The effectiveness of transcranial magnetic stimulation in treating persons with OCD

Abstract

Background: The purpose of this study is to determine the effectiveness of transcranial magnetic stimulation (TMS) in treating persons with OCD. Hence, this evidence-based dissertation analysed the research question “Is Transcranial Magnetic Stimulation effective in treating Obsessive-Compulsive Disorder (OCD)? of which the PICO elements were P-Individuals suffering from OCD, I- TMS, C- sham TMS, O- Response or remission of OCD. Methods: The key terms of the PICO question were used to extrapolate alternative key words. These key elements along with strict inclusion and exclusion criteria were used to carry out an advanced literature search. The articles chosen were written in English, peer-reviewed, full text and published within the past decade. The selected articles’ sample population were all adults and examined the effectiveness of TMS for OCD. Studies focusing on other mental illnesses, genetic studies, other modalities of treatment and which did not compare active TMS vs sham TMS in relation to OCD were excluded. Ten key databases pertinent to the health sciences were chosen using EBSCO host. These included AgeLine, Academic Search Ultimate, CINAHL Complete, Cochrane Central Register of Controlled Trials, Cochrane Clinical Answers, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Library, Information Science & Technology Abstracts, MEDLINE Complete, and PsycINFO. A further search was carried out through Scopus and MEDLINE (ProQuest) so as to have a more comprehensive search. The literature search resulted in fourteen salient studies, three Meta-Analyses (MAs) and eleven Randomised-Controlled Trials (RCTs). The AMSTAR 2 and the Critical Appraisal Skills Programme (CASP) tool were used for the appraisal of the MAs and the RCTs respectively. Results: There is a body of evidence to be able to answer the PICO question of whether TMS is an effective treatment for OCD or not. There is encouraging evidence that dTMS to the dmPFC and ACC using the H coil. Furthermore, LF TMS to the OFC, SMA and RDLPFC using the figure-of-eight coil can yield positive outcomes in inducing response, at least in the short term (3 months). Implications and Recommendations: More local and foreign research addressing heterogeneity, devising fine-tuned protocols and improved methodology will elucidate or replicate these outcomes. Additionally, further education to professionals and the public alike are required to dispel myths and better comprehend TMS as an evolving adjunct to treat OCD.