Dramatic Response of Resistant Obsessive Compulsive Disorder to Repeated Transcranial Magnetic Stimulation on Right Supplementary Motor Area

Abstract

The response rate to the treatment of obsessive compulsivedisorder (OCD) is 21.6% to 61.3%, which shows a relativeresistance to current treatments and a need for noveltherapeutic approaches. Here we report a case of resistantOCD with fast and dramatic response to a relatively newmethod of repeated transcranial magnetic stimulation. In thismethod a pulse magnetic field emits from a coil over thesurface of the scalp to induce a localized electrical current inthe cortex below. Cortical activity can then be either inhibitedor stimulated. The patient was a 40-year-old woman withsevere OCD who admitted to our psychiatric hospital. She wastreated with 10 sessions of rTMS (110% intensity, 1 Hzfrequency and duration of 30 minutes per day / a total of 1200pulses per day) on right supplementary motor area. Herimprovement evaluated serially with Yale Brown Scale. Bythe end of the 2nd day she reported a major improvement ofsymptoms. Dramatic improvement was observed in herobsessive and compulsive behaviors, and avoidance recoveredcompletely. She also reported significant improvement inability to control obsessive thoughts and impulses, and anxietysymptoms. Since repeated transcranial magnetic stimulation isa low risk method with almost no interaction with the commonmedications, as well as the faster response obtained by usingthis method, it can be used as an add-on treatment in resistantcases of OCD and even in the initial stages of this disorder.

Keywords

• Obsessive compulsive disorder
• transcranial
• magnetic stimulation
• treatment
• motor cortex