EPP368
Deep transcranial magnetic stimulation in the treatment of OCD: Comparison of treatment with Double-Cone and H7 coil
M. Jakubec 1 2,*, O. Laskov 1, N.-A. Böhmová 1 2, N. Biačková 1 2, A. Čechová 1 2, T. Novák 1 2, M. Klírová 1 2
1Non-Invasive Brain Stimulation Working Group, National Institute of Mental Health, Klecany, 2Third Faculty of Medicine, Charles University, Prague, Czech Republic
Introduction: Obsessive–compulsive disorder (OCD) is a chronic neuropsychiatric illness characterized by intrusive thoughts (obsessions) and repetitive acts (compulsions). Hyperactivity within the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC), structures in the cortico-striato-thalamo-cortical (CSTC) loop that affect inhibitory control, has been implicated in its pathophysiology (Zhang et al. Front Psychiatry 2019; 10 522). Deep transcranial magnetic stimulation (dTMS) is a modern variation on non-invasive brain-stimulation (NIBS) that, unlike other NIBS approaches, targets deeper cortical structures to alleviate OCD symptomatology (Laskov & Klírová Neurosci Lett 2021; 755 135906). Its efficacy has been proven in several RCTs and meta-analyses (Trevizol et al. J ECT 2016; 32 262-266; Cruz et al. Psychiatry Res 2022; 317 114869; Carmi et al. Am J Psychiatry 2019; 176 931-938).
Objectives: Two dTMS coils cleared by the US FDA for OCD are available – The BrainsWay H7 coil and the MagVenture Cool D-B80 Double-Cone coil. The Double-Cone coil, approved in 2020 for adjunctive treatment, is electromagnetically less potent in OCD-associated brain structures stimulation than H7 (Tzirini et al. PLoS One 2022; 17 e0263145). We compared the clinical performance of these two coils in a preliminary analysis of an ongoing randomised, sham (placebo)-controlled study designed to identify neurobiological predictors of dTMS response.
Methods: Twenty DSM-5-diagnosed OCD patients underwent six weeks of dTMS. Ten received the Double-Cone stimulation [active n = 8, sham n = 2] and ten the H7 stimulation [active n = 8, sham n = 2] (Figure 1). Treatment response was defined as ≥ 35% reduction on the Yale–Brown Obsessive Compulsive Scale (Y-BOCS).
Results: The highest responder rate occurred with active H7 stimulation (4/8; 50%), followed by active Double-Cone stimulation (1/8; 12.5%); no sham-treated patient responded (Figure 2). χ² tests showed no significant differences between coils (χ² = 2.50, p = 0.114) or between active and sham stimulation (χ² = 2.78, p = 0.095). Mean reduction in Y-BOCS (indicates improvement) was greatest in H7-active (19.5%), followed by H7-sham (16.2%), Double-Cone-sham (12.2%), and Double-Cone-active (4.7%). Figure 3 shows boxplots of percentage Y-BOCS reduction by study group. Logistic regression identified shorter OCD duration as a significant predictor of response (B = −0.12, p = 0.048). Younger age also favoured response (p = 0.071). Although type of stimulation and coil both favoured the H7 coil, these effects did not reach significance (p = 0.086 and p = 0.059, respectively).
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Conclusions: Although the difference between the coils didn't reach significance, owing to the small sample size, our data suggest that the H7 coil may be more effective than the Double-Cone coil for OCD, and that shorter illness duration is associated with a higher likelihood of response.
Disclosure of Interest: M. Jakubec: None Declared, O. Laskov: None Declared, N.-A. Böhmová: None Declared, N. Biačková: None Declared, A. Čechová: None Declared, T. Novák: None Declared, M. Klírová Grant / Research support from: Received honoraria in the form of travel reimbursement from Brainsway Inc. (Israel) and consulting fees from BTL Industries JSC (Czechia) and Deymed (Czechia).