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

Abstract

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.

Neuromodulation approaches for borderline personality disorder

“…The median population prevalence is estimated to be 1.6% but could be as high as 5.9% 1 . BPD is characterised by a pervasive pattern of deficits in emotional regulation, impulsivity, behavioural control and self‐identity 2,3 . Self‐injurious behaviour and suicidality associated with BPD are challenging to manage.…”

“…Functional neuroimaging and neuropsychology studies have identified a dysfunctional frontolimbic network that may be involved in clinical symptoms, including emotional instability and impulsivity 2,3 . Positron emission tomography (PET) imaging has been shown to have an altered metabolism in the prefrontal region of patients 2,3 .…”

“…Functional neuroimaging and neuropsychology studies have identified a dysfunctional frontolimbic network that may be involved in clinical symptoms, including emotional instability and impulsivity 2,3 . Positron emission tomography (PET) imaging has been shown to have an altered metabolism in the prefrontal region of patients 2,3 . The prefrontal cortical areas can be targeted by the neurostimulation therapies transcranial magnetic stimulation (TMS), repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS).…”

“…The prefrontal cortical areas can be targeted by the neurostimulation therapies transcranial magnetic stimulation (TMS), repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS). These are promisingly safe, non‐invasive and well tolerated interventions that are developing an evidence base in treating some core symptoms in BPD 1–3 . In the preparation of this article we looked for studies that have explored neuromodulation techniques in BPD.…”