Woodside D Blake, Dunlop Katharine, Sathi Charlene, Lam Eileen, McDonald Brigitte, Downar Jonathan
Program for Eating Disorders, University Health Network, Toronto, Canada.
Centre for Mental Health, University Health Network, Toronto, Canada.
J Eat Disord. 2021 Apr 17;9(1):52. doi: 10.1186/s40337-021-00411-x.
Patients 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.
Nineteen 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.
Following 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.
Despite 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 registration ClinicalTrials.gov NCT04409704 . Registered May 282,020. Retrospectively registered.
尽管目前有最佳的常规治疗方法，但神经性厌食症（AN）患者仍面临严重的慢性疾病且死亡率很高。重复经颅磁刺激（rTMS）在治疗与AN共病的多种精神疾病（包括重度抑郁症、强迫症（OCD）和创伤后应激障碍（PTSD））的难治性病例中显示出越来越高的疗效。然而，迄今为止，很少有研究探讨rTMS疗程对AN病理本身的影响。
19名AN患者接受了为期20 - 30次的开放性背内侧前额叶rTMS治疗，用于治疗共病的重度抑郁症（MDD）±PTSD。16/19名患者在基线时进行了静息态功能磁共振成像。
治疗后，在EDE全球量表上，AN的核心病理有显著改善，在体型和体重关注子量表上改善程度较小。共病的焦虑也有显著改善，抑郁改善程度较小。从背内侧前额叶皮质（DMPFC）靶点到右侧额极和左侧角回区域基线功能连接性较低的患者改善最为明显。
尽管这项初步的开放性研究规模有限，但结果表明rTMS在AN患者中是安全的，并且可能有助于解决AN病理的一些核心领域。在未来更大样本量的假对照试验中，其他靶点也可能值得在这一人群中进行研究。
试验注册ClinicalTrials.gov NCT04409704。于2020年5月28日注册。回顾性注册。
