Journal of Neural Transmission

, Volume 126, Issue 12, pp 1667–1677 | Cite as

Theta burst stimulation for the treatment of obsessive–compulsive disorder: a pilot study

  • Antonino Naro
  • Luana Billeri
  • Antonino Cannavò
  • Rosaria De Luca
  • Simona Portaro
  • Placido Bramanti
  • Rocco Salvatore CalabròEmail author
Psychiatry and Preclinical Psychiatric Studies - Original Article


A non-negligible part of patients with obsessive–compulsive disorder (OCD) experiences inadequate response to pharmacological and cognitive therapies. Therefore, new approaches are required to overcome this problem. The present pilot study estimates the capacity of theta burst stimulation (TBS) in reducing OCD symptoms, also focusing on the neurophysiological basis of TBS aftereffects. Ten patients with OCD who were unsatisfactorily responsive to the pharmacological and neuropsychological treatment, participated to the present randomized crossover pilot study, in which they were subjected to a real or sham intermittent TBS (iTBS) paradigm over the left dorsolateral prefrontal cortex (L-DLPFC) as add-on treatment. They were randomly assigned to a real or sham iTBS in a 1:1 allocation ratio. Patients received the TBS treatment every morning, 5 days a week for 1 month, and were clinically and electrophysiologically evaluated (EEG phase synchronization and coherence) before, immediately after (T0), and one (T1), three (T3) and six (T6) months after the end of the TBS treatment. Then, each patient was subjected to the alternative treatment (that was not practiced before), and followed up to 6 months. We found that all the patients improved in OCD symptomatology up to T1, while four among them improved up to T3. These patients were those showing a more extensive reshape of frontal areas phase synchronization and frontoparietal coherence compared to the other participants. Our pilot study suggests that iTBS over L-DLPFC may represent a feasible approach to improve OCD symptoms. The efficacy of iTBS seems to depend on the extent of frontal and frontoparietal connectivity modulation.


Obsessive–compulsive disorder Theta burst stimulation Coherence Connectivity Dorsolateral-prefrontal cortex Cortico-striato-thalamo-cortical network 



No funding to be reported.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Data availability

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Antonino Naro
    • 1
  • Luana Billeri
    • 1
  • Antonino Cannavò
    • 1
  • Rosaria De Luca
    • 1
  • Simona Portaro
    • 1
  • Placido Bramanti
    • 1
  • Rocco Salvatore Calabrò
    • 1
    Email author
  1. 1.IRCCS Centro Neurolesi Bonino PulejoMessinaItaly

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