Tratamento do transtorno obsessivo-compulsivo resistente com estimulação magnética transcraniana de repetição (EMTr): um estudo duplo-cego controlado / Treatment of resistant obsessive-compulsive disorder with repetitive transcranial magnetic stimulation (rTMS): a double-blind, placebo controlled trial

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

Introduction: The present study aims to evaluate the efficacy of added excitatory repetitive transcranial magnetic stimulation (rTMS), applied to the right dorsolateral prefrontal cortex in patients with treatment resistant obsessive-compulsive disorder (OCD). Methods: 30 treatment resistant OCD outpatients were randomized to receive either active or sham rTMS, remaining both patients and rater blind to treatment condition. Baseline treatment was kept stable for at least 8 weeks, and rTMS was performed with a figure-of-eight coil at 10Hz, 110% of motor threshold at 30 daily sessions of 40 trains of 5 seconds with 25 seconds interval. Symptom severity was determined at baseline and after 2 and 6 weeks of treatment and further 2 and 6 weeks of follow-up, using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Clinical Global Impression Scale (CGI), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D17) and SF-36 quality of life inventory. The primary outcome measure was defined as 30% or more improvement in Y-BOCS scores and a much improved or improved score at the CGIimprovement subscale by the end of follow up. Results: The analysis of primary outcome measure revealed that only one patient on each group met response criteria for treatment with rTMS (P=1.00). Repeated-measures analysis of Y-BOCS scores showed a significant effect of time (F=7.33, P=0.002). However, no significant group effect or group by time interaction was observed. Repeated measures analysis of CGI (severity), HAM-D17 and HAM-A also showed a significant effect of time (P<0.001, =0.001 and <0.001 respectively) with no significant group effect or group by time interaction. Conclusion: Excitatory rTMS delivered to the rDLPFC of treatment resistant OCD patients was not different from placebo in reducing obsessive-compulsive symptoms or improving clinical global impression. However, a significant placebo response occurred

ASSUNTO(S)

anxiety disorders/therapy transcranial magnetic stimulation/utilization transtornos de ansiedade/terapia transtorno obsessivo-compulsivo/ terapia estimulação magnética transcraniana/utilização obsessive-compulsive disorder/therapy placebo effect efeito placebo randomized controlled trial ensaio clínico controlado aleatório quality of life qualidade de vida

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