CBT-TMS: Cognitive Behavioral Strategies and Transcranial Magnetic Stimulation in Obsessive-Compulsive Disorder: Open Label Study
Study Details
Study Description
Brief Summary
The purpose of this study is to evaluate the effectiveness of repetitive TMS (rTMS) delivered simultaneously with elements of cognitive behavioral therapy/exposure-response prevention (CBT/ERP) in adult subjects (greater or equal to 18 years old) with obsessive-compulsive disorder (OCD). This is an open label study that involves standard of care for OCD (CBT) and an investigational treatment modality (TMS). The investigators will compare the Yale-Brown Obsessive Compulsive Scale (YBOCS) scores before and after treatment to quantify clinical improvement. The side effects from TMS include, but are not limited to, headache, seizure, and general pain. CBT has minimal side effects other than mental discomfort during the exposure sessions. For safety concerns, pregnant women and subjects with seizure-related history will be excluded as well as other indicated conditions in the details protocol.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
N/A |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: rTMS and Cognitive Behavior Therapy
|
Device: Transcranial magnetic stimulation
Behavioral: Cognitive behavioral therapy
|
Outcome Measures
Primary Outcome Measures
- Remission Rate, as Measured by Y-BOCS [6 weeks]
Remission is defined as end-point Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score less than the value of 16.
Secondary Outcome Measures
- Complete Response, as Measured by Y-BOCS [6 weeks]
Complete response is defined as a reduction of Y-BOCS score greater than 35%.
- Partial Response Rate, as Measured by Y-BOCS [6 weeks]
Partial response is defined as a reduction of greater than 25%.
- Percentage of Adverse Events [6 weeks]
Eligibility Criteria
Criteria
Inclusion Criteria
Subjects must meet all of the following inclusion criteria to qualify for enrollment into the study:
-
All subjects will be 18 - 65 years of age.
-
Obsessive-compulsive disorder:
-
Subjects will meet the DSM-IV primary diagnosis of obsessive-compulsive
-
Y-BOCS total score > 16
- Subjects are willing and able to adhere to the intensive treatment schedule and all required study visits.
Exclusion Criteria
Subjects will be excluded from study participation if one of the following exclusion criteria applies:
-
Subjects are unable or unwilling to give informed consent.
-
No exclusion criteria for comorbid DSM diagnosis.
-
Subjects with a clinically defined neurological disorder that caused significant safety concern to receive TMS treatment, including, but not limited to:
-
Any condition likely to be associated with increased intracranial pressure.
-
Space occupying brain lesion.
-
Any history of seizure EXCEPT those therapeutically induced by ECT (childhood febrile seizures are acceptable and these subjects may be included in the study).
-
History of stroke.
-
Transient ischemic attack within two years.
-
Cerebral aneurysm.
-
Dementia.
-
Mini Mental Status Exam (MMSE-2) score of <24.
-
Parkinson's disease.
-
Huntington's disease.
-
Multiple sclerosis.
-
Increased risk of seizure for any reason, including prior diagnosis of increased intracranial pressure (such as after large infarctions or trauma), or currently taking medication that lowers the seizure threshold. Medications that lower the seizure threshold are included in the Prohibited Concomitant Medication (Section 5.8).
- Subjects with any of the following treatment histories:
-
TMS treatment within 6 months prior to the screening visit.
-
Lifetime history of treatment with Deep Brain Stimulation
-
Use of any investigational drug or device within 4 weeks of the randomization visit.
-
If participating in psychotherapy, must have been in stable treatment for at least 2 months prior to entry into the study, with no anticipation of change in the frequency of therapeutic sessions, or the therapeutic focus over the duration of the trial.
-
Recent 2-month medication changes
- Contraindication to receive TMS:
-
Cardiac pacemakers, implanted medication pumps, intracardiac lines, or acute, unstable cardiac disease.
-
Intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear implants, stents, or electrodes) or any other metal object within or near the head, excluding the mouth, which cannot be safely removed.
