS treatment protocols for OCD with clinical value and guidance.Methods:A total of 44 patients with OCD were included and divided into ah TBS group and 1Hz rTMS group.ah TBS group:intra-plexus frequency 50Hz,inter-plexus frequency 5Hz,single stimulation time about 2 minutes and 24 seconds(single 1800pulses).10 stimulations per day,50 minutes apart,for a total of 18,000 pulses/day,for 5 consecutive days(total of 90,000 pulses),with a stimulation intensity of 80%of the resting motor threshold(RMT).1Hz rTMS group:frequency 1Hz,stimulation time about 31 minutes 30 seconds,once a day,total 1800 pulses/day,for 5 days,stimulation at 80%of the RMT.The right Pre-SMA was selected as the stimulation target and stimulation treatment was performed under the precise localization of the navigation system(based on individualized precise localization of the resting state functional connectivity of the STN).All subjects were assessed with clinical symptoms and neuropsychological tests before and after the intervention.Also,to explore potential predictors of rTMS response,a binary logistic regression analysis of demographic and clinical variables was performed.Results:There was no significant difference between the two groups in each symptom scale score before the intervention(P>0.05),and the time main effects of Y-BOCS,OCI-R,HAMA and HAMD scores were significant in both groups after the intervention(P<0.001),but the group main effect and group*time interactions(P>0.05)was not significant.The results of the analysis of remission rates showed that the ah TBS group had significantly higher numbers of people achieving 35%and25%remission rates than the 1Hz rTMS group(35%:χ~2=4.46,P=0.035,25%:χ~2=4.54,P=0.033).The results of the neuropsychological tests showed a significant group*time interaction on the digital smoothback task(F=4.45,P=0.041)and a significant time main effect on the Stroop task,digital smoothback task,and digital backwards task(P<0.05).The results of the binary logistic regression analysis showed that the scores of"Interference due to obsessive thoughts"and"Control over compulsions"in the Y-BOCS were significant predictors of the response to rTMS(P<0.05).Conclusions:This study was the first to clinically compare the efficacy of ah TBS with1Hz rTMS in the treatment of OCD with the help of clinical symptom assessment scales and neuropsychological tests,and to further analyze the clinical predictors of response to rTMS in patients with OCD.It was found that(1)ah TBS for OCD has clinically comparable short-term efficacy to conventional 1Hz rTMS,with no significant difference in post-intervention Y-BOCS scores between the two groups.However,there was a significant difference between the two groups in the number of people achieving remission rates,and this uncertainty needs to be verified in the future by including a larger sample size.(2)Patients with more disturbances in obsessive thinking and less control over compulsive behaviors may not be suitable for rTMS treatment. |
PDF Full Text Request