Kar SK, Kumari B, Joseph R, Chatterjee S, Joshi M, Agrawal A. Role of transcranial magnetic stimulation in the management of trichotillomania: A systematic review. World J Meta-Anal 2025; 13(1): 98933 [DOI: 10.13105/wjma.v13.i1.98933]
Corresponding Author of This Article
Sujita Kumar Kar, MD, Additional Professor, Department of Psychiatry, King George's Medical University, Shahmina Road, Lucknow 226003, Uttar Pradesh, India. drsujita@gmail.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sujita Kumar Kar, Babli Kumari, Mohita Joshi, Department of Psychiatry, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
Rini Joseph, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
Surobhi Chatterjee, Department of Psychiatry, All India Institute of Medical Sciences, Mangalagiri 522503, Andhra Pradesh, India
Aditya Agrawal, Department of Psychiatry, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow 226010, Uttar Pradesh, India
Author contributions: Kar SK was responsible for conceptualization; Kar SK and Kumari B were responsible for manuscript writing; Kar SK, Joshi M, and Agrawal A were responsible for the literature search; Kumari B was responsible for tabulation and data extraction; Joseph R and Chatterjee S were responsible for risk of bias assessment; Kar SK, Kumari B, Joseph R, Chatterjee S, Joshi M, and Agrawal A were responsible for revision and editing of the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sujita Kumar Kar, MD, Additional Professor, Department of Psychiatry, King George's Medical University, Shahmina Road, Lucknow 226003, Uttar Pradesh, India. drsujita@gmail.com
Received: July 9, 2024 Revised: October 16, 2024 Accepted: December 12, 2024 Published online: March 18, 2025 Processing time: 247 Days and 17.2 Hours
Abstract
BACKGROUND
Trichotillomania is a challenging to treat psychiatric disorder, with limited evidence for pharmacotherapy. Treatment typically involves medication, cognitive behavioral therapy, and behavioral interventions. Recently, transcranial magnetic stimulation (TMS) has emerged as a potential treatment strategy.
AIM
To assess the role of TMS in treating trichotillomania.
METHODS
A systematic search using specific terms was done in PubMed and Scopus databases for articles published until May 17, 2024, related to trichotillomania and TMS. The search included randomized controlled trials, open-label studies, case series, case reports, and retrospective chart reviews, following the Preferred Items for Systematic Reviews and Meta-Analysis guideline.
RESULTS
We identified 32 articles (6 in PubMed and 26 in Scopus). After removing duplicates and articles that did not meet the selection criteria, we conducted a final analysis of four articles. These included one retrospective study, two case series, and one case study, with a total of 22 patients diagnosed with trichotillomania enrolled across all four studies. The brain areas targeted were the supplementary motor area (SMA), pre-SMA, and left dorsolateral prefrontal cortex. The studies reported an improvement in the severity of symptoms of trichotillomania in the majority of patients with negligible side effects. Nevertheless, it is important to note that the existing studies are mostly of low to moderate quality.
CONCLUSION
Early evidence suggests repetitive TMS and accelerated continuous theta burst stimulation can help treat trichotillomania adjunctively to other treatments.
Core Tip: Transcranial magnetic stimulation (TMS) can be a viable treatment option in the management of trichotillomania. The brain areas targeted are supplementary motor area (SMA), pre-SMA, and left dorsolateral prefrontal cortex. TMS is well tolerated with negligible side effects. Maintenance TMS treatment facilitates sustained improvement of symptoms of trichotillomania.
