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Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: An Updated Systematic Review and Meta-analysis

Trevizol, Alisson Paulino MD; Shiozawa, Pedro MD, PhD; Cook, Ian A. MD; Sato, Isa Albuquerque MD; Kaku, Caio Barbosa MD; Guimarães, Fernanda BS. MD; Sachdev, Perminder MD, PhD; Sarkhel, Sujit MD; Cordeiro, Quirino MD, PhD

doi: 10.1097/YCT.0000000000000335
Original Studies

Background Transcranial magnetic stimulation (TMS) is a promising noninvasive brain stimulation intervention. Transcranial magnetic stimulation has been proposed for obsessive-compulsive disorder (OCD) with auspicious results.

Objective To assess the efficacy of TMS for OCD in randomized clinical trials (RCTs).

Methods Systematic review using MEDLINE and EMBASE from the first RCT available until March 11, 2016. The main outcome was the Hedges g for continuous scores for Yale-Brown Obsessive Compulsive Scale in a random-effects model. Heterogeneity was evaluated with the I2 and the χ2 test. Publication bias was evaluated using the Begg funnel plot. Metaregression was performed using the random-effects model modified by Knapp and Hartung.

Results We included 15 RCTs (n = 483), most had small-to-modest sample sizes. Comparing active versus sham TMS, active stimulation was significantly superior for OCD symptoms (Hedges g = 0.45; 95% confidence interval, 0.2–0.71). The funnel plot showed that the risk of publication bias was low and between-study heterogeneity was low (I2 = 43%, P = 0.039 for the χ2 test). Metaregression showed no particular influence of any variable on the results.

Conclusions Transcranial magnetic stimulation active was superior to sham stimulation for the amelioration of OCD symptoms. Trials had moderate heterogeneity results, despite different protocols of stimulation used. Further RCTs with larger sample sizes are fundamentally needed to clarify the precise impact of TMS in OCD symptoms.

From the *Interdisciplinary Center for Clinical Neuromodulation, Santa Casa School of Medical Sciences, São Paulo, Brazil; †Neuromodulation Division, Departments of Psychiatry and Bioengineering, University of California, Los Angeles, CA; ‡Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia; and §Institute of Psychiatry, Kolkata, India.

Received for publication March 15, 2016; accepted April 19, 2016.

Reprints: Alisson Trevizol, Department of Psychiatry, Santa Casa Medical School, Rua Major Maragliano, 241, Vila Mariana, ZIP: 0460001, São Paulo, Brazil (e-mail:

The authors have no conflicts of interest or financial disclosures to report.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved