Obsessive-Compulsive DisorderON-TARGETNCT06490965
Improving Obsessive-compulsive Disorder Treatments: From Lesions to Neuromodulation Targets
A study testing Repetitive Transcranial Magnetic Stimulation, Neuronavigation and Magnetic Resonance Imaging in people with Obsessive-Compulsive Disorder, run by Fundacao Champalimaud at 1 site in Portugal.
Trial summary
While in most cases of obsessive-compulsive disorder (OCD) a cause cannot be identified, this syndrome may develop as a consequence of focal brain lesions. Neuropsychiatric disorders secondary to brain insults are open windows to understand their underlying neurobiology. Read more about this study
- Who is it for?
- Ages 18 to 75 years
- Conditions the study is for
- Obsessive-Compulsive Disorder
- What is being tested?
- Repetitive Transcranial Magnetic Stimulation, Neuronavigation and Magnetic Resonance Imaging
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 32 participants
- Where
- 1 sitePortugal
- Study dates
- 7 Nov 2024to 31 Dec 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 75 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age between 18 and 75 years;
- Established diagnosis of Obsessive-Compulsive Disorder according to Diagnostic and statistical manual of mental disorders 5 (DSM5) criteria;
- Capacity to give consent;
- Fluent in Portuguese and/or English;
- If potential for pregnancy, agrees to use an effective method of contraception throughout the study period.
Who cannot join
- Obsessive-compulsive symptoms severity assessed at baseline visit with the instrument Yale-Brown Obsessive Compulsive Scale - II (YBOCS-II) ≤ 24;
- Presence of uncontrolled active medical illness;
- Known structural lesion of the central nervous system;
- Electric or metallic implants in the body not compatible with electromagnetic radiation;
- Electric or metallic brain implants;
- Cardiac implants;
Show all 16Show fewer
- Epilepsy;
- Pregnant, breastfeeding, or planning pregnancy women;
- Alcohol or substance abuse and/or dependence;
- Major Neurocognitive Disorder;
- Developmental disorders with low intelligence quotient or any other form of cognitive deficit;
- Active neurological disease;
- Individuals presenting with any psychotic or mood disorder requiring hospitalization at the time of eligibility criteria assessment;
- Contraindication for performing MRI;
- Individuals who have already been treated for OCD with TMS;
- Any other reason that renders the individual unable to provide informed consent.
Trial locations and contacts
1 site in 1 country.
About this study
While in most cases of obsessive-compulsive disorder (OCD) a cause cannot be identified, this syndrome may develop as a consequence of focal brain lesions. Neuropsychiatric disorders secondary to brain insults are open windows to understand their underlying neurobiology. Different neuroimaging analysis methods, including pooled lesion topography and lesion network mapping, can be used to study lesional neuropsychiatric syndromes, including OCD. If successful, these strategies can also reveal new neuromodulation treatment targets, including for transcranial magnetic stimulation (TMS). Indeed, TMS targets to treat depression evolved from evidence extracted from lesional studies that were then refined and validated. For OCD treatment with TMS, already approved by the FDA and European Commission, targets were defined using a distinct approach, not involving causal brain lesions, which may contribute to lower than desirable remission rates. Lesional OCD is characterized by specific dysfunctional brain circuits. These circuits may be effectively targeted by TMS, which may optimize treatment of OCD. To address these hypotheses, we will test the therapeutic benefits of optimizing brain targets for the currently used TMS treatment of OCD, using information from the lesional-OCD brain network namely refining the target in the medial orbitofrontal cortex, bilaterally. Specifically, we will conduct a randomized clinical interventional study, using TMS to treat patients with OCD with inadequate response to other treatments, comparing, within the approved protocol for OCD treatment, the most frequently used stimulation site with a new target, adjusted according to the connectivity of lesions associated with the occurrence of OCD. If successful, our results may have immediate clinical implications in OCD treatment, as it will contribute to refine current therapeutic TMS strategies for OCD and defining new clinical research strategies in this domain.
Read the detailed description
In this study, we hypothesize that the cortical region identified from connectivity networks associated with lesional OCD may be a more effective TMS stimulation site than the one currently used in OCD treatment. Thus, we intend to compare the efficacy of the TMS protocol as approved for OCD, between its application at the currently used stimulation site (bilateral dorsomedial prefrontal cortex) and its application at an adjusted stimulation site, according to the more specific cortical areas of dysfunctional circuits associated with lesional OCD, namely the bilateral medial orbitofrontal cortex (OFC) region.
