Does Deep TMS Heal Obsessive-Compulsive Disorder Symptoms?

Derin TMS, Obsesif Kompulsif Bozukluk Semptomlarını İyileştirir mi?

Studies show that the application of the Deep TMS treatment by focusing on a specific region of the brain works in the treatment of Obsessive-Compulsive Disorder. Functioning as a new dimension in the treatment of individuals that do not respond to conventional treatment, Deep TMS also paves the way for the treatment of a great majority of the patients.

Obsessive-Compulsive Disorder (OCD) and Conventional Treatment Methods

It is generally defined as recurrent thoughts, impulsions or the intense, recurrent behaviors that the person feels compelled to carry out. Having a lifelong recurrence rate of 2.3% even though it is observed in an average of 1% of the people on a yearly basis, OCD becomes painful at a specific point of those people’s lives. In general, exposure and response prevention therapy (this treatment method can be taken as making the patient exposed to the content of their obsessions and not letting them realize or preventing them from realizing the compulsions) and SSRI (Selective Serotonin Reuptake Inhibitors/Drugs) are the healing methods that could be considered conventional; however, one-third to half of the patients do not respond to these treatments.

What is Deep TMS? What Does it Do?

Deep Transcranial Magnetic Stimulation (dTMS) is a brain stimulation technique, in which a coil placed on the scalp produces magnetic fields through magnetic stimuli. This magnetic field, which is formed through stimuli, enables symptoms to heal by activating the neuronal circuits in the target brain region. It is also used clinically in the treatment of some challenging/resistant depression cases.

Results of a Study Conducted on OCB, using Deep TMS

In a multicenter, randomized controlled study conducted by Dr. Lior Carmi (along with Prof. Joseph Zohar and Prof. Abraham Zangen, and a large research team at the Chaim Sheba Medical Center), they applied a real treatment on a specific portion of a 99-patient group through Deep TMS, while the other part was subjected to false treatment (false treatment stands for an unreal practice with realistic appearances, in which patients are given only the sound of the device, and not the magnetic field itself). All of the patients in this study consisted of individuals who had previously received an antidepressant treatment and had not responded to this treatment.

“An interesting point about this study is the fact that we intentionally provoked the patients prior to each dTMS session. We did these provocations by preparing them in accordance with each patient’s own obsession. Each exposure was designed specifically for each patient. During the initial interview made with the patients, we learned about their symptoms and created a list that included which exposures would be used during the practice. The fundamental idea here was to provide the treatment when the brain circuits were activated, not after the session of the patient ended,” said Dr. Carmi.

The sessions consisted of a 6-week 20Hz Deep TMS practices, which focused on the specific OCD-related regions of the brain. The response rate was measured, using the Yale-Brown Obsessive-Compulsive Scale. Of the patients who were treated, 38% were observed to have responded to the treatment as a result of the study. While the group, which was exposed to real stimuli, had a treatment response rate of 45.2%, this rate was 17.8% in the group, which was exposed to false stimuli, in the assessment made one month following the conclusion of the treatment.

Prof. Jose M. Menchon (Bellvitge University Hospital, Spain) made the following statements about this study:

“This is quite an exciting study, for it shows it is possible to obtain positive results in OCD, using Deep TMS. Until now, clinical experiments made with TMS on OCD were carried out with non-deep TMS, which might have some limitations due to its non-magnetic effects. Nevertheless, deep TMS makes it possible to reach deeper brain regions that could have a much more critical role in OCD and to have access to these regions. Deep TMS will become a beneficial treatment strategy following an increase in the number of these positive results in future studies.”

REFERENCES:

  • ScienceDaily
  • Efficacy and Safety of Deep Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Prospective Multicenter Randomized Double-Blind Placebo-Controlled Trial, Lior Carmi, Aron Tendler, Alexander Bystritsky, Eric Hollander, Daniel M. Blumberger, Jeff Daskalakis, Herbert Ward, Kyle Lapidus, Wayne Goodman, Leah Casuto, David Feifel, Noam Barnea-Ygael, Yiftach Roth, Abraham Zangen, and Joseph Zohar, American Journal of Psychiatry, 2019, 176:11, 931-938
Prof. Dr. Kemal Arıkan
Psychiatrist