Transcranial magnetic stimulation as a novel approach to effectively treat musical obsession (stuck song syndrome): a case series and a systematic review of case reports.

This is the first case series that demonstrates the use of transcranial magnetic stimulation (TMS) for the treatment of musical obsessions or stuck song syndrome (SSS), following a systematic review that identified existing treatments. SSS can occur independently, but in literature it is commonly reported as an obsessive-compulsive disorder (OCD) or major depressive disorder (MDD) symptom. Most people are familiar with earworms, experienced by up to 98% of the western population. Earworms can become severe leading to the SSS diagnosis. SSS is a distressing repetition of involuntary tunes persisting in one's mind. According to literature, SSS has often been treated using antidepressants which are used to treat MDD and OCD. As TMS has shown a positive therapeutic effect for psychiatric disorders particularly MDD and OCD, we hypothesized that TMS could be an effective treatment that reduces symptoms of patients with SSS. We present two cases of TMS treatment contributing to a reduction in symptoms of SSS. We also aim to provide a systematic review of cases where SSS has been described and compare the pharmacological or psychotherapeutic treatments used with our novel TMS interventions for SSS. This report highlights some limitations, including patient's psychiatric comorbidities and treatment protocol changes, which affect the findings generalizability. Despite these limitations, TMS appears promising as a treatment for SSS due to the observed effectiveness in reducing SSS symptoms and minimal side effects especially in medication-resistant cases.