Repetitive transcranial magnetic stimulation as adjuvant to exposure therapy in obsessive-compulsive disorder

Repetitive transcranial magnetic stimulation (rTMS) is now more often used both as mono-therapy and as adjuvant therapy to exposure and response prevention (ERP) therapy in obsessive-compulsive disorder (OCD). Various rTMS targets have been studies, among others the dorsolateral prefrontal cortex (DLPFC) and the (pre-)supplementary motor area ((pre)SMA). In my lecture I will present the findings a the proof-of-concept randomized controlled trial TIPICCO (TMS-induced plasticity improving cognitive control in OCD), comparing 3 rTMS conditions as adjuvant therapy to ERP and show how pre-post treatment MRI can help to understand the mechanisms of treatment success. I will also present new unpublished data on how variation in between-individuals structural anatomy and between-rTMS target variation in coil-to-target distance contributes to differences in rTMS-induced E-field and thus rTMS dosage. I will also present new unpublished data on how pre-treatment target-to-normative network functional connectivity influences treatment response and how this functional connectivity changes after treatment. Finally I will eloborate on innovative strategies on personalizing rTMS target selection and coil positioning.