-
Clinically significant abnormality or clinically significant unstable medical condition, as indicated by medical history, physical examination, ECG results, or clinical laboratory testing, that in the Investigator's judgment might pose a potential safety risk to the subject or limit interpretation of the trial results, e.g., any uncontrolled thyroid disorders, hepatic, cardiac, pulmonary and renal malfunctioning.
- Women who are currently pregnant or not using a medically acceptable means of birth control and women who are breastfeeding.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Duke University Medical Center | Durham | North Carolina | United States | 27705 |
Sponsors and Collaborators
- Duke University
Investigators
- Principal Investigator: Richard Weiner, MD, Duke University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- Pro00047168
Study Results
Participant Flow
Recruitment Details | |
---|---|
Pre-assignment Detail |
Arm/Group Title | rTMS and Cognitive Behavior Therapy |
---|---|
Arm/Group Description | Transcranial magnetic stimulation Cognitive behavioral therapy |
Period Title: Overall Study | |
STARTED | 2 |
COMPLETED | 0 |
NOT COMPLETED | 2 |
Baseline Characteristics
Arm/Group Title | rTMS and Cognitive Behavior Therapy |
---|---|
Arm/Group Description | Transcranial magnetic stimulation Cognitive behavioral therapy |
Overall Participants | 2 |
Age (Count of Participants) | |
<=18 years |
0
0%
|
Between 18 and 65 years |
2
100%
|
>=65 years |
0
0%
|
Age (years) [Mean (Full Range) ] | |
Mean (Full Range) [years] |
51.5
|
Gender (Count of Participants) | |
Female |
1
50%
|
Male |
1
50%
|
Region of Enrollment (participants) [Number] | |
United States |
2
100%
|
Outcome Measures
Title | Remission Rate, as Measured by Y-BOCS |
---|---|
Description | Remission is defined as end-point Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score less than the value of 16. |
Time Frame | 6 weeks |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | rTMS and Cognitive Behavior Therapy |
---|---|
Arm/Group Description | Transcranial magnetic stimulation Cognitive behavioral therapy |
Measure Participants | 2 |
Number [percentage of participants] |
50
2500%
|
Title | Complete Response, as Measured by Y-BOCS |
---|---|
Description | Complete response is defined as a reduction of Y-BOCS score greater than 35%. |
Time Frame | 6 weeks |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | rTMS and Cognitive Behavior Therapy |
---|---|
Arm/Group Description | Transcranial magnetic stimulation Cognitive behavioral therapy |
Measure Participants | 2 |
Number [percentage of participants] |
50
2500%
|
Title | Partial Response Rate, as Measured by Y-BOCS |
---|---|
Description | Partial response is defined as a reduction of greater than 25%. |
Time Frame | 6 weeks |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | rTMS and Cognitive Behavior Therapy |
---|---|
Arm/Group Description | Transcranial magnetic stimulation Cognitive behavioral therapy |
Measure Participants | 2 |
Number [percentage of participants] |
50
2500%
|
Title | Percentage of Adverse Events |
---|---|
Description | |
Time Frame | 6 weeks |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | rTMS and Cognitive Behavior Therapy |
---|---|
Arm/Group Description | Transcranial magnetic stimulation Cognitive behavioral therapy |
Measure Participants | 2 |
Number [percentage of adverse events] |
0
|
Adverse Events
Time Frame | ||
---|---|---|
Adverse Event Reporting Description | ||
Arm/Group Title | rTMS and Cognitive Behavior Therapy | |
Arm/Group Description | Transcranial magnetic stimulation Cognitive behavioral therapy | |
All Cause Mortality |
||
rTMS and Cognitive Behavior Therapy | ||
Affected / at Risk (%) | # Events | |
Total | / (NaN) | |
Serious Adverse Events |
||
rTMS and Cognitive Behavior Therapy | ||
Affected / at Risk (%) | # Events | |
Total | 0/2 (0%) | |
Other (Not Including Serious) Adverse Events |
||
rTMS and Cognitive Behavior Therapy | ||
Affected / at Risk (%) | # Events | |
Total | 0/2 (0%) |
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
Name/Title | Richard Weiner, MD, PhD |
---|---|
Organization | Duke University |
Phone | 919-681-8742 |
weine002@duke.edu |
- Pro00047168