A Case Series on the Effect of Continuous Theta Burst Stimulation over Supplementary Motor Cortex in Obsessive-compulsive Disorder.

Objective: Transcranial magnetic stimulation is an effective treatment modality for obsessive-compulsive disorder (OCD). In this large case series, we attempted to discuss various factors that might have a bearing on therapeutic response in OCD.

Methods: This study included patients with OCD receiving continuous theta burst stimulation over the supplementary motor area attending a tertiary care centre between April and December 2023.

Results: Our study evaluated 11 patients, of which seven showed a significant reduction in their symptoms (based on reduction in Yale-Brown Obsessive-Compulsive Scale score) by more than 35% from the baseline, indicating a positive response to the treatment. We found that patients who received twice-daily sessions had a higher response rate (four out of five patients or 80%). However, four patients reported experiencing a transient headache during the sessions, with two patients being from the twice-daily sessions group and the other two from the once-daily sessions group. In our case series, even patients with early onset, multiple obsessions, treatment resistance, chronic illness, and psychiatric comorbidities responded to add-on continuous theta burst stimulation (cTBS).

Conclusion: cTBS is a potentially promising add-on treatment modality in OCD that warrants further investigation and the presence of predictors of poor response should not discourage its use.