Chmiel James, Stępień-Słodkowska Marta
Faculty of Physical Culture and Health, Institute of Physical Culture Sciences, University of Szczecin, Al. Piastów 40B blok 6, 71-065 Szczecin, Poland.
J Clin Med. 2024 Sep 10;13(18):5364. doi: 10.3390/jcm13185364.
Bulimia nervosa (BN) is a disorder primarily affecting adolescent females, characterized by episodes of binge eating followed by inappropriate compensatory behaviors aimed at preventing weight gain, including self-induced vomiting and the misuse of diuretics, laxatives, and insulin. The precise etiology of BN remains unknown, with factors such as genetics, biological influences, emotional disturbances, societal pressures, and other challenges contributing to its prevalence. First-line treatment typically includes pharmacotherapy, which has shown moderate effectiveness. Neuroimaging evidence suggests that altered brain activity may contribute to the development of BN, making interventions that directly target the brain extremely valuable. One such intervention is repetitive transcranial magnetic stimulation (rTMS), a non-invasive stimulation technique that has been garnering interest in the medical community for many years.
This review explores the use of rTMS in the treatment of BN. Searches were conducted in the PubMed/Medline, ResearchGate, and Cochrane databases.
Twelve relevant studies were identified. Analysis of the results from these studies reveals promising findings, particularly regarding key parameters in the pathophysiology of BN. Several studies assessed the impact of rTMS on binge episodes. While some studies did not find significant reductions, most reported decreases in binge eating and purging behaviors, with some cases showing complete remission. Reductions in symptoms of depression and food cravings were also demonstrated. However, results regarding cognitive improvement were mixed. The discussion focused heavily on potential mechanisms of action, including neuromodulation of brain networks, induction of neuroplasticity, impact on serotonergic dysfunction, anti-inflammatory action, and HPA axis modulation. rTMS was found to be a safe intervention with no serious side effects.
rTMS in the treatment of BN appears to be a promising intervention that alleviates some symptoms characteristic of the pathophysiology of this disorder. An additional effect is a significant reduction in depressive symptoms. However, despite these findings, further research is required to confirm its effectiveness and elucidate the mechanisms of action. It is also recommended to further investigate the potential mechanisms of action described in this review.
神经性贪食症（BN）是一种主要影响青春期女性的疾病，其特征是暴饮暴食发作，随后出现旨在防止体重增加的不适当代偿行为，包括自我催吐以及滥用利尿剂、泻药和胰岛素。BN的确切病因尚不清楚，遗传、生物影响、情绪障碍、社会压力和其他因素共同导致了其流行。一线治疗通常包括药物治疗，已显示出一定疗效。神经影像学证据表明，大脑活动改变可能导致BN的发生，这使得直接针对大脑的干预措施极具价值。重复经颅磁刺激（rTMS）就是这样一种干预措施，它是一种非侵入性刺激技术，多年来一直引起医学界的关注。
本综述探讨了rTMS在BN治疗中的应用。在PubMed/Medline、ResearchGate和Cochrane数据库中进行了检索。
共确定了12项相关研究。对这些研究结果的分析显示出有前景的发现，特别是关于BN病理生理学中的关键参数。几项研究评估了rTMS对暴饮暴食发作的影响。虽然一些研究未发现显著减少，但大多数报告称暴饮暴食和清除行为有所减少，有些病例显示完全缓解。抑郁症状和食物渴望也有所减轻。然而，关于认知改善的结果不一。讨论主要集中在潜在的作用机制上，包括脑网络的神经调节、神经可塑性的诱导、对血清素功能障碍的影响、抗炎作用和下丘脑-垂体-肾上腺（HPA）轴调节。rTMS被发现是一种安全的干预措施，没有严重的副作用。
rTMS治疗BN似乎是一种有前景的干预措施，可缓解该疾病病理生理学的一些特征性症状。另一个作用是显著减轻抑郁症状。然而，尽管有这些发现，仍需要进一步研究来证实其有效性并阐明作用机制。还建议进一步研究本综述中描述的潜在作用机制。