The participants in this study will be recruited at the Champalimaud Foundation. The physicians on the research team will identify patients who are being treated for OCD in the Neuropsychiatry Unit, or who are referred to the unit for this purpose. In this study, we aim to prospectively recruit 32 individuals according to the eligibility criteria specified in the respective section.
We propose to conduct a randomized, double-blinded interventional study, open only to the technician administering the treatment. After agreeing to participate in the study, the participant will be invited to attend the first study visit. There, participants will be assigned a unique identification number to maintain their anonymity in the study. Then, a qualified team member will ask the participant to complete the sociodemographic and clinical questionnaire to confirm the conditions for TMS and MRI, including an appropriate screening tool for the occurrence of seizures and/or epilepsy. The Mini International Neuropsychiatric Interview (MINI) and he Structured Clinical Interview for Diagnostic and statistical manual of mental disorders (SCID) will serve the purpose of verifying the eligibility criteria of the study participant, including confirmation of the OCD diagnosis, using SCID. After confirming their eligibility, the participant will be invited to complete the remaining psychometric assessment, which will reflect the baseline values of each instrument. The following will be assessed: YBOCS-II (primary outcome), BDI-II, OCI-R, STAI, World Health Organization Five Well-Being Index (WHO-5), and YMRS (secondary outcomes), and Edinburgh Handedness Inventory (EHI).
In this study, to ensure that the TMS target site used is precisely located, we will use neuronavigation in each TMS session performed. Thus, in the next step of the first visit, the participant will be invited to undergo an MRI scan. This procedure cannot be waived, as without the MRI scan of each individual, the appropriate use of neuronavigation is compromised. If the participant cannot or does not want to undergo this procedure, they will be excluded from the study. The MRI protocol will include the collection of structural and functional neuroimaging data. The duration of this neuroimaging exam will be approximately 20-30 minutes.
After completing this step, the participant will be randomized to one of the two study arms. Please see details of each study arm in the respective section. The first visit of the TMS treatment cycle will be scheduled later. During this first visit of the TMS treatment cycle, the motor hotspot and the motor excitability threshold will be determined, which will be subsequently used to define the appropriate treatment intensity for each individual. Finally, the stimulation site will be determined using the neuronavigation system utilizing each individual's MRI scan. It is emphasized that the stimulation site will be mandatory determined at all TMS treatment visits. The TMS protocol will then commence, characterized by 20 Hz frequency irrespective of study arm. At the beginning of each TMS treatment cycle visit, the presence of potential side effects since the last TMS session will be screened. Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits), the following psychometric scales will be repeated at the beginning of each visit: BDI-II, WHO-5, OCI-R, and YMRS (secondary outcomes). Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits), the motor hotspot and the motor excitability threshold will be redefined, and consequently, the treatment stimulation intensity will be adjusted. At the end of each TMS treatment cycle visit, the next visit will be scheduled to occur on a daily basis, on business days, for a total of 30 visits. After the end of the TMS treatment cycle, the last study visit will be scheduled (primary endpoint, end-of-study visit), which should preferably occur between 2-3 weeks after the 30th TMS treatment cycle visit. During this visit, the YBOCS-II (primary outcome) will be applied. Participants will also be invited to undergo a new MRI scan, with the same characteristics as identified above.
Clinical efficacy will be assessed by changes in the severity of OCD symptoms compared to baseline, evaluated (using YBOCS-II; primary outcome) after 30 daily sessions of TMS, comparing the two study arms.
- Conditions
- Obsessive-Compulsive Disorder
- Being tested
- Repetitive Transcranial Magnetic Stimulation, Neuronavigation, Magnetic Resonance Imaging
- Keywords
- OCD
- Medical subject headings
- Obsessive-Compulsive Disorder
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Repetitive Transcranial Magnetic StimulationOther
Also called rTMS, TMS, Non Invasive Brain Stimulation
Transcranial Magnetic Stimulation (TMS) involves generating a magnetic field with specific spatial and temporal properties, allowing the induction of electric current in conductive material near this field. The electro-physiological principle of TMS is based on placing a coil over the skull that will induce a magnetic field generating action potentials in neuronal tissue in response to each TMS pulse. The repetitive application of TMS pulses (rTMS) allows for the modulation of neuronal excitability for a period after rTMS, ranging from inhibition, in the case of low frequencies (~1 Hz), or facilitation if high frequencies (equal to or greater than 5 Hz) are used.
