The Efficacy and Acceptability of Non-Invasive Brain Stimulation Interventions for Obsessive-Compulsive Disorder Management: A Network Meta-Analysis Based on 24 Stimulation Methods

Introduction: Despite the high lifetime prevalence and elevated disability rates, treatments for obsessive-compulsive disorder (OCD) have limited efficacy. Considering the abnormal connectivity in the cortical-striatal-thalamic-cortical loop circuits in OCD, several randomized controlled trials (RCTs) have addressed the efficacy of different non-invasive brain stimulation (NIBS) modalities for the management of OCD. However, these RCTs yielded inconclusive results. Methods: This network meta-analysis (NMA) included RCTs of NIBS interventions, such as transcranial direct current stimulation (tDCS) and various repetitive transcranial magnetic stimulation (rTMS), in OCD patients. The primary outcomes were changes in the overall severity of OCD and acceptability (i.e., dropout rates). Results: This NMA of 34 eligible RCTs (1089 participants) and 24 different NIBS interventions revealed that three NIBS interventions significantly improved overall OCD severity compared with sham controls, which were high-frequency rTMS over the dorsolateral prefrontal cortex (DLPFC) [mean difference (MD) = −10.81, 95% confidence intervals (95% CIs) = −20.80 to −0.82], high-frequency deep TMS over the dorsal medial prefrontal cortex/anterior cingulate cortex (dmPFC/ACC) (MD = −9.74, 95% CIs = −16.42 to −3.06), and low-frequency rTMS over the right DLPFC (MD = −4.70, 95% CIs = −8.84 to −0.57). Conclusions: This study highlighted that excitatory stimulation over the dmPFC/ACC and bilateral DLPFC, or inhibitory stimulation over the right DLPFC, was associated with significant improvements in overall OCD severity. Further large-scale RCTs with longer follow-up periods are needed to investigate the true impact of NIBS-based intervention to manage OCD. Trial Registration:PROSPERO: CRD42023394953.