Transcranial Magnetic Stimulation in Obsessive Compulsive Disorder: mechanisms and biomarkers.

Description

We are doing a treatment study to examine the use of transcranial magnetic stimulation (TMS) in treating people with OCD and to investigate what areas of the brain are involved during emotional learning. TMS is a noninvasive method in which a magnetic “coil” is placed near an individual’s head and delivers small magnetic pulses into the brain, which produce small electrical currents in the brain, stimulating brain cells that may relieve OCD symptoms. TMS has been FDA approved since 2008 and Health Canada approved since 2002 as a treatment for depression. Our hope is to demonstrate that TMS is a successful treatment option for individuals struggling with OCD symptoms, and to identify the specific areas of the brain that are targeted through TMS.

If you have OCD and are enrolled in this study, you may be randomized (like the flip of a coin) to one of two groups: you will either participate in 6 weeks of daily, active TMS, or partake in 6 weeks of placebo (sham) TMS sessions. During phase I, your participation in this study will last about 8 weeks and you will be asked to make about 36 visits to our clinics at the MGH main campus and the MGH Charlestown Navy Yard campus during the study.

The appointments include:

• A baseline clinical appointment (~3 hours) taking place in the Richard Simches building at MGH main campus near the red line T stop
• A baseline 2-day series of MRIs, typically on Mondays and Tuesdays, but somewhat flexible, occurring at the Charleston Navy Yard campus of MGH
• Daily TMS appointments, Monday through Friday, each lasting about 45 minutes, occurring at the CNY campus
• Bi-weekly clinical assessments occurring over the phone (sometimes) and in-person at the main MGH campus
• Bi-weekly neurophysiologic (measuring changes in how your brain functions) occurring adjacent to TMS appointments at the CNY campus
• 3 more MRI appointments, at the end of week one of treatment (one day) and at the end of treatment (two days, back to back), occurring at CNY
• One in-person 3-month follow up assessment, occurring at the MGH main campus

If your symptoms do not improve after phase 1, you will be invited to participate in phase 2. During phase 2, you would receive 30 active TMS sessions over 6 weeks. There would be several additional MRI scans and clinical assessments, similar to phase 1.

Part of the MRI scanning sessions will include participating in a task that uses mild, half-second electric shocks to your fingers. The electric current will be generated from a 9V battery (e.g., battery in a smoke alarm), and is much less annoying than a static shock. In order to set the level of the current to be used during the study, we will begin at a level below what you will be able to feel, and then increase in gradual steps with your permission. You will be asked to stop the increase at a level of the current that you find highly annoying but not painful. The level of current that you select during this trial procedure, and no higher level, will be used during the study so that you will not receive any painful electric shocks. The purpose of the electric shock is to create a situation in which emotional learning may occur. You will receive no more than twelve of these electric shocks.

For more information, please contact Dylan Abrams at 617-643-4387 or dabrams3@mgh.harvard.edu.

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