Transcranial Magnetic Stimulation of Dorsolateral Prefrontal Cortex in Treatment-Resistant Obsessive Compulsive Disorder: A Mini-Review
Authors:   Universidad Católica Santiago de Guayaquil, Guayaquil, Ecuador, Vivanco Ricardo A. , Rech Lavinia ,   Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria,   Department of Cardiac Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States, Ramos-Orosco Elizabeth J. ,   School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru,   Harvard T.H. Chan School of Public Health, Boston, MA, United States, Prilip Paula ,   Harvard T.H. Chan School of Public Health, Boston, MA, United States, Mengide Juan Pablo ,   Hospital Provincial Neuquén Dr. Castro Rendón, Buenos Aires, Argentina, Bonilla Rivera Paulina ,   Hospital del Trabajador, Asociación Chilena de Seguridad ACHS, Santiago, Chile, Vergas-Ruiz Ariana ,   Hospital F. Escalante Pradilla, Pérez Zeledón, San José, Costa Rica, Maia Barros Levi Coelho ,   Harvard T.H. Chan School of Public Health, Boston, MA, United States, Abbarh Shahem ,   Hamad Medical Corporation, Doha, Qatar, Aspee Rayza ,   Harvard T.H. Chan School of Public Health, Boston, MA, United States, Bazán-Perkins Blanca ,   Instituto Nacional de Enfermedades Respiratorias, México City, México,   Tecnologico de Monterrey, México City, México, Crisóstmomo Ninapaytan Gianina M. ,   Instituto Nacional de Salud Mental Honorio Delgado - Hideyo Noguchi, Lima, Perú, Felipe Martha ,   Harvard T.H. Chan School of Public Health, Boston, MA, United States, Guersoni Ana Claudia ,   Faculty of Medicine of the University of São Paulo, Preventive Medicine Department, São Paulo, Brazil, Guiterrez-Brito Geovanny ,   National School of Tropical Medicine at Baylor College of Medicine, Houston, TX, United States, Hoessly Linard ,   University Hospital Basel, Abu Hussein Nebal ,   Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, United States, de Melo Lobo Matheus ,   A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil, Nakamura Gisele E.K. ,   Pontifical Catholic University of Paraná, Londrina, Paraná, Brazil, Mohamed Wafa ,   Harvard T.H. Chan School of Public Health, Boston, MA, United States, de Almeida Roedinger Manuela ,   Instituto Butantan; São Paulo; São Paulo-Brazil, Salman Dan ,   Harvard T.H. Chan School of Public Health, Boston, MA, United States, Teo Tessa ,   Harvard T.H. Chan School of Public Health, Boston, MA, United States, Siqueira Amanda R.O. ,   FGM IPDC Paulista Institute of Cardiovascular Diseases, Sao Paulo, SP, Brazil
Published: February 2024

Introduction: Approximately two-thirds of patients with Obsessive-Compulsive Disorder (OCD) exhibit inadequate responses to current standard therapies. A previous meta-analysis has shown the potential benefit of repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (dlPFC) area in patients with OCD. However, the analysis also included patients who had not previously failed first-line treatments. This mini-review aims to explore the therapeutic effects of rTMS applied to the dlPFC area in patients with treatment-resistant OCD. Methods: We conducted a comprehensive search for randomized controlled trials (RCTs) and observational studies across various databases (PubMed, EMBASE, Ebsco, Web of Science, and Cochrane Central). Eligible studies encompassed rTMS administered to the dlPFC area in cases of treatment-resistant OCD. Studies that did not focus on using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to assess the efficacy of rTMS were excluded. Quality assessments were conducted based on the Cochrane risk-of-bias tool. Results: Our review identified five RCTs involving 132 patients that met the established criteria. The application of high-frequency (HF) and low-frequency (LF) rTMS to the dlPFC region yielded controversial post-treatment Y-BOCS findings due to factors such as small sample sizes, short-term study durations, variations in rTMS protocols, and four studies exhibiting a high risk of bias. Discussion: The available data is constrained by a scarcity of high-quality, large-scale trials with extended follow-up periods and optimized protocols. Further research is warranted to establish the efficacy of rTMS administered to the dlPFC in this patient population.