Clinical Research Case Report

Abstract

Objectives: Age-of-onset for Obsessive Compulsive disorderis not a unimodal phenomena. There are two distinguishable groups; early and late onset. Repetitive transcranial magnetic stimulation (rTMS) targeting the supplementary motor area seems to be efficacious for treating OCD, however little information is available about difference in efficacy in these two groups. Treatment of late onset OCD with Low-frequency rTMS has rarely been reported.

Methods: Here we report a case of 44 years old male with OC symptoms since last 4 years. The patient was treated with anti obsessional drugs in last 2 years with partial improvement but developed prominent side effects as constipation and postural hypotension which were tried to be managed but patient became non compliant to medication. From last year patient developed motor tics and phonic tic. The patient was tried on low dose antipsychotics with no improvement in either OC symptoms or Tics and had developed sedation as side effect. Secondary causes of OCD and Tic disorder was ruled out. It was decided to give a trial of rTMS. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 28/40 and Yale
Global Tic Severity Score (YGTSS) was 42/100. The protocol designed was 1Hz, 110%MT, 900 pulses/session, total 20 sessions over 4 weeks to be given B/L over supplementary motor area.

Results: The patient reported improvement in both OC symptoms and decrease in TICS within a week of therapy and by the end of 20 sessions, YBOCS score was 14/40 and YGTSS score was 16/100. The patient was further followed up for another 3 months in which he maintained the improvement with addition of Fluoxetine. Low frequency rTMS normalize overactive motor cortical regions and thereby improve symptoms.

Conclusion: Low-frequency rTMS over the SMA appears to be effective treatment modality in late onset Obsessive compulsive disorder.