Repetitive transcranial magnetic stimulation: A possible novel therapeutic approach to eating disorders

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.

Is transcranial direct current stimulation an effective modality in reducing food craving? A systematic review and meta-analysis

Non-invasive electrical stimulation of the brain has recently been extensively investigated to regulate food craving. However, the existing literature is controversial and there are some important questions which need to be addressed about clinical and technical factors contributing to efficacy of this method. A systematic search was performed in reliable scientific databases, and 15 eligible studies were identified. The pooled standardized mean differences for the effects of transcranial direct current stimulation (tDCS) on Visual Analogue Scale, energy intake and food craving questionnaire were -0.78 [-1.12, -0.44], -0.91 [-1.38, -0.44], -0.54 [-0.85, -0.24], respectively. Subgroup analysis showed that the most important factors associated with the impact of tDCS on food craving were the population under study, current intensity of stimulation, and number of stimulation sessions. The findings of this study support a significant impact of neuromodulation of dorsolateral prefrontal cortex (DLPFC) on energy intake and food craving using tDCS. It is recommended that multisession bilateral stimulation of the DLPFC with the current intensity of 2 mA be used to reduce food craving.

Potential role of repetitive transcranial magnetic stimulation in obesity

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique with mild side effects. Some forms of obesity may arise from eating disorders and recent data suggest that rTMS treatment could have beneficial effects in eating disorders.

PURPOSE

The purpose of this comprehensive review is to hypothesize that rTMS may play a role in obesity.

MATERIALS AND METHODS

Articles were selected based on a search on medline using the terms "rTMS", "food craving", "eating disorders", "addiction", and "obesity". They were published between 1995 and 2013.

RESULTS

Repetitive transcranial magnetic stimulation has been evaluated in the treatment of bulimia nervosa. It appears that it exerts its effect via the reduction of the level of craving for food. Obesity is being recognized as one of the endpoints of food addiction and craving. Besides, rTMS and transcranial direct current stimulation are brain stimulation techniques being used in the treatment of psychoactive substance addiction.

CONCLUSIONS

Repetitive transcranial magnetic stimulation, through the reduction of food craving may be a potential treatment for a subset of individuals suffering from obesity. Further studies with a higher number of subjects are still needed to confirm the effects of rTMS on obesity.

[Transcranial magnetic stimulation for comorbid depression in anorexia]

A 24-year-old anorexic patient with cormobid symptoms of depression was treated for depression with repetitive transcranial magnetic stimulation (rTMS) rather than with psychopharmacotherapy, due to her poor physical condition. The depressive symptomatology significantly improved in correlation with two rTMS cycles but occurred again within 2 weeks. A third successful cycle was then followed by a maintenance rTMS protocol with the patient going into remission from depression. This case illustrates that rTMS may be considered as a therapeutic option for comorbid depression in anorectic patients.

Treatment of bulimia nervosa: where are we and where are we going?

OBJECTIVE

The purpose of this article is to review the extant treatment literature on bulimia nervosa and to offer suggestions for future research directions.

METHOD

The available treatment studies regarding both pharmacotherapy and psychotherapy are reviewed.

RESULTS

Both pharmacotherapy and psychotherapy appear to play a role in the treatment of bulimia nervosa; however, available data suggest that cognitive behavioral therapy remains the treatment of choice.

CONCLUSION

Additional work is clearly indicated regarding assisted and unassisted self-help. An enhanced form of CBT and the integrative cognitive-affective therapy both deserve further study. New approaches need to be piloted. More research is needed on treatment modeling.