rTMS as a Treatment for Anorexia Nervosa

Repetitive transcranial magnetic stimulation in the treatment of eating disorders: A review of safety and efficacy

Eating disorders are a significant public health concern accounting for significant morbidity and mortality. Therapeutic approaches are available to treat eating disorders but less than half of the patients recover. Therapeutic alternatives are needed such as repetitive transcranial magnetic stimulation. I reviewed studies that evaluated the safety and efficacy of this technique for the treatment of eating disorders. The electronic literature on repetitive transcranial magnetic stimulation, theta burst and deep transcranial magnetic stimulation in the treatment of eating disorders was retrieved. The findings were quite heterogeneous in results with some studies showing relatively positive results with reduction of both craving and eating behaviors with active stimulation versus sham. Repetitive transcranial magnetic stimulation was safe. Research in this field was limited by the small number of studies and sample sizes, diversity of stimulation parameters, questionable placebo conditions, the lack of a sham-controlled design and the use of subjective scales lacking in sensitivity. The evidence supporting rTMS for eating disorders is somewhat promising. Future studies on high frequency rTMS of the LDLPFC/DMPFC with increased statistical power, rigorous randomization, outcome measures and optimal parameters are needed to confirm the short- and long-term safety and efficacy of rTMS for the treatment of eating disorders.

Targeting Neural Endophenotypes of Eating Disorders with Non-invasive Brain Stimulation

The term "eating disorders" (ED) encompasses a wide variety of disordered eating and compensatory behaviors, and so the term is associated with considerable clinical and phenotypic heterogeneity. This heterogeneity makes optimizing treatment techniques difficult. One class of treatments is non-invasive brain stimulation (NIBS). NIBS, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), are accessible forms of neuromodulation that alter the cortical excitability of a target brain region. It is crucial for NIBS to be successful that the target is well selected for the patient population in question. Targets may best be selected by stepping back from conventional DSM-5 diagnostic criteria to identify neural substrates of more basic phenotypes, including behavior related to rewards and punishment, cognitive control, and social processes. These phenotypic dimensions have been recently laid out by the Research Domain Criteria (RDoC) initiative. Consequently, this review is intended to identify potential dimensions as outlined by the RDoC and the underlying behavioral and neurobiological targets associated with ED. This review will also identify candidate targets for NIBS based on these dimensions and review the available literature on rTMS and tDCS in ED. This review systematically reviews abnormal neural circuitry in ED within the RDoC framework, and also systematically reviews the available literature investigating NIBS as a treatment for ED.