The effects of repetitive transcranial magnetic stimulation in obese females with binge eating disorder: a protocol for a double-blinded, randomized, sham-controlled trial

Abstract

BackgroundBinge eating disorder is a new category in DSM-5 and highly associated with higher body mass index. The neural mechanisms that underlie binge eating are of great interest in order to improve treatment interventions. Brain mechanisms underlying drug and food craving are suggested to be similar: for example, both are reported to be associated with increased neural activity in the orbitofrontal and anterior cingulate cortex, and a diminished regulatory influence from lateral prefrontal circuits. Several studies have begun to assess the potential benefits of brain stimulation in reducing craving and addictive behaviors. Data from a study of a one-off session of transcranial magnetic stimulation in healthy women identified as strong cravers and of individuals with bulimic-type eating disorders, reported a reduction in food craving and binge eating episodes. This provides support for a more extensive investigation of the potential therapeutic benefits of transcranial magnetic stimulation. Lastly, brain imaging studies and a dimensional approach, will improve understanding of the neural correlates of the disorders and of the mode of action of transcranial magnetic stimulation.Methods/DesignSixty eligible obese females, with binge eating disorder, will be randomly allocated to receive 20 sessions of transcranial magnetic stimulation intervention (n = 30) or the sham transcranial magnetic stimulation intervention (n = 30) scattered 3 days/week. Thirty eligible controls will complete the baseline assessment. The primary outcome (number of binge eating episodes) will be assed at each treatment sessions, and 8 weeks after intervention completion (follow-up). It is hypothesized that mean weekly binge-eating episodes will be reduced in the intervention group, compared to the sham group, and that the effect will be maintained at follow-up.DiscussionDespite the severity associated with Binge Eating Disorder, there are limited treatment options. This study is an important step in the development of more effective treatments. Importantly, the study is the first to investigating binge eating disorder using a dimensional approach, by looking at the different aspects of the disorder, such as behavioral factors, biological factors, brain circuits and chemistry.Trial registrationClinical Trials NCT02180984. Registered in July 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0569-8) contains supplementary material, which is available to authorized users.

Reduced Inhibitory Control Mediates the Relationship Between Cortical Thickness in the Right Superior Frontal Gyrus and Body Mass Index

“…Our findings point to opportunities for the development of novel treatment options for obesity and BED. For instance, the right PFC could be a target for non-invasive brain stimulation treatments aimed to improve inhibitory control performance and facilitate dietary self-control (Alonso-Alonso, 2013; Maranhão et al, 2015). If our findings hold true in future replications, the right superior frontal gyrus should be considered a promising candidate for modulatory techniques.…”

“…It is associated with high scores in standardized questionnaires on eating behavior such as the disinhibition scale of the three-factor eating questionnaire (TFEQ) (Hsu et al, 2002) and with substantial psychiatric co-morbidity, most notably anxiety and mood disorders (Hudson et al, 2007). It is currently uncertain whether binge eating is related to impairment in inhibitory control (Davis et al, 2010;Calvo et al, 2014;Maranhão et al, 2015). Enhanced clarity as to the role of binge eating and inhibitory control in weight gain is important in order to facilitate the development of more effective personalized treatment and prevention strategies in obesity.…”

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

“…Finally, Maranhão et al 38 published a protocol to explore the effects of rTMS to the left DLPFC in patients with obesity and BED. As noted above, with respect to a protocol by Bartholdy et al, 30 due to the rigorous methodology, this study is worth to be included in this revision.…”

“…The second study protocol aimed to be applied in patients with BED. 38 Inclusion criteria for patients were as follows: 1) meeting DSM-5 criteria for BED; 2) age ranging from 18 to 55; 3) right-handed and able to write, read, and understand all elements of the study; 4) females; 5) BMI ≥35 kg/m 2 and body weight ≤150 kg; and 6) laboratory blood tests within normal range at study enrollment. In this case, the current use of psychotropic drugs (except for antidepressants on a stable dose for at least 1 month), the current use of any antiobesity drug and medications that are known to reduce weight, and major psychiatric disorder requiring immediate treatment (eg, schizophrenia, bipolar disorder), substance dependence, and individuals currently receiving any psychological therapy for ED were exclusion criteria.…”

Brain Stimulation in Eating Disorders: State of the Art and Future Perspectives

“…Hence, rTMS is an important tool to explore the neurobiology of craving and binge eating (BE). An ongoing study is investigating rTMS tolerability and safety and its effects on food craving and BE behavior, and also on ED-related psychopathology (including depression, anxiety, and stress symptoms), anthropometric measures, cognition, brain structure and function, hormones, and inflammatory biomarkers [46].…”