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Summary:
Two patient cases illustrate the safety and potential clinical effectiveness of an accelerated deep transcranial magnetic stimulation (dTMS) protocol as an adjunctive approach in treating OCD. In contrast to the conventional once-daily protocol, the accelerated protocol may lead to quicker clinical improvement. However, it remains to be determined whether a higher number of sessions is necessary for a sustained response.
The FDA-approved high-frequency (HF) dTMS protocol for OCD involves 50 trains of 2 seconds at 20Hz, with a 20-second inter-train interval, totaling 2000 pulses per session and taking 18 minutes. We utilized an intermittent theta-burst stimulation (iTBS) protocol with 1200 pulses per session, delivered in only 6 minutes, potentially making it more tolerable.
While the improvement observed was modest, the rapid changes in treatment-refractory patients were encouraging. Nevertheless, one patient relapsed within a few weeks, and the other lacked sufficient follow-up data. Further investigation is needed to assess whether protocol optimization or maintenance sessions are required for sustaining improvement.
In summary, the experiences with these two cases underscore the necessity for more systematic studies to evaluate the efficacy and tolerability of accelerated dTMS in OCD
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