Continuous Theta Burst Stimulation To SMA Obsessive-complsive Disorder Tretment

Objective: At present,there are few studies on continuous theta burst stimulation(c TBS)intervention in OCD.The purpose of this study was to investigate the effect of c TBS on bilateral supplementary motor area(SMA)in patients with OCD.Methods: A randomized double-blind sham-controlled design was used in this study.Forty-one OCD outpatients were randomized to receive either active c TBS or sham c TBS.Two patients withdrew before the 2th week visit,leaving 41 patients in the final sample(ACTIVE = 10,SHAM = 12).All patients were 16 ≤ Y-BOCS ≤ 31 and had no other comorbidities.Among them,there were 9 patients who had never taken the drugs,8 patients who had stopped taking the drugs at least one month ago,and 24 patients who had taken the stable dose drugs at least one month ago.c TBS mode was adopted for stimulation.The stimulation parameters were as follows: 110% RMT,1200 pulses/day,1 time/day,5times/week,and 20 times in total for four consecutive weeks of intervention.The intervention target was bilateral SMA.All patients received Y-BOCS,HAMA14,HAMD24,BAS/BIS evaluations at baseline,2th week visit,4th week visit.They also received STAI,SDS,and OBQ evaluations at baseline,4th week visit,as well as surveys of treatment satisfaction and side effects after the fourth week of treatment.Response to treatment was defined as at least 25% decrease on the Y-BOCS.In addition,in order to exclude the effect of drugs on the results,we analyzed the data of 17 patients who did not take drugs.Results:(1)Repeated measures analysis showed that there was a significant effect of time on YBOCS scores(P <0.01)whereas there was no significant group*time interaction(P >0.05).There was no significant difference in percentage reduction in YBOCS over the 4 weeks of treatment between the active and sham groups(20.92% vs 13.87%,P >0.05).Nine patients(42.86%)in the active r TMS group and 6(30%)in the sham group met the response criterion at the end of treatment;the difference was not statistically significant(P >0.05).(2)In terms of secondary outcomes,HAMD24,SDS and OBQ scores showed similar results with significant time effects(P <0.01)and nonsignificant time*group interaction(P >0.05);HAMA14 scores revealed significant time effects(P <0.01)and critical significant time*group interaction(P =0.07);S-AI scores critical revealed significant time effects(P = 0.08)and nonsignificant time*group interaction(P >0.05);BAS/BIS scores revealed neither significant time effect nor time*group interaction(P >0.05).(3)There was no significant difference in treatment satisfaction between the two groups(P >0.05).(4)None of the patients had any serious adverse events.In addition,an analysis of 17 patients who were not taking the drugs yielded similar results.Conclusion: It is safe to use continuous theta burst stimulation to intervene the bilateral supplementary motor area in patients with OCD,but its efficacy in improving obsessive-compulsive symptoms with anxiety and depression is not supported by this study.Future studies need to be designed to further explore its efficacy,or to explore alternate r TMS protocols in OCD.