{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T12:22:26Z","timestamp":1791375746006,"version":"4.3.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obsessive-compulsive disorder (OCD) imposes a substantial burden on patients and health systems alike: despite established pharmacological and psychological interventions, up to 40% of patients fail to achieve full remission with first-line treatment, driving persistent interest in alternative neuromodulation approaches. Among the neuromodulation strategies under investigation, low-frequency (predominantly 1 Hz), non-neuronavigated repetitive transcranial magnetic stimulation (rTMS) represents a surface-coil protocol class distinct from\u00a0the FDA-cleared deep TMS approach for OCD, yet its effectiveness remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate the pooled effect of low-frequency (predominantly 1 Hz), non-neuronavigated rTMS versus sham stimulation on Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, and to determine whether stimulation target, treatment duration, or frequency systematically moderates that effect within this protocol class.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This PRISMA 2020-compliant systematic review and meta-analysis (PROSPERO: CRD420261302647) searched PubMed, Embase, and Web of Science from inception through May 2025. Eligible studies were sham-controlled RCTs reporting Y-BOCS total scores; risk of bias was assessed using the Cochrane RoB 2.0 tool. The primary outcome was the between-group mean difference (MD) in Y-BOCS scores under a DerSimonian-Laird random-effects model, selected per pre-specified criteria (random effects if I\u00b2 \u226550% or Q-test P \u2264 0.1). Pre-specified subgroup analyses examined stimulation target, treatment duration, and frequency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fourteen RCTs (N = 460; 252 active rTMS, 208 sham or control) were included. The primary pooled analysis yielded a mean difference (MD) in Y-BOCS scores of \u22120.69 (95% CI: \u22121.75 to 0.38; P = 0.21; I\u00b2 = 58%), indicating no statistically significant benefit of rTMS over sham. Moderate heterogeneity was substantially reduced by exclusion of a single outlying trial, without altering the null direction of the estimate. All pre-specified subgroup analyses \u2014 by stimulation target (DLPFC vs. SMA), treatment duration (2\u201312 weeks), and stimulation frequency (1 Hz vs. 10 Hz) \u2014 were non-significant, and leave-one-out sensitivity analysis confirmed robustness across all 14 permutations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pooled evidence from 14 RCTs does not support a statistically significant benefit of low-frequency, non-neuronavigated rTMS over sham for OCD symptom reduction (MD = \u22120.69, 95% CI: \u22121.75 to 0.38; P = 0.21). This finding is specific to low-frequency, non-neuronavigated surface-coil protocols and should not be interpreted as evidence against rTMS efficacy more broadly; approved deep TMS and neuronavigated protocols were outside the scope of this review. These results indicate that this low-frequency, non-navigated protocol class lacks demonstrated efficacy in controlled trials. Whether neuronavigation and cortical field verification can bridge this performance gap requires adequately powered trials designed for direct protocol comparison.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1887581","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:43:59Z","timestamp":1784267039000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of low-frequency, non-navigated repetitive transcranial magnetic stimulation for obsessive-compulsive disorder: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiaojiang","family":"Liu","sequence":"first","affiliation":[{"name":"Neurosurgery, Neurosurgery of Hai'an People\u2019s Hospital","place":["Nantong, 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