NeuronavigationOther
Neuronavigation is a non-invasive method that allows the creation of computerized three-dimensional models of brain structures based on neuroimaging exams of each individual (e.g., cranial magnetic resonance imaging). As such, this method has been used for various purposes, such as assisting in neurosurgery or mapping functional regions of the brain, but also in the context of TMS (Transcranial Magnetic Stimulation). In this latter area, its use as support for TMS has been employed for therapeutic, diagnostic, and research purposes. The neuronavigation system consists of several components, namely a locating camera, locators for the TMS coil, an adjustable headband with locators, a calibration system for these elements, and the neuronavigation software, which is installed on a supporting computer.
Magnetic Resonance ImagingOther
Also called MRI
Magnetic Resonance Imaging (MRI) is a non-invasive medical imaging technique that generates detailed images of the internal structures of the body using a strong magnetic field and radio waves. It provides high-resolution images of soft tissues, such as organs, muscles, and the brain, helping doctors diagnose and monitor various conditions, including injuries, tumors, and neurological disorders. MRI is particularly useful because it does not involve ionizing radiation, making it safer for patients than other imaging methods like X-rays or CT scans.
| Study group | Role | What they receive |
|---|---|---|
| Arm A | Active comparator | Standard of care rTMS protocol, i.e., daily frequency of repetitive excitatory TMS at 20 Hz of the medial prefrontal cortex - approximate duration of each session between 40-60 minutes. Receives: Other: Repetitive Transcranial Magnetic Stimulation; Other: Neuronavigation; Other: Magnetic Resonance Imaging |
| Arm B | Experimental | Standard of care rTMS protocol, i.e., daily frequency of repetitive excitatory TMS at 20 Hz with adjustment of the stimulation site to primarily target the bilateral medial orbitofrontal cortex. Receives: Other: Repetitive Transcranial Magnetic Stimulation; Other: Neuronavigation; Other: Magnetic Resonance Imaging |
What is being measured
The primary outcome is the main question the study is designed to answer.
Yale-Brown Obsessive Compulsive Scale - II (YBOCS-II)
Assessment instrument for the severity of OCD symptoms; scores can range from 0-50; higher scores mean worse outcome.
Measured: Before and after TMS treatment cycle. The latter will be considered the primary endpoint (end-of-study visit) and will occur preferably between 2-3 weeks after last TMS session.
Secondary outcomes (5)
State Trait Anxiety Inventory (STAI)
Self-report instrument that measures anxiety in the dimensions of state anxiety and trait anxiety that often occur in comorbidity with OCD symptoms; scores for both state anxiety and trait anxiety can range from 20-80; higher scores mean worse outcome for both state anxiety and trait anxiety.
Measured: Before and after TMS treatment cycle. The latter will be considered the primary endpoint (end-of-study visit) and will occur preferably between 2-3 weeks after last TMS session.
Beck Depression Inventory II (BDI-II)
Self-report scale that measures the severity of depressive symptoms often occurring in comorbidity with OCD symptoms; scores can range from 0-63; higher scores mean worse outcome.
Measured: Before TMS treatment cycle. Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits). After TMS treatment cycle, i.e., 2-3 weeks after last TMS session.
Obsessive-Compulsive Inventory - Revised (OCI-R)
Self-report scale that allows the assessment of dimensions present in OCD; scores can range from 0-72; higher scores mean worse outcome.
Measured: Before TMS treatment cycle. Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits). After TMS treatment cycle, i.e., 2-3 weeks after last TMS session.
Young Mania Rating Scale (YMRS)
Assessment instrument for the severity of manic symptoms, a possible neuropsychiatric adverse effect of TMS; scores can range from 0-60; higher scores mean worse outcome.
Measured: Before TMS treatment cycle. Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits). After TMS treatment cycle, i.e., 2-3 weeks after last TMS session.
World Health Organization Five Well-Being Index (WHO-5)
Self-report scale that measures subjective quality of life based on mood, vitality, and interest in things in general; scores can range from 0-25; higher scores mean better outcome.
Measured: Before TMS treatment cycle. Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits). After TMS treatment cycle, i.e., 2-3 weeks after last TMS session.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Jul 2024
- Study start7 Nov 2024
- Primary completion31 Dec 2026 (estimated)
- Study completion31 Dec 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (44)Papers the sponsor has linked to this study.
- Other trials for Obsessive-Compulsive DisorderStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 32 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Fundacao Champalimaud
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Gonçalo Cotovio, MD, PhD, Principal investigator, Champalimaud FoundationAlbino J. Oliveira-Maia, MD, MPH, PhD, Principal investigator, Champalimaud Foundation
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06490965
- Sponsor's protocol ID
- ON-TARGET
- Other IDs
- 31379
- Acronym
- ON-TARGET
- Status last verified
- Aug 2026
- First submitted
- 1 Jul 2024
- Last updated
- 5 Oct 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: To date there is no plan to make individual participant data (IPD) available to other researchers.
