Low Frequency TMS on DLPFC and OFC in OCD Patients
Condition: Psychiatric Disorder
MeSH terms: Mental Disorders; Problem Behavior
Study type: Interventional

Summary: 
      This study aims to evaluate the therapeutic effect of low frequency rTMS over the right
      DLPFC, versus right OFC versus Sham group of obsessive-compulsive disorder (OCD) patients.
      Sixty patients will be recruited from the out-patient psychiatric clinic of a university
      hospital, and randomized into three equal groups. The 1st group will receive 10 sessions of
      low frequency rTMS targeting right DLPFC by means of a butterfly coil, 120% RMT, 1 Hz, 3
      trains, each of 500 pulses with a 40 seconds inter-train interval allowing the coil to cool.
      The 2nd group will receive 10 sessions of low-frequency rTMS over the right orbitofrontal
      cortex (OFC), the international 10-20 EEG system will be used to position the coil over the
      right OFC, at the right frontopolar 2 (Fp2) electrode site, using the following parameters:
      120% motor threshold, 1 Hz, 3 trains, each of 500 pulses with a 40 seconds inter-train
      interval allowing the coil to cool. The 3rd group will receive sham stimulations with the
      same pulse delivery as the other groups but with the coil placed perpendicular to the scalp.

      The resting motor threshold (RMT) and cortical silent period (CSP) at different intensities
      from 110 % to 150 % will be measured before and after the end of sessions. All assessments
      like (Y-BOCS), (HAM-A), Beck Depression Inventory, (CGI-S), (MoCA) will be performed before
      and after end of the sessions and 3 months later.
    

Detailed description: 
      This study aims to evaluate the therapeutic effect of low frequency rTMS over the right
      DLPFC, versus right OFC versus Sham group of OCD patients. Sixty patients will be recruited
      from the out-patient psychiatric clinic of a university hospital, the patients will be
      randomized into three groups (20 patients for each group) using closed envelopes.

      The first group (20 patients) will receive 10 sessions of low frequency rTMS targeting right
      DLPFC by means of a Butterfly coil, The DLPFC stimulation site was defined as the region 5 cm
      dorsolateral in the same sagittal plane as the optimal site for MT production in the first
      dorsal interosseous, using the following parameters: 120% RMT, 1 Hz, 3 trains, each of 500
      pulses with a 40 seconds inter-train interval allowing the coil to cool.

      The second group (20 patients) will receive 10 sessions of low-frequency rTMS over the right
      orbitofrontal cortex (OFC) by means of a butterfly coil, the international 10-20 EEG system
      will be used to position the coil over the right OFC, at the right frontopolar 2 (Fp2)
      electrode site, using the following parameters: 120% motor threshold, 1 Hz, 3 trains, each of
      500 pulses with a 40 seconds inter-train interval allowing the coil to cool.

      The third group (the sham condition) (20 patients) group will receive sham stimulations with
      the same pulse delivery as the other groups but with the coil placed perpendicular to the
      scalp.

      The resting motor threshold (RMT) and cortical silent period (CSP) at different intensities
      from 110 % to 150 % will be measured before and after the end of sessions. All assessments
      like (Y-BOCS), (HAM-A), Beck Depression Inventory, (CGI-S), (MoCA) will be performed before
      and after end of the sessions and 3 months later.
    

Intervention name(s): Repetitive trans-magnetic stimulation (rTMS) on DLPFC; Repetitive trans-magnetic stimulation (rTMS) on OFC; Sham repetitive trans-magnetic stimulation (rTMS)
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Repetitive trans-magnetic stimulation (rTMS) on DLPFC; Repetitive trans-magnetic stimulation (rTMS) on OFC; Sham repetitive trans-magnetic stimulation (rTMS)
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: OCD, rTMS, right orbitofrontal cortex