A pilot trial of repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex in anorexia nervosa: resting fMRI correlates of response

Journal of Eating Disorders

Jonathan Downar¹  Katharine Dunlop²  Eileen Lam³  Brigitte McDonald³  Charlene Sathi³  D. Blake Woodside⁴ 

[1] Centre for Mental Health, University Health Network, Toronto, Canada;Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada;MRI-Guided rTMS Clinic, University Health Network, Toronto, Canada;Krembil Research Institute, University Health Network, Toronto, Canada;Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, USA;MRI-Guided rTMS Clinic, University Health Network, Toronto, Canada;Program for Eating Disorders, University Health Network, Toronto, Canada;Centre for Mental Health, University Health Network, Toronto, Canada;Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada;Institute of Medical Science, University of Toronto, Toronto, Canada;

关键词: Anorexia nervosa;    R-TMS;    fMRI;    Anorexia;    Treatment;    Neuromodulation;   

DOI  :  10.1186/s40337-021-00411-x

来源: Springer

【 摘 要 】

BackgroundPatients with anorexia nervosa (AN) face severe and chronic illness with high mortality rates, despite our best currently available conventional treatments. Repetitive transcranial magnetic stimulation (rTMS) has shown increasing efficacy in treatment-refractory cases across a variety of psychiatric disorders comorbid with AN, including major depression, Obsessive Compulsive Disorder (OCD), and Post traumatic Stress Disorder (PTSD). However, to date few studies have examined the effects of a course of rTMS on AN pathology itself.MethodsNineteen patients with AN underwent a 20–30 session open-label course of dorsomedial prefrontal rTMS for comorbid Major Depressive Disorder (MDD) ± PTSD. Resting-state functional MRI was acquired at baseline in 16/19 patients.ResultsFollowing treatment, significant improvements were seen in core AN pathology on the EDE global scale, and to a lesser extent on the shape and weight concerns subscales. Significant improvements in comorbid anxiety, and to a lesser extent depression, also ensued. The greatest improvements were seen in patients with lower baseline functional connectivity from the dorsomedial prefrontal cortex (DMPFC) target to regions in the right frontal pole and left angular gyrus.ConclusionsDespite the limited size of this preliminary, open-label study, the results suggest that rTMS is safe in AN, and may be useful in addressing some core domains of AN pathology. Other targets may also be worth studying in this population, in future sham-controlled trials with larger sample sizes.Trial registrationTrial registration ClinicalTrials.gov NCT04409704.Registered May 282,020. Retrospectively registered.

【 授权许可】

CC BY