Publications
Barahona-Correa JB, Cotovio G, Costa RM, Ribeiro R, Velosa A, Silva VCE, Sperber C, Karnath HO, Senova S, Oliveira-Maia AJ. Right-sided brain lesions predominate among patients with lesional mania: evidence from a systematic review and pooled lesion analysis. Transl Psychiatry. 2020 May 12;10(1):139. doi: 10.1038/s41398-020-0811-0.
PubMed 32398699Carmi L, Alyagon U, Barnea-Ygael N, Zohar J, Dar R, Zangen A. Clinical and electrophysiological outcomes of deep TMS over the medial prefrontal and anterior cingulate cortices in OCD patients. Brain Stimul. 2018 Jan-Feb;11(1):158-165. doi: 10.1016/j.brs.2017.09.004. Epub 2017 Sep 6.
PubMed 28927961Carmi L, Tendler A, Bystritsky A, Hollander E, Blumberger DM, Daskalakis J, Ward H, Lapidus K, Goodman W, Casuto L, Feifel D, Barnea-Ygael N, Roth Y, Zangen A, Zohar J. Efficacy and Safety of Deep Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Prospective Multicenter Randomized Double-Blind Placebo-Controlled Trial. Am J Psychiatry. 2019 Nov 1;176(11):931-938. doi: 10.1176/appi.ajp.2019.18101180. Epub 2019 May 21.
PubMed 31109199Cocchi L, Naze S, Robinson C, Webb L, Sonkusare S, Hearne LJ, et al. Effects of transcranial magnetic stimulation of the rostromedial prefrontal cortex in obsessive-compulsive disorder: a randomized clinical trial. Nat Mental Health. 2023 Jul 24;1(8):555-63.
Cole EJ, Stimpson KH, Bentzley BS, Gulser M, Cherian K, Tischler C, Nejad R, Pankow H, Choi E, Aaron H, Espil FM, Pannu J, Xiao X, Duvio D, Solvason HB, Hawkins J, Guerra A, Jo B, Raj KS, Phillips AL, Barmak F, Bishop JH, Coetzee JP, DeBattista C, Keller J, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. Am J Psychiatry. 2020 Aug 1;177(8):716-726. doi: 10.1176/appi.ajp.2019.19070720. Epub 2020 Apr 7.
PubMed 32252538Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med. 2006 Feb;119(2):166.e7-16. doi: 10.1016/j.amjmed.2005.10.036.
PubMed 16443422Cotovio G, Talmasov D, Barahona-Correa JB, Hsu J, Senova S, Ribeiro R, Soussand L, Velosa A, Silva VCE, Rost N, Wu O, Cohen AL, Oliveira-Maia AJ, Fox MD. Mapping mania symptoms based on focal brain damage. J Clin Invest. 2020 Oct 1;130(10):5209-5222. doi: 10.1172/JCI136096.
PubMed 32831292Cotovio G, Ventura F, Rodrigues da Silva D, Pereira P, Oliveira-Maia AJ. Regulatory Clearance and Approval of Therapeutic Protocols of Transcranial Magnetic Stimulation for Psychiatric Disorders. Brain Sci. 2023 Jul 5;13(7):1029. doi: 10.3390/brainsci13071029.
PubMed 37508962Feffer K, Fettes P, Giacobbe P, Daskalakis ZJ, Blumberger DM, Downar J. 1Hz rTMS of the right orbitofrontal cortex for major depression: Safety, tolerability and clinical outcomes. Eur Neuropsychopharmacol. 2018 Jan;28(1):109-117. doi: 10.1016/j.euroneuro.2017.11.011. Epub 2017 Nov 17.
PubMed 29153927Fitzgerald, Paul B., and Z. Jeff Daskalakis. Repetitive Transcranial Magnetic Stimulation Treatment for Depressive Disorders: A Practical Guide. Heidelberg: Springer, 2013.
Fitzsimmons SMDD, van der Werf YD, van Campen AD, Arns M, Sack AT, Hoogendoorn AW; other members of the TETRO Consortium; van den Heuvel OA. Repetitive transcranial magnetic stimulation for obsessive-compulsive disorder: A systematic review and pairwise/network meta-analysis. J Affect Disord. 2022 Apr 1;302:302-312. doi: 10.1016/j.jad.2022.01.048. Epub 2022 Jan 15.
