Case studyRepetitive transcranial magnetic stimulation of the supplementary motor area in treatment-resistant obsessive-compulsive disorder: An open-label pilot study

•Obsessive-compulsive disorder (OCD) is a distressing disorder and 40-60% of cases remain refractory to treatment.•Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, has been proposed as an alternative treatment.•We assessed the efficacy and safety of 1 Hz rTMS over the supplementary motor area (SMA).•In this present open-label exploratory study, symptoms in treatment-resistant OCD patients significantly decreased after 20 sessions of 1 Hz rTMS over the SMA without cognitive decline or severe adverse effects.

Obsessive-compulsive disorder (OCD) is a severely distressing disorder represented by obsessions and compulsions. A significant proportion of OCD patients fail to improve with conventional treatment methods. Repetitive transcranial magnetic stimulation (rTMS) has been proposed as an alternative for OCD treatment. Functional neuroimaging studies indicate that OCD is associated with increased activity in the supplementary motor area (SMA), a region that plays an important role in the pathophysiology of this disorder. In this study, we assessed the efficacy of augmentation with 1 Hz rTMS over the SMA in treatment-resistant OCD patients. The participants received 1 Hz rTMS over the SMA in 20 daily sessions for 4 weeks. We observed significant reduction in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score at the 4th week of the treatment. Reduction in compulsion contributed to the reduction of global Y-BOCS whereas there was no significant reduction in obsession. Clinical global impression-global improvement also showed significant change at the 2nd and 4th week of the treatment. No additional significant changes or significant adverse effects were seen. These findings suggest that 1 Hz rTMS over the SMA can be an efficient and safe add-on therapeutic method in treatment-resistant patients with OCD. Further controlled studies in larger samples are required to confirm the effect of 1 Hz rTMS over the SMA in OCD.