Improvement in borderline personality disorder symptomatology after repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: preliminary results

Objective: Current treatment for borderline personality disorder (BPD) involves psychological and pharmacological interventions. However, neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) may positively affect BPD symptomatology. The objective of this study was to evaluate the clinical and neuropsychological effects of rTMS on the dorsomedial prefrontal cortex (DMPFC) in BPD patients. Methods: Fourteen patients with BPD were randomized into two groups (active vs. sham) for 15 sessions of rTMS on the DMPFC. Clinical effects were measured using the Borderline Symptoms List (BSL), Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity over Time (BEST), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Barratt's Impulsiveness Scale (BIS). Neuropsychological effects were determined by a Stop-Signal Task (SST), the Wisconsin Card-Sorting Test (WCST), and the Iowa Gambling Test (IGT). Results: Within-group comparison showed significant differences (p < 0.05) in CGI-BPD (total score and six of nine psychopathologic domains), BEST, HDRS, HARS, and IGT scores for active modality. Conclusion: The 5 Hz-DMPFC rTMS technique was well tolerated and lessened the severity of BPD symptomatology, especially abandonment, affective issues, interpersonal relationships, suicidal behavior, anger, and paranoid ideation. Cognitive improvement was seen in decision-making. Additional studies are needed to fully evaluate the effects of rTMS on BPD symptomatology. Clinical Trial Registration: NCT03832777.

Características clínicas, neuropsicológicos y psicofisiológicos del trastorno por atracón: Resultados preliminares / Clinical, neuropsychological and psychophysiological features of binge eating disorder: Preliminary results

Resumen El trastorno por atracón (TA) es una condición compleja en la que se han descrito diferentes aspectos clínicos y fallas neuropsicológicas en los sujetos que lo padecen. En este estudio se compararon variables clínicas (VC), neuropsicológicas (VNPS) y psicofisiológicas (VPFS) entre participantes sanos (n = 15) y con TA (n = 15) evaluados en la [Omitido por el editor]. Las VC incluyeron el inventario del anhelo por el consumo de alimentos (IACA), sintomatología depresiva (SD), ansiedad (SA) e impulsividad. Se utilizaron la Tarea de Cartas de Wisconsin para evaluar flexibilidad cognitiva (FC) y la Tarea de Señal de Alto para control inhibitorio (CI) dentro de las VNPS; en las VPFS se obtuvo la variabilidad de la frecuencia cardiaca (VFC) durante una prueba de exposición a imágenes de alimentos. Los resultados muestran que los participantes con TA obtuvieron puntuaciones mayores en los instrumentos IACA (p < .0001), SD (p < .0001) y SA (p < .0001); mientras que en las VNPS mostraron fallas en la FC con incremento en el porcentaje de errores totales (p = .01), errores perseverativos (p = .03) y CI (p = .004). Para las VPFS se encontró una reducción de la VFC (p < .0001) en aquellos participantes con TA.

Abstract Binge eating disorder (BED) is a complex condition in which different clinical aspects and neuropsychological faults have been treated in subjects who have it. In this study, clinical (VC), neuropsychological (VNPS) and psychophysiological (VPFS) variables were compared between healthy participants (n = 15) and with BED (n = 15) evaluated in the medicine school of the Autonomous University of Querétaro. The VC included the evaluation of the food craving scale (FCS), depressive symptomatology (DS), anxiety (AS) and impulsivity. It is used in the Wisconsin Cards Sorting Test for Cognitive Flexibility (CF) and the Stop Signal Task for Inhibitory Control (IC) within the VNPS; In the VPFS, the heart rate variability (HRV) was obtained during an exposure test to food images. The results showed that the participants obtained high scores in the evaluation instruments for FCS (p < .0001), SD (p < .0001) and SA (p < .0001); whereas in the VNPS it failed in the FC with an increase in the percentage of total errors (p = .01), perseverative errors (p = .03) and CI (p = .004). For the VPFS, a reduction in HRV (p < .0001) was found in those participants with AT.

Clinical improvement in patients with borderline personality disorder after treatment with repetitive transcranial magnetic stimulation: preliminary results

Objective: Current treatment of borderline personality disorder (BPD) consists of psychotherapy and pharmacological interventions. However, the use of repetitive transcranial magnetic stimulation (rTMS) could be beneficial to improve some BPD symptoms. The objective of this study was to evaluate clinical improvement in patients with BPD after application of rTMS over the right or left dorsolateral prefrontal cortex (DLPFC). Method: Twenty-nine patients with BPD from the National Institute of Psychiatry, Mexico, were randomized in two groups to receive 15 sessions of rTMS applied over the right (1 Hz, n=15) or left (5 Hz, n=14) DLPFC. Improvement was measured by the Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity Over Time (BEST), Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), and Barratt Impulsiveness Scale (BIS). Results: Intragroup comparison showed significant (p < 0.05) reductions in every psychopathologic domain of the CGI-BPD and in the total scores of all scales in both groups. Conclusions: Both protocols produced global improvement in severity and symptoms of BPD, particularly in impulsiveness, affective instability, and anger. Further studies are warranted to explore the therapeutic effect of rTMS in BPD. Clinical trial registration: NCT02273674.