Efficacy of pre-supplementary motor area transcranial direct current stimulation for treatment resistant obsessive compulsive disorder: A randomized, double blinded, sham controlled trial.

Abstract

BACKGROUND:

A significant proportion of obsessive compulsive disorder (OCD) patients do not respond to specific serotonin reuptake inhibitors (SSRIs). There is a need to evaluate novel treatment options for OCD.

OBJECTIVE:

In this double blinded, randomized, sham controlled study, we investigated the efficacy of add-on transcranial direct current stimulation (tDCS) in reducing the symptoms in SSRI-resistant OCD patients by employing anodal pre-supplementary motor area (pre-SMA) stimulation.

METHOD:

Twenty-five patients with DSM-IV OCD having persistent symptoms despite adequate and stable treatment with at least one SSRI were randomly allocated to receive 20 min of verum (active) 2-mA tDCS or sham stimulation twice daily on 5 consecutive days [anode over Pre-SMA; cathode over right supra-orbital area]. Response to treatment was defined as at least 35% reduction in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) total score along with a Clinical Global Impression - Improvement (CGI-I) score of 1 (very much improved) or 2 (much improved).

RESULTS:

The response rate was significantly greater in the verum tDCS(4 out of 12) compared to sham-tDCS (0 out of 13) [Fisher's exact test, p = 0.04]. Repeated measures analysis of variance with tDCS type (verum vs. sham) as between subjects factor showed that there was a significant tDCS-type X time-point interaction with significantly greater reduction of YBOCS total score [F (1,22) = 4.95,p = 0.04,partial-η2 = 0.18] in verum-tDCS group.

CONCLUSIONS:

The results of this RCT suggest that tDCS may be effective in treating SSRI-resistant OCD. Future studies should examine the efficacy in larger samples of OCD and explore other potential target regions using randomized sham-controlled designs, in addition to examining the sustainability of the beneficial effects.

TRIAL REGISTRATION:

Clinical Trials Registry India (http://ctri.nic.in/Clinicaltrials/login.php): Registration Number- CTRI/2016/04/006837).

• Authors: Shayanth M Gowda, Janardhanan C Narayanaswamy, Nandita Hazari, Anushree Bose, Harleen Chhabra, Srinivas Balachander, Binukumar Bhaskarapillai, Venkataram Shivakumar, Ganesan Venkatasubramanian, Y C Janardhan Reddy
• Journal: Brain stimulation (Brain Stimul) 2019 Jul - Aug Vol. 12 Issue 4 Pg. 922-929 ISSN: 1876-4754 [Electronic] United States
• PMID: 30808612 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Double-Blind Method
• Female
• Humans
• Male
• Middle Aged
• Motor Cortex (physiology)
• Obsessive-Compulsive Disorder (physiopathology, psychology, therapy)
• Psychiatric Status Rating Scales
• Transcranial Direct Current Stimulation (methods)
• Treatment Outcome
• Young Adult