Table 1.
Summary of Open and Controlled Studies of rTMS and its Effects on Anxiety Disorders
| Study OCD | Design | N | rTMS Protocol | Efficacy |
|---|---|---|---|---|
| Greenberg et al. 1998 | Open study 1 session | 12 | PFC-R 20Hz of 80% MT PFC-L 20Hz of 80% MT Occipital 20Hz 80% MT |
Reduction in OCD symptoms only with right-sided treatment.* |
| Sachdev et al. 2001 | Open study 10 sessions (5 days per week for 2 weeks) | 12 | PFC-R 10Hz of 110%MT PFC-L 10Hz of 110% MT |
Both groups showed a significant reduction in OCD symptoms.* However, no significant difference was noted between groups. |
| Alonso et al. 2001 | RCT 18 sessions (3 days per week for 6 weeks) | 18 | DLPFC-R 1Hz of 110% MT Sham-rTMS |
Slight reduction in OCD symptoms in rTMS group.* However, no significant difference was noted between groups. |
| Mantovani et al. 2006 | Open study 10 sessions (5 days per week for 2 weeks) | 10 | SMA-bilaterally 1Hz of 100% MT | Significant reduction in OCD symptoms.* |
| Prasko et al. 2006 | RCT 10 sessions (5 days per week for 2 weeks) | 30 | DLPFC-L 1Hz of 110% MT Sham-rTMS |
Both groups showed a significant reduction in anxiety.* However, no significant difference was found between groups. |
| Sachdev et al. 2007 | RCT 10 sessions (5 days per week for 2 weeks) | 18 | DLPFC-L 10Hz of 110% MT Sham-rTMS |
No significant difference was found between groups. However, after comparison, all subjects received rTMS showed a significant reduction in OCD symptoms. |
| Kang et al. 2009 | RCT 10 sessions (5 days per week for 2 weeks) | 20 | DLPFC-R 1 Hz of 110% MT SMA-bilaterally 1Hz of 100% MT Sham-rTMS |
No significant difference was found on both groups and between groups. |
| Ruffini et al. 2009 | RCT 15 sessions (5 days per week for 3 weeks) | 23 | OFC-L 1Hz of 80% MT Sham-rTMS |
Significant reduction in OCD symptoms in favor of rTMS compared to sham-rTMS.* However, no significant reduction in anxiety and depression symptoms was found between groups. |
| Mantovani et al. 2010 | RCT 20 sessions (5 days per week for 4 weeks) | 18 | SMA-bilaterally 1Hz of 100% MT Sham-rTMS |
Significant reduction in OCD symptoms in favor of rTMS compared to sham-rTMS.* |
| Sarkhel et al. 2010 | RCT 10 sessions (5 days per week for 2 weeks) | 42 | PFC-R 10Hz of 110% MT Sham-rTMS |
Significant reduction in OCD symptoms and a significant improvement in mood in both groups.* However, no significant difference was observed between groups. |
| PTSD | ||||
| Grisaru et al. 1998 | Open study 1 session | 10 | Motor cortex-R of 0.3 Hz of 100% MT Motor cortex-L of 0.3 Hz of 100% MT |
Significant reduction in anxiety, and PTSD symptoms.* |
| Rosenberg et al. 2002 | Open study 10 sessions (5 days per week for 2 weeks) | 12 | DLPFC-L 1Hz of 90% MT DLPFC-L 5 Hz of 90% MT |
Significant improvement of insomnia, hostility and anxiety, but minimal improvements in PTSD symptoms.* However, no significant different was noted between groups. |
| Cohen et al. 2004 | RCT 10 sessions (5 days per week for 2 weeks) | 24 | DLPFC-R 1Hz of 80%MT DLPFC-R 10Hz of 80%MT Sham-rTMS |
Significant improvement of PTSD symptoms and a significant reduction in general anxiety levels in favor of 10Hz-rTMS group when compared to other groups.* |
| Boggio et al. 2010 | RCT 10 sessions (5 days per week for 2 weeks) | 30 | DLPFC-L 20Hz of 80%MT DLPFC-R 20Hz of 80%MT Sham-rTMS |
Significant reduction in PTSD symptoms, anxiety and improvement of mood in favor of rTMS compared to sham-rTMS.* |
| PD | ||||
| Prasko et al. 2007 | RCT 10 sessions (5 days per week for 2 weeks) | 15 | DLPFC-R 1Hz of 110% MT Sham-rTMS | Both groups showed a significant reduction in anxiety symptoms.* However, no significant difference was found between groups for PD symptoms. |
| GAD | ||||
| Bystrisky et al. 2008 | Open study 6 sessions (2 days per week for 3 weeks) | 10 | DLPFC-R 1Hz of 90% MT | Significant reduction in anxiety symptoms.* |
*
Significant level at ≤ 0.05
DLPFC: dorso lateral prefrontal cortex; L: left; GAD: generalized anxiety disorder; MT: motor threshold; OCD: obsessive compulsive disorder; PD: panic disorder; PTSD: posttraumatic stress disorder; R: right; RCT: randomized clinical trial; rTMS: repetitive transcranial magnetic stimulation; SMA: supplementary motor area.