Adjunctive low-frequency repetitive transcranial magnetic stimulation over the right dorsolateral prefrontal cortex in patients with treatment-resistant obsessive?compulsive disorder: A randomized controlled trial
Ho Jun Seo 1, Young-Eun Jung 2, Hyun Kook Lim 1, Yoo-Hyun Um 1, Chang Uk Lee 3, Jeong-Ho Chae 3*
1Department of Psychiatry, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea, 2Department of Psychiatry, School of Medicine, Jeju National University, Jeju, Korea, 3Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Received: August 13, 2015; Revised: September 9, 2015; Accepted: October 1, 2015; Published online: October 1, 2015.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: The present study aimed to evaluate the efficacy of low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over the right dorsolateral prefrontal cortex (DLPFC) for the treatment of obsessive?compulsive disorder (OCD).
Methods: Twenty-seven patients with treatment resistant OCD were randomly assigned to 3 week either active (n=14) or sham (n=13) rTMS. The active rTMS parameters consisted of 1 Hz, 20-minute trains (1,200 pulses/day) at 100% of the resting motor threshold (MT). OCD symptoms, mood, and anxiety were assessed at baseline and every week throughout the treatment period.
Results: A repeated-measures analysis of variance (ANOVA) was used to evaluate changes on the Yale?Brown Obsessive Compulsive Scale (YBOCS). Our results revealed a significant reduction in YBOCS scores in the active group compared with the sham group after 3 weeks. Similarly, a repeated-measures ANOVA revealed significant effect of time and time × group interaction on scores on the Hamilton Depression Rating Scale (HAMD) and the Clinical Global Impression-Severity scale (CGI-S). There were no reports of any serious adverse effects following the active and sham rTMS treatments.
Conclusion: LF rTMS over the right DLPFC appeared to be superior to sham rTMS for relieving OCD symptoms and depression in patients with treatment-resistant OCD. Further trials with larger sample sizes should be conducted to confirm the present findings.
Keywords: Repetitive transcranial magnetic stimulation, obsessive?compulsive disorder, right dorsolateral prefrontal cortex, low frequency


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