High frequency TMS for the management of Borderline Personality Disorder: A case report

Arbabi, Mohammad; Hafizi, Sina; Ansari, Sahar; Oghabian, Mohammad Ali; Hasani, Nafiseh

doi:10.1016/j.ajp.2013.05.006

Cited by 18 publications

(22 citation statements)

References 10 publications

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“…Their work showed improvement in depressive symptomatology in a three-case series of MDD co-morbid with BPD. Our preliminary results are similar to those reported previously for clinical areas (anger, affective instability, impulsiveness) with the application of high-frequency rTMS (10 Hz) to the left 17 and right DLPFC. 18,19 Cailhol et al 18 observed improvement in neuropsychological areas (decision-making).…”

Section: Discussionsupporting

confidence: 90%

Improvement in borderline personality disorder symptomatology after repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: preliminary results

Calderón-Moctezuma

Reyes-López

Rodríguez-Valdés

et al. 2021

Braz. J. Psychiatry

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Objective: Current treatment for borderline personality disorder (BPD) involves psychological and pharmacological interventions. However, neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) may positively affect BPD symptomatology. The objective of this study was to evaluate the clinical and neuropsychological effects of rTMS on the dorsomedial prefrontal cortex (DMPFC) in BPD patients. Methods: Fourteen patients with BPD were randomized into two groups (active vs. sham) for 15 sessions of rTMS on the DMPFC. Clinical effects were measured using the Borderline Symptoms List (BSL), Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity over Time (BEST), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Barratt's Impulsiveness Scale (BIS). Neuropsychological effects were determined by a Stop-Signal Task (SST), the Wisconsin Card-Sorting Test (WCST), and the Iowa Gambling Test (IGT). Results: Within-group comparison showed significant differences (p o 0.05) in CGI-BPD (total score and six of nine psychopathologic domains), BEST, HDRS, HARS, and IGT scores for active modality. Conclusion: The 5 Hz-DMPFC rTMS technique was well tolerated and lessened the severity of BPD symptomatology, especially abandonment, affective issues, interpersonal relationships, suicidal behavior, anger, and paranoid ideation. Cognitive improvement was seen in decision-making. Additional studies are needed to fully evaluate the effects of rTMS on BPD symptomatology. Clinical Trial Registration: NCT03832777.

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Section: Discussionsupporting

confidence: 90%

Improvement in borderline personality disorder symptomatology after repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: preliminary results

Calderón-Moctezuma

Reyes-López

Rodríguez-Valdés

et al. 2021

Braz. J. Psychiatry

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“…Neuroimaging and neuropsychological studies1,5 have shown that the clinical manifestations of BPD are related to changes in the frontolimbic network,2,3 including amygdala hyperactivity and hypofunctionality in prefrontal structures6 such as the orbitofrontal cortex (OFC), the ventromedial prefrontal cortex (VMPFC), and the dorsolateral (DLPFC) cortex 7-9. Particularly, the DLPFC plays a key role in regulating top-down emotional control and impulsiveness 9,10. These findings become relevant when considering that the current lines of treatment are psychotherapy (maintenance treatment) and pharmacological interventions (which are used during exacerbations of symptoms) 2…”

Section: Introductionmentioning

confidence: 99%

“…Studies have explored the therapeutic potential of rTMS in BPD using high-frequency protocols (10 Hz) on the right13 and left9 DLPFCs, although evidence shows that use of frequencies in the inhibitory (≤ 1 Hz) or 5-Hz ranges can provide clinical benefits with greater tolerability and reduced risk of adverse events 11,21,24. Thus, the aim of this study was to evaluate clinical improvement in patients with BPD after treatment with high-frequency (5 Hz) or low-frequency (1 Hz) rTMS of the left or right DLPFC, respectively.…”

Section: Introductionmentioning

confidence: 99%

Clinical improvement in patients with borderline personality disorder after treatment with repetitive transcranial magnetic stimulation: preliminary results

Reyes-López

Ricardo-Garcell

Armas-Castañeda

et al. 2017

Rev. Bras. Psiquiatr.

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Objective:Current treatment of borderline personality disorder (BPD) consists of psychotherapy and pharmacological interventions. However, the use of repetitive transcranial magnetic stimulation (rTMS) could be beneficial to improve some BPD symptoms. The objective of this study was to evaluate clinical improvement in patients with BPD after application of rTMS over the right or left dorsolateral prefrontal cortex (DLPFC).Method:Twenty-nine patients with BPD from the National Institute of Psychiatry, Mexico, were randomized in two groups to receive 15 sessions of rTMS applied over the right (1 Hz, n=15) or left (5 Hz, n=14) DLPFC. Improvement was measured by the Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity Over Time (BEST), Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), and Barratt Impulsiveness Scale (BIS).Results:Intragroup comparison showed significant (p < 0.05) reductions in every psychopathologic domain of the CGI-BPD and in the total scores of all scales in both groups.Conclusions:Both protocols produced global improvement in severity and symptoms of BPD, particularly in impulsiveness, affective instability, and anger. Further studies are warranted to explore the therapeutic effect of rTMS in BPD.Clinical trial registration:NCT02273674.

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“…After excluding duplicates and nonrelevant contributions (e.g. theoretical articles), five studies were included in the review [70][71][72][73][74].…”

Section: Review Of Rtms Treatment Studies In Bpdmentioning

confidence: 99%

“…The first rTMS study in BPD [70] was a case report published in 2013. A 22-year-old female BPD patient received high frequency (HF) 10 Hz stimulation over her left DLPFC at 100% of her individual motor threshold (MT).…”

Section: Review Of Rtms Treatment Studies In Bpdmentioning

confidence: 99%

Repetitive Transcranial Magnetic Stimulation Treating Impulsivity in Borderline Personality Disorder and Attention Deficit/Hyperactivity Disorder

Svěrák¹,

Linhartová²,

Fiala³

et al. 2018

Transcranial Magnetic Stimulation in Neuropsychiatry

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The need for novel treatment approaches that target impulsivity symptoms in neuropsychiatric disorders is clear. Repetitive transcranial magnetic stimulation (rTMS) allows selective neuromodulation of regions involved in the functional neuroanatomy of neuropsychiatric disorders. This chapter presents impulsivity in psychiatry, especially in borderline personality disorder (BPD) and attention-deficit hyperactivity disorder (ADHD), its neural underpinnings, and its possible treatment by rTMS. We reviewed available studies on rTMS in impulsivity in BPD and ADHD published before August 13, 2017, systematically searching in the PubMed, Web of Science, and Scopus databases. The results are discussed in the context of the latest neuropsychological models of impulsivity and their underlying functional neuroanatomy. rTMS treatment of impulsivity in BPD and ADHD seems to be a plausible approach. The functional neuroanatomy of processes related to impulsive behavior and decision making in these disorders is linked with abnormalities in the fronto-limbic structures that can be targeted and modulated by rTMS. Although limited evidence is available, rTMS seems to be a safe and potentially effective method of impulsivity treatment in patients with BPD and ADHD. However, more studies are needed to determine the most efficient cortical location and design for rTMS treatment of impulsivity.

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High frequency TMS for the management of Borderline Personality Disorder: A case report

Cited by 18 publications

References 10 publications

Improvement in borderline personality disorder symptomatology after repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: preliminary results

Improvement in borderline personality disorder symptomatology after repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: preliminary results

Clinical improvement in patients with borderline personality disorder after treatment with repetitive transcranial magnetic stimulation: preliminary results

Repetitive Transcranial Magnetic Stimulation Treating Impulsivity in Borderline Personality Disorder and Attention Deficit/Hyperactivity Disorder

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