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 ≤ 0.05DLPFC: 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.