Repetitive Transcranial Magnetic Stimulation in Anorexia Nervosa: a Pilot Study

AbstractThe search for new treatments to improve outcome in people with anorexia nervosa continues. This pilot study investigated whether one session of high frequency repetitive transcranial magnetic stimulation (rTMS) delivered to the left dorsolateral prefrontal cortex reduces eating disorder related symptoms following exposure to visual and real food stimuli. Safety and tolerability were also assessed. Ten right-handed people with anorexia nervosa underwent one session of rTMS. Subjective experiences related to the eating disorder (e.g. urge to restrict, feeling full etc.) were assessed before and after rTMS. Non-parametric repeated measures tests were used. rTMS was safe and well-tolerated, and resulted in reduced levels of feeling full, feeling fat and feeling anxious. Thus, rTMS may reduce core symptoms of anorexia nervosa. Future research should establish the therapeutic potential of rTMS in anorexia nervosa.

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A pilot study exploring the effect of repetitive transcranial magnetic stimulation (rTMS) treatment on cerebral blood flow and its relation to clinical outcomes in severe enduring anorexia nervosa

Journal of Eating Disorders ◽

10.1186/s40337-021-00420-w ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Bethan Dalton ◽

Erica Maloney ◽

Samantha J. Rennalls ◽

Savani Bartholdy ◽

Maria Kekic ◽

...

Keyword(s):

Blood Flow ◽

Anorexia Nervosa ◽

Cerebral Blood Flow ◽

Weight Gain ◽

Transcranial Magnetic Stimulation ◽

Pilot Study ◽

Clinical Outcomes ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Post Randomisation

Abstract Background Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment option for people with severe enduring anorexia nervosa (SE-AN), but associated neurobiological changes are poorly understood. This study investigated the effect of rTMS treatment on regional cerebral blood flow (CBF) and whether any observed changes in CBF are associated with changes in clinical outcomes in people with SE-AN. Methods As part of a randomised sham-controlled feasibility trial of 20 sessions of high-frequency rTMS to the left dorsolateral prefrontal cortex, 26 of 34 trial participants completed arterial spin labelling (ASL) functional magnetic resonance imaging (fMRI) to quantify regional and global resting state CBF before (pre-randomisation baseline) and after real or sham treatment (1-month post-randomisation). A group of healthy females (n = 30) were recruited for baseline comparison. Clinical outcomes, including BMI, and depression and anxiety symptoms, were assessed at baseline, 1-, 4-, and 18-months post-randomisation. Results No group differences in regional CBF were identified between the SE-AN and healthy comparison participants. A significant treatment-by-time interaction in a medial temporal lobe cluster with the maximal peak in the right amygdala was identified, reflecting a greater reduction in amygdala CBF following real rTMS compared to sham. Participants with the greatest rTMS-related reduction in amygdala CBF (i.e., between baseline and 1-month post-randomisation) showed the greatest sustained weight gain at 18-months post-randomisation. Higher baseline CBF in the insula predicted greater weight gain between baseline and 1-month post-randomisation and between baseline and 4-months post-randomisation. Conclusions This exploratory pilot study identified rTMS treatment related changes in CBF in adults with SE-AN and these were associated with changes in weight. Our preliminary findings also suggest that CBF (as measured by ASL fMRI) may be a marker of rTMS treatment response in this patient group. Future rTMS studies in AN should employ longitudinal neuroimaging to further explore the neurobiological changes related to rTMS treatment. Trial registration ISRCTN14329415, registered 23rd July 2015.

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Repetitive Transcranial Magnetic Stimulation for Cognitive Function in Adults with Bipolar Disorder: A Pilot Study

Journal of Affective Disorders ◽

10.1016/j.jad.2021.05.075 ◽

2021 ◽

Author(s):

Roger S. McIntyre ◽

Yena Lee ◽

Nelson B. Rodrigues ◽

Flora Nasri ◽

Guohui Lao ◽

...

Keyword(s):

Bipolar Disorder ◽

Cognitive Function ◽

Transcranial Magnetic Stimulation ◽

Pilot Study ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation

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A pilot trial of repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex in anorexia nervosa: resting fMRI correlates of response

Journal of Eating Disorders ◽

10.1186/s40337-021-00411-x ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

D. Blake Woodside ◽

Katharine Dunlop ◽

Charlene Sathi ◽

Eileen Lam ◽

Brigitte McDonald ◽

...

Keyword(s):

Anorexia Nervosa ◽

Prefrontal Cortex ◽

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Trial Registration ◽

Angular Gyrus ◽

Open Label ◽

Compulsive Disorder ◽

Dorsomedial Prefrontal Cortex

Abstract Background Patients with anorexia nervosa (AN) face severe and chronic illness with high mortality rates, despite our best currently available conventional treatments. Repetitive transcranial magnetic stimulation (rTMS) has shown increasing efficacy in treatment-refractory cases across a variety of psychiatric disorders comorbid with AN, including major depression, Obsessive Compulsive Disorder (OCD), and Post traumatic Stress Disorder (PTSD). However, to date few studies have examined the effects of a course of rTMS on AN pathology itself. Methods Nineteen patients with AN underwent a 20–30 session open-label course of dorsomedial prefrontal rTMS for comorbid Major Depressive Disorder (MDD) ± PTSD. Resting-state functional MRI was acquired at baseline in 16/19 patients. Results Following treatment, significant improvements were seen in core AN pathology on the EDE global scale, and to a lesser extent on the shape and weight concerns subscales. Significant improvements in comorbid anxiety, and to a lesser extent depression, also ensued. The greatest improvements were seen in patients with lower baseline functional connectivity from the dorsomedial prefrontal cortex (DMPFC) target to regions in the right frontal pole and left angular gyrus. Conclusions Despite the limited size of this preliminary, open-label study, the results suggest that rTMS is safe in AN, and may be useful in addressing some core domains of AN pathology. Other targets may also be worth studying in this population, in future sham-controlled trials with larger sample sizes. Trial registration Trial registration ClinicalTrials.gov NCT04409704. Registered May 282,020. Retrospectively registered.

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