Abstract
BackgroundObsessive–compulsive disorder (OCD) is a complex disorder with 40%–60% of patients' refractory to treatment. Transcranial direct current stimulation (tDCS) has been shown to induce potent and long‐lasting effects on cortical excitability. The aim of the present clinical trial was to evaluate the therapeutic efficacy and tolerability of cathodal tDCS over the supplementary motor area (SMA) in treatment‐resistant OCD patients.MethodsTwenty‐one treatment‐resistant OCD outpatients received 10 sessions of tDCS. Each treatment session consisted of 2 mA stimuli for 30 min. The cathode was positioned over the bilateral SMA and the anode over the right supraorbital area. Patients were evaluated at baseline, end of treatment, one‐month follow‐up, and three‐month follow‐up. Response to treatment was defined as at least a decrease of 35% on the Yale–Brown Obsessive–Compulsive Scale (YBOCS) and a score of 2 or less on the Clinical Global Impressions‐Improvement (CGI‐I) between baseline and 1‐month follow‐up.ResultsThere was a significant decrease of YBOCS scores between baseline and one‐month assessment. At one month, five patients (24%) were considered as responders and 3 (15%) at 3 months. We also observed concomitant changes in depressive symptoms, and insight. The treatment was well tolerated. Short‐lasting side effects were reported as localized tingling sensation and skin redness.ConclusionOur results suggest that the use of cathodal tDCS over the SMA and anodal tDCS over the right supraorbital area in OCD treatment‐refractory patients is safe and promising to improve obsessive and compulsive symptoms. Large randomized controlled trials are needed to confirm this positive result.
Highlights
Obsessive–compulsive disorder (OCD) is a complex disorder with 40%–60% of patients' refractory to treatment
The secondary outcome measures were the change in severity rating score on the Montgomery–Asberg depression rating scale (MADRS), Brown Assessment of Belief Scale (BABS), Clinical Global Impressions-Severity (CGI-S), Clinical Global Impressions-Improvement (CGI-I), Hospital Anxiety and Depression scale (HAD), and SF-36 at 1-month follow-up, and the change in Yale–Brown Obsessive–Compulsive Scale (YBOCS), MADRS, BABS, CGIS, CGI-I, HAD, and SF-36 at 3-month follow-up
Our primary outcome was the score obtained by YBOCS at the 4 assessment times
Summary
We performed a 2-week open label study of tDCS. All patients provided written informed consent after a full description of the study and potential tDCS adverse effects. Each patient received a total of 10 tDCS sessions, which were delivered once a day, 5 days a week, for 2 weeks (from Monday to Friday). During the tDCS session, patients were instructed to relax and stay awake with open eyes. The primary outcome measure was the total YBOCS score. The secondary outcome measures were the change in severity rating score on the MADRS, BABS, CGI-S, CGI-I, HAD, and SF-36 at 1-month follow-up, and the change in YBOCS, MADRS, BABS, CGIS, CGI-I, HAD, and SF-36 at 3-month follow-up
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