{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T13:18:16Z","timestamp":1767705496396,"version":"build-2065373602"},"reference-count":48,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Obsessive\u2013Compulsive Disorder (OCD) is a chronic psychiatric condition with a lifetime prevalence of 2\u20133%. It significantly burdens quality of life and is associated with substantial economic and disease burdens. Cognitive-behavioral therapy and high-dose selective serotonin reuptake inhibitors are considered the first-line treatments for OCD. Approximately two-thirds of patients with Obsessive\u2013Compulsive Disorder (OCD) exhibit inadequate responses to current standard therapies, thus lacking adequate therapy, resulting in a loss of quality of life and huge economic burdens. Repetitive transcranial stimulation (rTMS) is a non-invasive, safe, and well-tolerated intervention that modulates prefrontal cortical circuits involved in OCD. A previous systematic review explored the therapeutic effects of rTMS applied to the dorsolateral prefrontal cortex (dlPFC) area in patients with treatment-resistant OCD. It showed that the application of high-frequency and low-frequency (LF) rTMS to the dlPFC region yielded controversial post-treatment Y-BOCS (Yale-Brown Obsessive\u2013Compulsive Scale) findings due to factors such as small sample sizes, short-term study durations, and variations in rTMS protocols. Objectives: Thus, we propose a theoretical protocol based on previous findings to assess better the effect of LF rTMS for treatment-resistant OCD patients. Methods: We will recruit patients with moderate to severe OCD and limited response to previous treatments from in- and outpatient clinics. We will use fMRI for precious localization of the right dlPFC and application of 1 Hz stimulation of in total 2000 pulses with three times 40 s inter-train intervals 5 days a week, in 6 consecutive weeks. The primary outcome will be the mean reduction in Y-BOCS at the end of this study. Conclusions: This study highlights rTMS\u2019s potential to reform OCD treatment, accentuate safety, accessibility, clinical integration, and future research foundations.<\/jats:p>","DOI":"10.3390\/brainsci15020106","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T04:54:31Z","timestamp":1737608071000},"page":"106","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["MAGNITUDE: Transcranial Magnetic Stimulation for Treatment-Resistant Obsessive\u2013Compulsive Disorder: A Randomized Sham-Controlled Phase II Trial Protocol"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0787-446X","authenticated-orcid":false,"given":"Lavinia","family":"Rech","sequence":"first","affiliation":[{"name":"ECPE Department-PPCR Program, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Division of Cardiology, University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6607-6492","authenticated-orcid":false,"given":"Ricardo A.","family":"Vivanco","sequence":"additional","affiliation":[{"name":"ECPE Department-PPCR Program, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Department of Neurology, University of Kentucky, Lexington, KY 40536, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6769-8923","authenticated-orcid":false,"given":"Ana Claudia","family":"Guersoni","sequence":"additional","affiliation":[{"name":"ECPE Department-PPCR Program, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Faculty of Medicine, Preventive Medicine Department, University of S\u00e3o Paulo, S\u00e3o Paulo 01246 903, Brazil"}]},{"given":"Gianina M. Cris\u00f3stmono","family":"Ninapaytan","sequence":"additional","affiliation":[{"name":"ECPE Department-PPCR Program, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Instituto Nacional de Salud Mental \u201cHonorio Delgado\u2014Hideyo Noguchi\u201d, Universidad Peruana Cayetano Heredia, Lima 15102, Peru"}]},{"given":"Paulina Bonilla","family":"Rivera","sequence":"additional","affiliation":[{"name":"ECPE Department-PPCR Program, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Hospital del Trabajador, Asociaci\u00f3n Chilena de Seguridad ACHS, Santiago 7501239, Chile"}]},{"given":"Elisabeth J.","family":"Ramos-Orosco","sequence":"additional","affiliation":[{"name":"ECPE Department-PPCR Program, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Department of Pediatrics, Nationwide Children\u2019s Hospital, The Ohio State University, Columbus, OH 43205, USA"}]},{"given":"Ariana","family":"Vargas-Ruiz","sequence":"additional","affiliation":[{"name":"ECPE Department-PPCR Program, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Children\u2019s National Hospital, San Jos\u00e9 267-1005, Costa Rica"}]},{"given":"Martha","family":"Felipe","sequence":"additional","affiliation":[{"name":"ECPE Department-PPCR Program, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"School of Global Public Health, New York University, New York, NY 10012, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1759-5146","authenticated-orcid":false,"given":"Sandra","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Psychological Neuroscience Laboratory, Basic Psychology Department, Centro de Investiga\u00e7\u00e3o em Psicologia (CIPsi), School of Psychology, University of Minho, 4710-057 Braga, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1038\/s41572-019-0102-3","article-title":"Obsessive-compulsive disorder","volume":"5","author":"Stein","year":"2019","journal-title":"Nat. Rev. Dis. 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