Transcranial magnetic stimulation in the treatment of obsessive–compulsive disorder: current perspectives

Ana Lusicic,1 Koen RJ Schruers,2 Stefano Pallanti,3,4 David J Castle5,6 1PACE Clinic, Orygen Youth Health, Melbourne, VIC, Australia; 2Research Institute for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; 3Institute of Neurosciences, Florence, Italy; 4Stanford University, Palo Alto, CA, USA; 5St Vincent’s Hospital, 6University of Melbourne, Melbourne, VIC, Australia Abstract: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neurostimulation technique receiving increasing attention in the treatment of different psychiatric disorders. Evidence for rTMS use in obsessive–compulsive disorder (OCD) is accumulating and informing further developments in the neurostimulation field, the latest being deep transcranial magnetic stimulation (dTMS). dTMS allows direct stimulation of deeper subcortical structures and larger brain volume than conventional rTMS. Underlying neurobiological mechanisms related to transcranial magnetic stimulation are still under evaluation, but appear to offer a novel “third” way of addressing symptoms via localized electrical stimulation compared to pharmacotherapy and psychotherapy approaches. This systematic review focuses on the effects of rTMS and dTMS stimulation on different brain targets in OCD. Brain areas included are the dorsolateral prefrontal cortex, supplementary motor area, orbitofrontal cortex/medial prefrontal cortex, and anterior cingulate cortex (ACC). Improved understanding of the therapeutic effects of rTMS in OCD will support fine-tuning of the method and help determine how we can best optimize the approach via rTMS or dTMS to achieve clinically relevant results. Keywords: repetitive transcranial magnetic stimulation, rTMS, deep TMS, obsessive–compulsive disorder, OCD, noninvasive neurostimulatio