Journal Article

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

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

2016

Overview

Anorexia nervosa (AN) is associated with morbid fear of fatness, extreme food restriction and altered self-regulation. Neuroimaging data implicate fronto-striatal circuitry, including the dorsolateral prefrontal cortex (DLPFC). In this double-blind parallel group study, we investigated the effects of one session of sham-controlled high-frequency repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC (l-DLPFC) in 60 individuals with AN. A food exposure task was administered before and after the procedure to elicit AN-related symptoms. The primary outcome measure was 'core AN symptoms', a variable which combined several subjective AN-related experiences. The effects of rTMS on other measures of psychopathology (e.g. mood), temporal discounting (TD; intertemporal choice behaviour) and on salivary cortisol concentrations were also investigated. Safety, tolerability and acceptability were assessed. Fourty-nine participants completed the study. Whilst there were no interaction effects of rTMS on core AN symptoms, there was a trend for group differences (p = 0.056): after controlling for pre-rTMS scores, individuals who received real rTMS had reduced symptoms post-rTMS and at 24-hour follow-up, relative to those who received sham stimulation. Other psychopathology was not altered differentially following real/sham rTMS. In relation to TD, there was an interaction trend (p = 0.060): real versus sham rTMS resulted in reduced rates of TD (more reflective choice behaviour). Salivary cortisol concentrations were unchanged by stimulation. rTMS was safe, well-tolerated and was considered an acceptable intervention. This study provides modest evidence that rTMS to the l-DLPFC transiently reduces core symptoms of AN and encourages prudent decision making. Importantly, individuals with AN considered rTMS to be a viable treatment option. These findings require replication in multiple-session studies to evaluate therapeutic efficacy. www.Controlled-Trials.com ISRCTN22851337.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acceptability / Addictive behaviors / Adult / Affect - physiology / Analysis / Anorexia / Anorexia nervosa / Anorexia Nervosa - metabolism / Anorexia Nervosa - physiopathology / Anorexia Nervosa - therapy / Automatic control / Behavior disorders / Biology and Life Sciences / Brain research / Brain-derived neurotrophic factor / Bulimia / Care and treatment / Circuits / Cognitive impairment / Cortex (temporal) / Decision making / Dopamine / Double-Blind Method / Eating disorders / Emotions / Female / Food availability / Humans / Hydrocortisone / Hydrocortisone - metabolism / Impulsivity / Magnetic brain stimulation / Magnetic fields / Male / Medical imaging / Medicine and Health Sciences / Mental depression / Mood / Neostriatum / Neuroimaging / Neurology / Neurosciences / Prefrontal cortex / Prefrontal Cortex - physiopathology / Psychiatry / Psychology / Psychopathology / Research and Analysis Methods / Social Sciences / Temporal lobe / Transcranial magnetic stimulation / Transcranial Magnetic Stimulation - methods / Treatment outcome / Young Adult