PubMed 35041869Herwig U, Padberg F, Unger J, Spitzer M, Schonfeldt-Lecuona C. Transcranial magnetic stimulation in therapy studies: examination of the reliability of "standard" coil positioning by neuronavigation. Biol Psychiatry. 2001 Jul 1;50(1):58-61. doi: 10.1016/s0006-3223(01)01153-2.
PubMed 11457424Herwig U, Schonfeldt-Lecuona C, Wunderlich AP, von Tiesenhausen C, Thielscher A, Walter H, Spitzer M. The navigation of transcranial magnetic stimulation. Psychiatry Res. 2001 Nov 30;108(2):123-31. doi: 10.1016/s0925-4927(01)00121-4.
PubMed 11738546Horn A, Reich M, Vorwerk J, Li N, Wenzel G, Fang Q, Schmitz-Hubsch T, Nickl R, Kupsch A, Volkmann J, Kuhn AA, Fox MD. Connectivity Predicts deep brain stimulation outcome in Parkinson disease. Ann Neurol. 2017 Jul;82(1):67-78. doi: 10.1002/ana.24974.
PubMed 28586141Ikawa H, Osawa R, Sato A, Mizuno H, Noda Y. A Case Series of Deep Transcranial Magnetic Stimulation Treatment for Patients with Obsessive-Compulsive Disorder in the Tokyo Metropolitan Area. J Clin Med. 2022 Oct 18;11(20):6133. doi: 10.3390/jcm11206133.
PubMed 36294453
Study at a glance
From the registry record, last updated by the sponsor on 5 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Improving Obsessive-compulsive Disorder Treatments: From Lesions to Neuromodulation Targets
- ClinicalTrials.gov ID
- NCT06490965
- Acronym / sponsor ID
- ON-TARGET / ON-TARGET
- Conditions
- Obsessive-Compulsive Disorder
- Keywords
- OCD
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 32 participants (estimated)
- Lead sponsor
- Fundacao ChampalimaudUniversity, hospital or other
- Study start
- 7 Nov 2024 (actual)
- Primary completion
- 31 Dec 2026 (estimated)
- Study completion
- 31 Dec 2026 (estimated)
- First posted
- 8 Jul 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
While in most cases of obsessive-compulsive disorder (OCD) a cause cannot be identified, this syndrome may develop as a consequence of focal brain lesions. Neuropsychiatric disorders secondary to brain insults are open windows to understand their underlying neurobiology. Different neuroimaging analysis methods, including pooled lesion topography and lesion network mapping, can be used to study lesional neuropsychiatric syndromes, including OCD. If successful, these strategies can also reveal new neuromodulation treatment targets, including for transcranial magnetic stimulation (TMS). Indeed, TMS targets to treat depression evolved from evidence extracted from lesional studies that were then refined and validated. For OCD treatment with TMS, already approved by the FDA and European Commission, targets were defined using a distinct approach, not involving causal brain lesions, which may contribute to lower than desirable remission rates. Lesional OCD is characterized by specific dysfunctional brain circuits. These circuits may be effectively targeted by TMS, which may optimize treatment of OCD. To address these hypotheses, we will test the therapeutic benefits of optimizing brain targets for the currently used TMS treatment of OCD, using information from the lesional-OCD brain network namely refining the target in the medial orbitofrontal cortex, bilaterally. Specifically, we will conduct a randomized clinical interventional study, using TMS to treat patients with OCD with inadequate response to other treatments, comparing, within the approved protocol for OCD treatment, the most frequently used stimulation site with a new target, adjusted according to the connectivity of lesions associated with the occurrence of OCD. If successful, our results may have immediate clinical implications in OCD treatment, as it will contribute to refine current therapeutic TMS strategies for OCD and defining new clinical research strategies in this domain.
Detailed description
In this study, we hypothesize that the cortical region identified from connectivity networks associated with lesional OCD may be a more effective TMS stimulation site than the one currently used in OCD treatment. Thus, we intend to compare the efficacy of the TMS protocol as approved for OCD, between its application at the currently used stimulation site (bilateral dorsomedial prefrontal cortex) and its application at an adjusted stimulation site, according to the more specific cortical areas of dysfunctional circuits associated with lesional OCD, namely the bilateral medial orbitofrontal cortex (OFC) region.
The participants in this study will be recruited at the Champalimaud Foundation. The physicians on the research team will identify patients who are being treated for OCD in the Neuropsychiatry Unit, or who are referred to the unit for this purpose. In this study, we aim to prospectively recruit 32 individuals according to the eligibility criteria specified in the respective section.
