CaltechAUTHORS
Published November 2024 | Version Published
Journal Article Metadata-only

Safety and efficacy of targeting the supplementary motor area with double-cone deep transcranial magnetic stimulation vs figure-eight coil in treatment of obsessive-compulsive disorder with comorbid major depressive disorder

Creators

  • 1. ROR icon University of California, Los Angeles
  • 2. ROR icon California Institute of Technology

Abstract

Background and objective:

The Supplementary Motor Area (SMA), a relatively large brain structure predominantly located along the interhemispheric fissure, is an established target for repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Obsessive-Compulsive Disorder (OCD). We investigated the feasibility, safety, and efficacy of targeting SMA using a double-cone “deep” TMS coil compared to conventional figure-eight coil for treatment of OCD with comorbid Major Depressive Disorder (MDD).

Methods:

Sixty-two patients with treatment-resistant OCD and comorbid MDD participated in the study. All patients received high-frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC) with a figure-eight coil (MagVenture B70), followed by 1 Hz rTMS over the bilateral SMA using either the B70 (N = 25) or double-cone deep coil (MagVenture DB80) (n = 23) for 36 treatment sessions. Weekly clinical assessments were conducted.

Results:

Subjects overall had significant reductions in OCD and depressive symptom severity at the primary endpoint. Subjects stimulated at SMA with the double-cone deep coil had statistically significantly lesser reductions in overall OCD and depression symptom severity compared to the figure-eight group. The intensity of stimulation at SMA was significantly greater with the double-cone deep than figure-eight coil and e-field modeling showed that it affected broader regions beyond SMA (off-target stimulation). There was no significant difference in reported tolerability between groups.

Conclusions:

SMA stimulation using either a double-cone deep or conventional figure-of-eight coil was safe and was associated with a significant reduction in comorbid OCD and depression symptoms, but the higher intensities of stimulation with the double-cone deep coil used in this study were significantly less clinically beneficial than figure-eight coil stimulation.

Copyright and License

© 2024 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Acknowledgement

We thank the Ryan Family for their generous support of innovative approaches to depression treatment and groundbreaking TMS technology.

Contributions

Reza Tadayonnejad: Writing – review & editing, Writing – original draft, Formal analysis, Data curation, Conceptualization. Juliana Corlier: Writing – original draft, Formal analysis, Conceptualization. Thomas E. Valles: Writing – original draft, Formal analysis, Data curation. Cole Citrenbaum: Formal analysis, Data curation. Cole Matthews: Data curation. Evan Einstein: Data curation. Scott A. Wilke: Data curation. Aaron Slan: Data curation. Margaret G. Distler: Data curation. Gil Hoftman: Writing – review & editing, Data curation. Adesewa E. Adelekun: Data curation. Hanadi A. Oughli: Data curation. Michael K. Leuchter: Data curation. Hewa Artin: Data curation. Ralph J. Koek: Data curation. Nathaniel D. Ginder: Data curation. David Krantz: Data curation. Thomas Strouse: Data curation. Andrew F. Leuchter: Writing – review & editing, Writing – original draft, Formal analysis, Conceptualization.

Conflict of Interest

Dr. Leuchter discloses that within the past 36 months, he has received research support from the National Institute of Health, MagVenture, BrainsWay, Abbott, and Neuroptics, Inc. He has served as a consultant to iFovea and Options MD. He was Chief Scientific Officer of Brain Biomarker Analytics LLC (BBA) and had an equity interest in BBA. Other authors declare no conflict of interest.

Additional details

Dates

Accepted
2024-09-20
Accepted
Available
2024-09-21
Available Online
Available
2024-09-28
Version or Record Published

Caltech Custom Metadata

Publication Status
Published