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

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Abstract

Background

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).

Methods

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.

Outcomes

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.

Results

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.

Conclusions

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.

Trial Registration

www.Controlled-Trials.com ISRCTN22851337

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Most cited references 62

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Author and article information

Contributors

Phillipa J. Hay: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 23 March 2016

Publication date Collection: 2016

Volume: 11

Issue: 3

Electronic Location Identifier: e0148606

Affiliations

[1 ]Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom

[2 ]Department of Clinical Biochemistry, King’s College Hospital, London, United Kingdom

[3 ]Neuromodulation Research Clinic, Douglas Mental Health University Institute, Montréal, Québec, Canada

Western Sydney University, AUSTRALIA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: JM FVE ICC US. Performed the experiments: JM MK NB SN TD. Analyzed the data: JM MK. Contributed reagents/materials/analysis tools: JM TD FVE ASD KR. Wrote the paper: JM MK ICC US.

* E-mail: jessica.mcclelland@ 123456kcl.ac.uk

Article

Publisher ID: PONE-D-15-39361

DOI: 10.1371/journal.pone.0148606

PMC ID: 4805273

PubMed ID: 27008620

SO-VID: fe447e36-f571-48f8-a33b-fc29f8103e27

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 8 September 2015

Date accepted : 19 January 2016

Page count

Figures: 4, Tables: 2, Pages: 17

Funding

This study represents independent research part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Jessica McClelland is supported by the NIHR BRC. Anthony David, Iain Campbell and Ulrike Schmidt receive salary support from the NIHR Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. Open access for this article was funded by King's College London.

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Data Availability All relevant data are within the paper and its Supporting Information files.

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

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Abstract

Background

Methods

Outcomes

Results

Conclusions

Trial Registration

Related collections

PLOS Climate

Most cited references 62

Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee.

Area under the curve as a measure of discounting.

Task switching.

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Page count

Funding

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