Transcranial magnetic stimulation (TMS) for patients with exposure therapy-resistant obsessive-compulsive disorder (OCD): TETRO – a multicenter randomized controlled trial
Obsessive-compulsive disorder (OCD) is a serious and disabling mental disorder, characterized by obsessions and compulsions and associated with substantial comorbidity and morbidity. Approximately 50% of patients treated with standard treatments (exposure therapy with response prevention (ERP) with/without medication) fail to respond fully, resulting in chronicity and poor participation in social and educational/occupational domains. We propose to fill the gap between the standard treatments (exposure therapy with/without medication) on the one side and invasive end-stage strategies (brain surgery) on the other side, using a non-invasive alternative: repetitive transcranial magnetic stimulation (rTMS). Despite proven efficacy rTMS for OCD is not yet covered by the Dutch insurance system while rTMS for treatment resistant depression is. This multi-center randomized controlled trial, supported by the ‘veelbelovende zorg’ grant of Zorginstituut Nederland (ZiNL), aims to establish the added value of rTMS applied over the pre-supplementary motor area (preSMA) when combined with ERP in OCD patients, who show no/insufficient response to ERP (alone or combined with medication). In case of proven cost-effectiveness it will lead to the addition of rTMS as insured health care for patients with OCD.
There 5 centers involved in the execution of the multi-center trial perfectly cover the country, enabling treatment in the catchment area of the patients’ home. These 5 sites are located in Amsterdam (Amsterdam UMC/GGZ inGeest), Nijmegen (Radboudumc/ProPersona, with MRI scans at Donders Center of Cognitive Neuroimaging), Maastricht (Maastricht UMC+/Mondriaan groep, with MRI scans at Scannexus), and Eindhoven and Groningen (two sites of the NeuroCare group).
This study is funded by Zorginstituut Nederland.