A Randomised Controlled Trial of Neuronavigated Repetitive Transcranial Magnetic Stimulation (rTMS) in Anorexia Nervosa

McClelland, Jessica; Kekic, Maria; Bozhilova, Natali; Nestler, Steffen; Dew, Tracy; Eynde, Frederique Frans Van Den; David, Anthony S.; Rubia, Katya; Campbell, Iain C.; Schmidt, Ulrike

doi:10.1371/journal.pone.0148606

Cited by 78 publications

(83 citation statements)

References 79 publications

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“…To the best of our knowledge, there has been no description of rTMS treatment in resistant comorbid AN patients with long-term follow-up. In comparison with previously published reports of successful rTMS treatment of AN, we used 10 sessions therapeutic mode instead of 20, and our patient was more severely underweight (14.5–18.5 kg/m 2 ) and this could have influenced our results [4]. …”

Section: Discussionmentioning

confidence: 97%

“…During these years she experienced substantial deterioration of her close relations and socioeconomic status. During her fourth hospitalization (after 300 days of hospitalization with persistent resistance to standard therapy), the therapeutic team, inspired by the literature showing its positive effect on AN [4] and comorbid anxiety and depressive symptomology [5], offered her rTMS therapy.…”

Section: Methodsmentioning

confidence: 99%

“…rTMS, a non-invasive technique targeting the dorsolateral prefrontal cortex (DLPFC), has been shown to have some efficacy across disorders by reducing cravings and consumption in substance dependence, decreasing compulsion and obsession, as well as reducing anxiety and potentially the urge to exercise in AN patients [4]. It has also been demonstrated that rTMS reduces the main symptoms of eating disorders such as food craving, feeling fat or full [4], and even decreases comorbid depression [5].…”

Section: Introductionmentioning

confidence: 99%

“…It has also been demonstrated that rTMS reduces the main symptoms of eating disorders such as food craving, feeling fat or full [4], and even decreases comorbid depression [5]. …”

Section: Introductionmentioning

confidence: 99%

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Repetitive Transcranial Magnetic Stimulation (rTMS) Treatment of Depression and Anxiety in a Patient with Anorexia Nervosa

et al. 2018

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Anorexia nervosa (AN) is characterized by restricted eating, emaciation, and distorted body image and tends to be a chronic and deadly disorder with a high risk of developing a relapsing course described as a severe and enduring anorexia. This case study reports a patient with AN with comorbid depression and anxiety who was treated by repetitive transcranial magnetic stimulation (rTMS).Our patient’s first hospitalization in our ED clinic was at the age of 25 in 2012. Her anorexia symptoms have been developing over 1.5 years. The body mass index (BMI) at admission was 12.21 kg/m2.She was stimulated by use of a MAGSTIM Super Rapid 2 device, every Monday through Friday (5 days a week) with the frequency 10 Hz, 15 trains/day, 100 pulses/train, intertrain interval 107 s for 10 days. The specific spot of stimulation was over the left DLPFC. The therapy was evaluated, both by the team and by the patient, as ineffective. Shortly after the therapy was finished, the patient was discharged with final weight of 46 kg and BMI 13.15 kg/m2.We showed, that despite our positive clinical experiences with rTMS therapy in depression and anxiety, the treatment of AN and comorbid depressive disorder with anxious distress, our patient’s anorexic, anxious, and depressive symptoms remained unaffected. In this case, only invasive medical intervention helped the patient to reach normal weight, but without any significant changes in her psychology.This case study shows the need for further investigation of the influence that body weight might have and whether the number of sessions has an effect on rTMS efficacy.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…It has also been demonstrated that rTMS reduces the main symptoms of eating disorders such as food craving, feeling fat or full [4], and even decreases comorbid depression [5]. …”

Section: Introductionmentioning

confidence: 99%

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Repetitive Transcranial Magnetic Stimulation (rTMS) Treatment of Depression and Anxiety in a Patient with Anorexia Nervosa

et al. 2018

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“…Collectively, neuromodulation includes a wide range of modalities such as transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), vagal nerve stimulation, electroconvulsive therapy (ECT), magnetic seizure therapy (MST), and deep brain stimulation (George and Aston-Jones 2010). Treatments stimulating relevant neurocircuitry in psychiatric disorders present unique research opportunities and much needed therapeutic advances for patients with limited options (McClelland et al 2016). Advances in brain stimulation have already changed the practice of psychiatry and composition of multidisciplinary treatment teams.…”

mentioning

confidence: 99%

Pediatric Neuromodulation Comes of Age

Croarkin

Rotenberg

2016

Journal of Child and Adolescent Psychopharmacology

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This special issue surveys recent work and underscores the challenges of psychiatric brain stimulation research with child and adolescent populations. The field of child and adolescent psychopharmacology is replete with examples of potential pitfalls in the assumption that ''children are little adults.'' Arguably, younger age portends more neurobiological and descriptive heterogeneity in research pursuits and clinical practice. For existing brain stimulation modalities, there are a paucity of translational models to design studies for youth and no well-studied dosing schemes. The long-term positive and negative effects of neuromodulation interventions in youth are unknown. Inherent pragmatic and ethical limitations often present barriers for participant recruitment and will necessitate innovative approaches to study design and team efforts. These challenges are not insurmountable, and sustained efforts will advance the growing field of pediatric neuromodulation.

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