We propose to conduct a randomized, double-blinded interventional study, open only to the technician administering the treatment. After agreeing to participate in the study, the participant will be invited to attend the first study visit. There, participants will be assigned a unique identification number to maintain their anonymity in the study. Then, a qualified team member will ask the participant to complete the sociodemographic and clinical questionnaire to confirm the conditions for TMS and MRI, including an appropriate screening tool for the occurrence of seizures and/or epilepsy. The Mini International Neuropsychiatric Interview (MINI) and he Structured Clinical Interview for Diagnostic and statistical manual of mental disorders (SCID) will serve the purpose of verifying the eligibility criteria of the study participant, including confirmation of the OCD diagnosis, using SCID. After confirming their eligibility, the participant will be invited to complete the remaining psychometric assessment, which will reflect the baseline values of each instrument. The following will be assessed: YBOCS-II (primary outcome), BDI-II, OCI-R, STAI, World Health Organization Five Well-Being Index (WHO-5), and YMRS (secondary outcomes), and Edinburgh Handedness Inventory (EHI).
In this study, to ensure that the TMS target site used is precisely located, we will use neuronavigation in each TMS session performed. Thus, in the next step of the first visit, the participant will be invited to undergo an MRI scan. This procedure cannot be waived, as without the MRI scan of each individual, the appropriate use of neuronavigation is compromised. If the participant cannot or does not want to undergo this procedure, they will be excluded from the study. The MRI protocol will include the collection of structural and functional neuroimaging data. The duration of this neuroimaging exam will be approximately 20-30 minutes.
After completing this step, the participant will be randomized to one of the two study arms. Please see details of each study arm in the respective section. The first visit of the TMS treatment cycle will be scheduled later. During this first visit of the TMS treatment cycle, the motor hotspot and the motor excitability threshold will be determined, which will be subsequently used to define the appropriate treatment intensity for each individual. Finally, the stimulation site will be determined using the neuronavigation system utilizing each individual's MRI scan. It is emphasized that the stimulation site will be mandatory determined at all TMS treatment visits. The TMS protocol will then commence, characterized by 20 Hz frequency irrespective of study arm. At the beginning of each TMS treatment cycle visit, the presence of potential side effects since the last TMS session will be screened. Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits), the following psychometric scales will be repeated at the beginning of each visit: BDI-II, WHO-5, OCI-R, and YMRS (secondary outcomes). Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits), the motor hotspot and the motor excitability threshold will be redefined, and consequently, the treatment stimulation intensity will be adjusted. At the end of each TMS treatment cycle visit, the next visit will be scheduled to occur on a daily basis, on business days, for a total of 30 visits. After the end of the TMS treatment cycle, the last study visit will be scheduled (primary endpoint, end-of-study visit), which should preferably occur between 2-3 weeks after the 30th TMS treatment cycle visit. During this visit, the YBOCS-II (primary outcome) will be applied. Participants will also be invited to undergo a new MRI scan, with the same characteristics as identified above.
Clinical efficacy will be assessed by changes in the severity of OCD symptoms compared to baseline, evaluated (using YBOCS-II; primary outcome) after 30 daily sessions of TMS, comparing the two study arms.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Arm A | Active comparator | Other: Repetitive Transcranial Magnetic Stimulation, Other: Neuronavigation, Other: Magnetic Resonance ImagingStandard of care rTMS protocol, i.e., daily frequency of repetitive excitatory TMS at 20 Hz of the medial prefrontal cortex - approximate duration of each session between 40-60 minutes. |
| Arm B | Experimental | Other: Repetitive Transcranial Magnetic Stimulation, Other: Neuronavigation, Other: Magnetic Resonance ImagingStandard of care rTMS protocol, i.e., daily frequency of repetitive excitatory TMS at 20 Hz with adjustment of the stimulation site to primarily target the bilateral medial orbitofrontal cortex. |
Who may qualify
- Ages
- 18 to 75 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Age between 18 and 75 years;
- Established diagnosis of Obsessive-Compulsive Disorder according to Diagnostic and statistical manual of mental disorders 5 (DSM5) criteria;
- Capacity to give consent;
- Fluent in Portuguese and/or English;
- If potential for pregnancy, agrees to use an effective method of contraception throughout the study period.
