Personalized Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: Impact of Cognitive Flexibility on Treatment Outcomes

Abstract

This systematic review evaluates the current evidence on the relationship between cognitive flexibility and transcranial magnetic stimulation (TMS) efficacy in Obsessive-compulsive disorder (OCD). Specifically, the potential of cognitive flexibility to serve as a neuropsychological marker capable of predicting treatment response and the potential of personalized TMS protocols developed on this basis to enhance therapeutic efficacy were investigated.A comprehensive search of PubMed, Scopus, and Google Scholar was conducted to identify clinical trials and observational studies examining both cognitive flexibility and response to TMS. Studies utilizing standardized neuropsychological measures such as the Wisconsin Card Sorting Test, Trail Making Test, and Verbal Fluency tasks were included. Results suggest that cognitive flexibility may play a moderating role in treatment outcomes, with about half of the reviewed studies reporting a positive association between higher cognitive flexibility and improved TMS response. Nevertheless, discrepancies across studies—particularly in assessment tools and stimulation protocols—limit the ability to draw firm conclusions. In conclusion, cognitive flexibility appears to be a potentially important factor in enhancing the effectiveness of TMS for OCD.

Keywords

• Obsessive-compulsive disorder
• transcranial magnetic stimulation
• cognitive flexibility
• neuromodulation
• executive function
• personalized treatment.

Obsesif-Kompulsif Bozuklukta Kişiselleştirilmiş Transkraniyal Manyetik Uyarım: Bilişsel Esnekliğin Tedavi Sonuçlarına Etkisi

Öz

Bu sistematik derleme, Obsesif-kompulsif bozukluk (OKB) hastalarında bilişsel esneklik ile ranskraniyal manyetik stimülasyon (TMS) tedavisinin etkinliği arasındaki ilişkiyi incelemektedir. Özellikle bilişsel esnekliğin, tedavi yanıtını öngörebilecek bir nöropsikolojik belirteç olup olamayacağı ve bu temelde geliştirilecek kişiselleştirilmiş TMS protokollerinin terapötik etkinliği artırma potansiyeli araştırılmıştır. PubMed, Scopus ve Google Scholar veri tabanlarında yapılan sistematik tarama ile, OKB’de bilişsel esneklik ve TMS tedavi yanıtını değerlendiren klinik deneyler ve gözlemsel çalışmalar belirlenmiştir. Wisconsin Kart Eşleme Testi, İz Sürme Testi ve Sözel Akıcılık Testi gibi standart nöropsikolojik araçları kullanan çalışmalar incelemeye alınmıştır. Bulgular, incelenen çalışmaların yaklaşık yarısında yüksek bilişsel esneklik düzeylerinin daha iyi TMS yanıtı ile pozitif yönde ilişkili olduğunu göstermektedir. Ancak bazı çalışmalarda bu ilişki doğrulanamamış; bu farklılıklar, kullanılan bilişsel değerlendirme yöntemleri ve TMS protokollerindeki metodolojik çeşitlilikle açıklanabilir. Sonuç olarak, bilişsel esneklik TMS uygulamalarının OKB tedavisinde optimize edilmesinde önemli bir faktör olabilir; ancak bu ilişkinin altında yatan mekanizmalar henüz tam olarak aydınlatılamamıştır.

Anahtar Kelimeler

• *Obsesif-Kompulsif Bozukluk
• Transkraniyal Magnetik Stimülasyon
• Bilişsel Esneklik
• Nöromodülasyon
• Yürütücü İşlev
• Kişiselleştirilmiş Tedavi*

Kaynakça

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