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

Shayanth M Gowda; Janardhanan C Narayanaswamy; Nandita Hazari; Anushree Bose; Harleen Chhabra; Srinivas Balachander; Binukumar Bhaskarapillai; Venkataram Shivakumar; Ganesan Venkatasubramanian; Y C Janardhan Reddy

doi:10.1016/j.brs.2019.02.005

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

Brain Stimul. 2019 Jul-Aug;12(4):922-929. doi: 10.1016/j.brs.2019.02.005. Epub 2019 Feb 13.

Affiliations

¹ Obsessive Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India.
² Obsessive Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India; Translational Psychiatry Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India. Electronic address: [email protected].
³ Translational Psychiatry Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India.
⁴ Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India.
⁵ Obsessive Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India; Translational Psychiatry Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India.

PMID: 30808612
DOI: 10.1016/j.brs.2019.02.005

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).

Keywords: Neuromodulation; Obsessive compulsive disorder; Pre-supplementary motor area; Transcranial direct current stimulation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

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

Associated data

CTRI/CTRI/2016/04/006837