Key exclusion criteria (16 listed)
- Obsessive-compulsive symptoms severity assessed at baseline visit with the instrument Yale-Brown Obsessive Compulsive Scale - II (YBOCS-II) ≤ 24;
- Presence of uncontrolled active medical illness;
- Known structural lesion of the central nervous system;
- Electric or metallic implants in the body not compatible with electromagnetic radiation;
- Electric or metallic brain implants;
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Repetitive Transcranial Magnetic StimulationAlso: rTMS, TMS, Non Invasive Brain StimulationTranscranial Magnetic Stimulation (TMS) involves generating a magnetic field with specific spatial and temporal properties, allowing the induction of electric current in conductive material near this field. The electro-physiological principle of TMS is based on placing a coil over the skull that will induce a magnetic field generating action potentials in neuronal tissue in response to each TMS pulse. The repetitive application of TMS pulses (rTMS) allows for the modulation of neuronal excitability for a period after rTMS, ranging from inhibition, in the case of low frequencies (~1 Hz), or facilitation if high frequencies (equal to or greater than 5 Hz) are used. | Other | Arm A, Arm B |
| NeuronavigationNeuronavigation is a non-invasive method that allows the creation of computerized three-dimensional models of brain structures based on neuroimaging exams of each individual (e.g., cranial magnetic resonance imaging). As such, this method has been used for various purposes, such as assisting in neurosurgery or mapping functional regions of the brain, but also in the context of TMS (Transcranial Magnetic Stimulation). In this latter area, its use as support for TMS has been employed for therapeutic, diagnostic, and research purposes. The neuronavigation system consists of several components, namely a locating camera, locators for the TMS coil, an adjustable headband with locators, a calibration system for these elements, and the neuronavigation software, which is installed on a supporting computer. | Other | Arm A, Arm B |
| Magnetic Resonance ImagingAlso: MRIMagnetic Resonance Imaging (MRI) is a non-invasive medical imaging technique that generates detailed images of the internal structures of the body using a strong magnetic field and radio waves. It provides high-resolution images of soft tissues, such as organs, muscles, and the brain, helping doctors diagnose and monitor various conditions, including injuries, tumors, and neurological disorders. MRI is particularly useful because it does not involve ionizing radiation, making it safer for patients than other imaging methods like X-rays or CT scans. | Other | Arm A, Arm B |
Primary outcome
Yale-Brown Obsessive Compulsive Scale - II (YBOCS-II)
Time frame: Before and after TMS treatment cycle. The latter will be considered the primary endpoint (end-of-study visit) and will occur preferably between 2-3 weeks after last TMS session.
Assessment instrument for the severity of OCD symptoms; scores can range from 0-50; higher scores mean worse outcome.
5 secondary outcomes
State Trait Anxiety Inventory (STAI)
Time frame: Before and after TMS treatment cycle. The latter will be considered the primary endpoint (end-of-study visit) and will occur preferably between 2-3 weeks after last TMS session.
Beck Depression Inventory II (BDI-II)
Time frame: Before TMS treatment cycle. Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits). After TMS treatment cycle, i.e., 2-3 weeks after last TMS session.
Obsessive-Compulsive Inventory - Revised (OCI-R)
Time frame: Before TMS treatment cycle. Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits). After TMS treatment cycle, i.e., 2-3 weeks after last TMS session.
Young Mania Rating Scale (YMRS)
Time frame: Before TMS treatment cycle. Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits). After TMS treatment cycle, i.e., 2-3 weeks after last TMS session.
World Health Organization Five Well-Being Index (WHO-5)
Time frame: Before TMS treatment cycle. Every 5 TMS treatment cycle visits (1st, 6th, 11th, 16th, 21st, and 26th visits). After TMS treatment cycle, i.e., 2-3 weeks after last TMS session.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 5 Oct 2026.
- Background: PubMed 32398699Barahona-Correa JB, Cotovio G, Costa RM, Ribeiro R, Velosa A, Silva VCE, Sperber C, Karnath HO, Senova S, Oliveira-Maia AJ. Right-sided brain lesions predominate among patients with lesional mania: evidence from a systematic review and pooled lesion analysis. Transl Psychiatry. 2020 May 12;10(1):139. doi: 10.1038/s41398-020-0811-0.
- Background: PubMed 28927961Carmi L, Alyagon U, Barnea-Ygael N, Zohar J, Dar R, Zangen A. Clinical and electrophysiological outcomes of deep TMS over the medial prefrontal and anterior cingulate cortices in OCD patients. Brain Stimul. 2018 Jan-Feb;11(1):158-165. doi: 10.1016/j.brs.2017.09.004. Epub 2017 Sep 6.
