Repetitive Transcranial Magnetic Stimulation in Obsessive Compulsive Disorder

Inclusion Criteria:

• Volunteer subjects with Obsessive Compulsive Disorders (OCD) according to theDiagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) criteria andvalidated by an experimented clinician following instruments like SCID (StructuredClinical Interview for DSM IV) or MINI (Mini-International Neuropsychiatric Interview)

• with or without associated tics ("Gilles de la Tourette" Syndrome)

• Age > 18 years old

• Y-BOCS score > 20 and CGI (Clinical Global Impression Scale) score ≥ 4

• Resistant patients to standard treatments - where treatment resistance is defined bypartial but insufficient response (Global Assessment of Functioning score GAF score < 60 and/or reduction of Yale Brown Obsessions and Compulsion Scale score < 35%) or lackof response to previous well conducted treatment including:

• pharmacotherapy : optimal tolerated dose and adequate duration (> 12 weeks) of atleast 2 Serotonin Reuptake Inhibitors (selective serotonin reuptake inhibitors,clomipramine), and one augmentation strategy (adjunction of an antipsychotic -such as risperidone or olanzapine or aripiprazole - or lithium or buspirone) ;

• psychotherapy (at least 6 months of cognitive and behavioral therapy)

Exclusion Criteria:

• other primary diagnosis than OCD (comorbid tics and depression are tolerated)

• comorbid diagnosis of schizophrenia/ psychotic disorder, bipolar disorder, substanceabuse or dependance

• medical condition involving cognitive decline and affecting brain structures such asParkinson disease, dementia, multiple sclerosis, HIV (human immunodeficiency virus)infection, lupus etc.

• Magnetic Resonance Imaging exclusion criteria (ferromagnetic implants etc)

• common TMS exclusion criteria (neurological condition with an increased risk ofseizure, cardiac pacemakers, implanted medication pumps, intracardiac lines, or acute,unstable cardiac disease, intracranial implants (e.g. cochlear implants, electrodes,aneurysm clips, stimulators... ) or any other metal object within or near the head,excluding the mouth, that cannot be safely removed will be excluded

• Current use of any investigational drug

• pregnancy / breast feeding patients

• visual or auditive important deficit