Transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder

  • Review
  • Intervention

Authors


Abstract

Background

Transcranial magnetic stimulation (TMS) was introduced as a neurophysiological technique in 1985 when Anthony Barker and his team developed a compact machine that permitted non-invasive stimulation of the cerebral cortex (Barker 1985). Since its introduction, TMS has been used to evaluate the motor system, to study the function of several cerebral regions, and for the pathophysiology of several neuropsychiatric illnesses. In addition, it has been suggested that TMS might have therapeutic potential.

Some controlled studies have evaluated the effects of repetitive TMS (rTMS) in patients with obsessive-compulsive disorder (OCD). Greenberg (Greenberg 1997) observed that a single session of right prefrontal cortex stimulation produced a significant decrease in compulsive urges in OCD patients lasting over eight hours. Other studies have reported transitory improvements in mood but there are no observations for changes in anxiety or obsessions.

Objectives

To develop a systematic review on the clinical efficacy and safety of transcranial magnetic stimulation from randomised controlled trials in the treatment of obsessive-compulsive disorder.

Search methods

An electronic search was performed including the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group trials register (last searched June, 2002), the Cochrane Controlled Trials Register (Issue 2, 2002), MEDLINE (1966-2002), EMBASE (1974-2002), PsycLIT (1980-2002), and bibliographies from reviewed articles.

Selection criteria

Randomised controlled trials assessing the therapeutic efficacy and safety of transcranial magnetic stimulation for obsessive-compulsive disorder.

Data collection and analysis

All reviewers independently extracted the information and verified it by cross-checking. Disagreements were resolved through discussion.

Main results

Three trials were included in the review and only two contained data in a suitable form for quantitative analysis. It was not possible to pool any results for a meta-analysis. No difference was seen between rTMS and sham TMS using the Yale-Brown Obsessive-Compulsive Scale or the Hamilton Depression Rating Scale for all time periods analysed.

Authors' conclusions

There are currently insufficient data from randomised controlled trials to draw any conclusions about the efficacy of transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder.

摘要

背景

穿顱磁刺激治療強迫症

穿顱磁刺激(TMS)是一種神經生理學技術,於1995年由Anthony Barker和其小組研發一精密儀器,以非侵入性方式刺激大腦皮質(Barker 1985). 問世後即用於評估運動系統,研究腦部幾個區域的功能,和研究神經精神疾病的病理生理學. 此外, TMS被認為可能有治療效果,一些對照試驗評估對強迫症,使用重複穿顱磁刺激(rTMS)的療效(Greenberg 1997),觀察到對右前額葉皮質進行一次刺激,可顯著減少強迫症患者的強迫衝動. 其他試驗顯示焦慮或強制行為會有短暫的改善

目標

有系統的回顧隨機對照試驗,研究穿顱磁刺激治療強迫症對臨床療效和安全性

搜尋策略

電子搜尋Cochrane Collaboration Depression, Anxiety and Neurosis Review Group trials register (last searched June, 2002), the Cochrane Controlled Trials Register (Issue 2, 2002), MEDLINE (1966 – 2002), EMBASE (1974 – 2002), PsycLIT (1980 – 2002), 和回顧文章的引用文獻

選擇標準

隨機對照試驗,評估穿顱磁刺激治療強迫症的治療效果和安全性

資料收集與分析

所有研究人員獨立擷取資料,再交互檢查. 不同之處經討論解決

主要結論

3個試驗納入本回顧. 只有兩個的資料可以進行量化分析. 無法將資料統合分析. 任何時間點,重複穿顱磁刺激和偽穿顱磁刺激(sham TMS)兩組的耶?布朗?迫症??量表(YaleBrown Obsessive Compulsive Scale)或漢彌爾頓憂鬱量表評量結果,都沒有差異.

作者結論

目前沒有足夠隨機對照試驗,無法對穿顱磁刺激治療強迫症得到任何結論

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

缺少證據證明穿顱磁刺激治療強迫症的療效. 穿顱磁刺激(TMS)是一種神經生理學技術,於1995年由Anthony Barker和其小組研發一精密儀器,以非侵入性方式刺激大腦皮質(Barker 1985). 此外, TMS被認為可能有治療效果. 它可以非侵入性方式,刺激或阻斷腦區,這是神經學的一大進展. 一些對照試驗評估對強迫症,使用重複穿顱磁刺激的療效,觀察強迫衝動或症狀改善狀況有改變. 本回顧評估現有關於穿顱磁刺激治療強迫症的證據. 缺少證據證明穿顱磁刺激對強迫症的療效

Plain language summary

Transcranial magnetic stimulation (TMS) for the treatment of obsessive compulsive disorder (OCD)

Transcranial magnetic stimulation was introduced as neurophysiological technique in 1985 when Anthony Barker and his team developed a compact machine that permitted a non-invasive stimulation of the cerebral cortex. In addition it has been suggested that TMS could have therapeutic potential. Its' capability for excitation or inhibition of cortical areas in a non-invasive way represents a remarkable advance in neuroscience researches. Some studies have evaluated the therapeutic effects of repetitive TMS in controlled studies on patients with obsessive-compulsive disorder observing some changes in their behaviour in terms of compulsive urges or improvements in mood. This review has evaluated the current evidence for TMS as a therapeutic treatment for obsessive-compulsive disorder (OCD). There is a lack of evidence for the effect of TMS in the treatment of OCD.

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