- Background: PubMed 31109199Carmi L, Tendler A, Bystritsky A, Hollander E, Blumberger DM, Daskalakis J, Ward H, Lapidus K, Goodman W, Casuto L, Feifel D, Barnea-Ygael N, Roth Y, Zangen A, Zohar J. Efficacy and Safety of Deep Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Prospective Multicenter Randomized Double-Blind Placebo-Controlled Trial. Am J Psychiatry. 2019 Nov 1;176(11):931-938. doi: 10.1176/appi.ajp.2019.18101180. Epub 2019 May 21.
- BackgroundCocchi L, Naze S, Robinson C, Webb L, Sonkusare S, Hearne LJ, et al. Effects of transcranial magnetic stimulation of the rostromedial prefrontal cortex in obsessive-compulsive disorder: a randomized clinical trial. Nat Mental Health. 2023 Jul 24;1(8):555-63.
- Background: PubMed 32252538Cole EJ, Stimpson KH, Bentzley BS, Gulser M, Cherian K, Tischler C, Nejad R, Pankow H, Choi E, Aaron H, Espil FM, Pannu J, Xiao X, Duvio D, Solvason HB, Hawkins J, Guerra A, Jo B, Raj KS, Phillips AL, Barmak F, Bishop JH, Coetzee JP, DeBattista C, Keller J, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. Am J Psychiatry. 2020 Aug 1;177(8):716-726. doi: 10.1176/appi.ajp.2019.19070720. Epub 2020 Apr 7.
- Background: PubMed 16443422Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med. 2006 Feb;119(2):166.e7-16. doi: 10.1016/j.amjmed.2005.10.036.
- Background: PubMed 32831292Cotovio G, Talmasov D, Barahona-Correa JB, Hsu J, Senova S, Ribeiro R, Soussand L, Velosa A, Silva VCE, Rost N, Wu O, Cohen AL, Oliveira-Maia AJ, Fox MD. Mapping mania symptoms based on focal brain damage. J Clin Invest. 2020 Oct 1;130(10):5209-5222. doi: 10.1172/JCI136096.
- Background: PubMed 37508962Cotovio G, Ventura F, Rodrigues da Silva D, Pereira P, Oliveira-Maia AJ. Regulatory Clearance and Approval of Therapeutic Protocols of Transcranial Magnetic Stimulation for Psychiatric Disorders. Brain Sci. 2023 Jul 5;13(7):1029. doi: 10.3390/brainsci13071029.
- Background: PubMed 29153927Feffer K, Fettes P, Giacobbe P, Daskalakis ZJ, Blumberger DM, Downar J. 1Hz rTMS of the right orbitofrontal cortex for major depression: Safety, tolerability and clinical outcomes. Eur Neuropsychopharmacol. 2018 Jan;28(1):109-117. doi: 10.1016/j.euroneuro.2017.11.011. Epub 2017 Nov 17.
- BackgroundFitzgerald, Paul B., and Z. Jeff Daskalakis. Repetitive Transcranial Magnetic Stimulation Treatment for Depressive Disorders: A Practical Guide. Heidelberg: Springer, 2013.
- Background: PubMed 35041869Fitzsimmons SMDD, van der Werf YD, van Campen AD, Arns M, Sack AT, Hoogendoorn AW; other members of the TETRO Consortium; van den Heuvel OA. Repetitive transcranial magnetic stimulation for obsessive-compulsive disorder: A systematic review and pairwise/network meta-analysis. J Affect Disord. 2022 Apr 1;302:302-312. doi: 10.1016/j.jad.2022.01.048. Epub 2022 Jan 15.
- Background: PubMed 11457424Herwig U, Padberg F, Unger J, Spitzer M, Schonfeldt-Lecuona C. Transcranial magnetic stimulation in therapy studies: examination of the reliability of "standard" coil positioning by neuronavigation. Biol Psychiatry. 2001 Jul 1;50(1):58-61. doi: 10.1016/s0006-3223(01)01153-2.
- Individual participant dataSharing planned: No. To date there is no plan to make individual participant data (IPD) available to other researchers.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Gonçalo Cotovio, MD, PhD principal investigator
Champalimaud Foundation
Albino J. Oliveira-Maia, MD, MPH, PhD principal investigator
Champalimaud Foundation
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Repetitive Transcranial Magnetic Stimulation, Neuronavigation and Magnetic Resonance Imaging in people with Obsessive-Compulsive Disorder, run by Fundacao Champalimaud at 1 site in Portugal.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 5 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Portugal. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Yale-Brown Obsessive Compulsive Scale - II (YBOCS-II) (time frame: Before and after TMS treatment cycle. The latter will be considered the primary endpoint (end-of-study visit) and will occur preferably between 2-3 weeks after last TMS session.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06490965, which also lists 44 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Oct 2026.