Clinical Report: Efficacy of Non-Navigated Low-Frequency rTMS in OCD

Overview

This systematic review and meta-analysis evaluated the efficacy of low-frequency, non-neuronavigated repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD). Fourteen randomized controlled trials (RCTs) with a total of 460 participants were included. The findings indicate no statistically significant benefit of rTMS over sham stimulation in reducing OCD symptoms as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).

Background

Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition that significantly impacts patients' quality of life. Despite existing treatments, a substantial proportion of patients do not achieve full remission, highlighting the need for alternative therapies. Non-invasive neuromodulation techniques, such as rTMS, are being explored as potential options for treatment-resistant OCD, particularly for the estimated 40% of patients who do not respond adequately to first-line treatments.

Data Highlights

Key Findings

• No statistically significant benefit of low-frequency rTMS over sham for OCD symptom reduction (MD = -0.69, P = 0.21).
• Fourteen RCTs were included in the analysis, with 252 participants receiving active rTMS and 208 receiving sham treatment.
• Moderate heterogeneity was observed, which was reduced by excluding one outlier trial.
• Subgroup analyses by stimulation target, treatment duration, and frequency were non-significant.
• Leave-one-out sensitivity analysis confirmed the robustness of the findings across all trials.

Clinical Implications

The findings suggest that low-frequency, non-neuronavigated rTMS does not provide a significant advantage over sham treatment for OCD. Clinicians should consider these results when discussing treatment options with patients who have not responded to first-line therapies.

Conclusion

The evidence from this systematic review indicates that low-frequency, non-neuronavigated rTMS lacks demonstrated efficacy for OCD symptom reduction. This finding is specific to low-frequency, non-neuronavigated surface-coil protocols.

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