American Journal of Psychiatry Research & Reviews

Abstract: Objectives:This pilot study aimed to evaluate whether a 50% or greater rise in Resting Motor Threshold can serve as a critical biomarker to predict the success of repetitive Transcranial Magnetic Stimulation in treatment-resistant Obsessive-Compulsive Disorder patients. Methods:Conducted at our advanced Neuromodulation laboratory in a tertiary care hospital, this case series-based pilot study involved 5 patients diagnosed with treatment-resistant OCD. Each underwent 12 to 18 sessions of rTMS targeting the supplementary motor area (1 Hz, 110% MT, 900 Pulses), anterior cingulate gyrus (20Hz, 100%MT, 2000 Pulses) and dorsomedial prefrontal cortex protocol (20 Hz, 100% MT, 750 Pulses). RMT was measured at baseline, after 10 sessions, and post-12 sessions, and then followed up at 3, 6, and 9 months. The clinical progress was assessed using standard OCD scales and correlated with RMT trajectory to evaluate predictive validity. Results:All three patients demonstrated a consistent rise in RMT by more than 50% viz: from 37% to 57% in case 1, from 32% to 53% in case 2, and from 42% to 63% in case 3 by the 12th rTMS session, aligning with significant symptomatic relief. Their MT values remained stable during remission over 12 months, reinforcing the link between early RMT elevation and sustained therapeutic benefit. This trend indicates that a more than 50% RMT rise post-initial rTMS targeted neural network sessions may signal a positive treatment trajectory in resistant OCD cases. 2 other cases where rTMS failed showed only minimal shift of RMT from 32% to only 37% at the end of 30 sessions in 4th Case while in 5th Case of failed rTMS showed 34% RMT baseline increased only to 38% after 30 sessions. Conclusion:To our knowledge, this is the first study in literature elucidating a 50% or greater rise in RMT as a reliable and early biomarker for successful rTMS response in treatment-resistant OCD. This finding although supports its potential role in guiding personalized, precision-based neuromodulation strategies for enhanced treatment outcomes, would require further large scale replication and validation.

Abstract: Three Torah-level commandments — shofar, lulav and megillah — are suspended when their day falls on Shabbat, not because the acts themselves are forbidden but because of a rabbinic fear: that a person might carry the object four cubits through the public domain to seek instruction from an expert. This paper takes that decree seriously as a theology of space. It traces a trajectory from the halachic unit of Shabbat violation (four cubits in reshut ha-rabbim, given not derived, and attached to the one labour that changes nothing but place) through the four cubits that constitute a human being’s portable domain, to the Talmud’s statement that after the destruction of the Temple God retains only four cubits of halachah, and on to the Zoharic and Hasidic transposition of the two domains into the domain of the One and the domain of separation. The halachic fear and the mystical reading are shown to converge: the shofar is not sounded on Shabbat because within the private domain the summons is already present and must not be carried out into multiplicity. The final movement applies this trajectory to the clinical encounter. The consulting room is a reshut ha-yachid; the patient brings a portable enclosure of four cubits into it; the contemporary health system — the record, the referral, the expert, the protocol — is a reshut ha-rabbim into which the contents of that enclosure are constantly carried out. The physician’s discipline, on this reading, is a Shabbat discipline: to enter the patient’s four cubits, to refrain from carrying, and to trust that what needs to be heard is already sounding within the domain.