From resistance to response: Repetitive transcranial magnetic stimulus in obsessive-compulsive disorder – A case series

ABSTRACT Background: Obsessive-compulsive disorder (OCD) is a chronic and debilitating mental health condition that affects approximately 1%–3% of the population, leading to significant impairment in quality of life and daily functioning. While first-line treatments, such as selective serotonin reuptake inhibitors and cognitive-behavioral therapy, are effective for many, a substantial proportion of patients fail to achieve adequate relief, resulting in the classification of treatment-resistant OCD (TR-OCD). Aims: This study aims to evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) targeting the dorsolateral prefrontal cortex (DLPFC) as an adjunctive treatment for patients diagnosed with TR-OCD. Subjects and Methods: A total of 14 patients diagnosed with TR-OCD were recruited for this case series study. Each participant underwent high-frequency rTMS over 10 sessions, with a frequency of 10 Hz and an intensity of 100%–120% of the resting motor threshold. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to assess changes in symptom severity before and after treatment. Results: Y-BOCS scores showed significant reductions posttreatment, with individual score reductions ranging from 20% to 60%. The mean score decreased from 31 to 11, and 10 out of 14 patients demonstrated a ≥30% reduction, indicating a clinically meaningful response. The intervention was well tolerated, with no major adverse effects reported. Conclusion: rTMS targeting the DLPFC shows promise as a noninvasive neuromodulation technique for TR-OCD, demonstrating efficacy in symptom reduction and a favorable safety profile. Further research should refine treatment parameters, explore predictors of response, and assess long-term outcomes. Larger randomized controlled trials are necessary to confirm these findings and establish the standardized clinical protocols.