Health Problem: Obsessive-compulsive disorder (OCD) is a disorder characterized by intrusive obsessions and repetitive compulsions where symptoms interfere with a person’s routine, occupation, or social functioning; lifetime prevalence of OCD is estimated between 2% to 3% in the United States. Repetitive transcranial magnetic stimulation (rTMS) has been proposed as an alternative treatment for patients who are treatment resistant to 1 or more rounds of pharmacotherapy or behavioral therapy interventions for OCD.

Technology Description: rTMS is a noninvasive technique that involves superficial but powerful magnetic stimulation of the brain. This is achieved by passing electrical energy through a round or figure-eight coil to focus an electromagnetic field over the scalp, penetrating the cortical surface. For treatment of OCD, cortical targets are typically the dorsolateral prefrontal cortex (DLPFC), the supplementary motor area (SMA), or orbitofrontal cortex (OFC). rTMS uses brief, repetitive magnetic pulses, called trains, at either a high-frequency (≥ 5 hertz [Hz]) or low-frequency stimulation (1 Hz) applied to the cortical target. Treatment is generally administered for 15 sessions over a period of 3 weeks but can extend up to as many as 6 weeks.

Controversy: Treatment with rTMS has become more common for some indications, such as depression, but concern still remains regarding if rTMS is efficacious in managing OCD symptoms. A large number of RCTs present mixed findings regarding whether rTMS is superior to sham control treatments for this indication. Recent meta-analyses have pooled these small trial results and suggest a potentially beneficial picture of rTMS treatment, but there is a lack of endorsement from national and international organizations at this time.

Key Questions:

  • Is rTMS effective in improving symptoms of OCD, and how durable is any observed treatment effect?
  • How does rTMS compare with alternative treatments or usual care for OCD?
  • Are there safety concerns related to rTMS?
  • Have definitive patient selection criteria for the use of rTMS for OCD been established?

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