Dorsomedial prefrontal cortex repetitive transcranial magnetic stimulation treatment of posttraumatic stress disorder in eating disorders: An open‐label case series

Abstract

Posttraumatic stress disorder (PTSD) is a common comorbid condition in anorexia nervosa (AN) and bulimia nervosa (BN), and may be associated with reduced response to treatment. We report on a case series employing repetitive transcranial magnetic stimulation (rTMS) with a novel target, the dorsomedial prefrontal cortex (DMPFC). Fourteen subjects with eating disorders and comorbid PTSD received 20-30 neuronavigated DMPFC-rTMS treatments on an open-label basis. PTSD symptoms were assessed pretreatment and posttreatment with the PTSD checklist-Civilian (PCL-C) and the Difficulties in Emotional Regulation Scale (DERS). PCL-C scores were reduced by 51.99% ± 27.24% overall, from a mean of 54.29 ± 19.34 pretreatment to 24.86 ± 17.43 posttreatment (p < .001). Of the 14, 8 showed an improvement of >50%. DERS scores improved by 36.02% ± 24.24% overall, from 140.00 ± 22.09 at pretreatment to 89.29 ± 38.31 at posttreatment (p < .001). OF the 14 subjects, 5 achieved >50% improvement. These data may suggest that DMPFC-rTMS could be helpful in the treatment of PTSD in some ED patients.

Treating Post-traumatic Stress Disorder with Neuromodulation Therapies: Transcranial Magnetic Stimulation, Transcranial Direct Current Stimulation, and Deep Brain Stimulation

“…With this rationale, several studies evaluated the feasibility and the clinical benefits of using TMS or tDCS alone or combined with psychotherapy. In this review, we evaluated 13 RCTs [9,10,18,[21][22][23][24][25][26][27][28][29][30], 11 case series [8,[31][32][33][34][35][36][37][38][39][40], and 6 case reports [7,21,[41][42][43][44] on neuromodulation for PTSD, focusing on TMS, tDCS, and DBS. Details of the articles pooled for analysis in our review are summarized in Tables 1 (TMS), 2 (tDCS), and 3 (DBS).…”

Neuromodulation in eating disorders and obesity: a promising way of treatment?

“…In other study, patients with AN (restrictive and binge-purge subtypes), BN, and EDNOS were included. 37 In this study, 20–30 sessions of rTMS were applied to the bilateral DMPFC, and all patients suffered from posttraumatic stress disorder (PTSD). Improvements in emotional regulation (emotional dysregulation is a central symptom in PTSD) accompanied improvements in PTSD symptoms.…”

Improving decision‐making and cognitive impulse control in bulimia nervosa by rTMS: An ancillary randomized controlled study

“…Enhanced frontostriatal connectivity in responders might explain the improvement in the binge/purge behaviors. Recently, a case series suggested that rTMS targeting the DMPFC could be helpful in treating people with comorbid eating disorders and post‐traumatic stress disorders (Woodside et al, ). These studies strongly suggest the interest of further work targeting the DMPFC in BN.…”