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

Abstract

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 o 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.

Brain Connectivity and Symptom Changes After Transcranial Magnetic Stimulation in Patients With Borderline Personality Disorder

“…High effects sizes were observed for the changes in Lack of Premeditation and emotion dysregulation, medium effect sizes were observed for changes in Lack of Perseverance and in anxiety and depression levels. The results are consistent with previous studies, specifically the decreased anxiety ( 19 , 22 ), depression ( 14 , 15 , 18 – 20 , 22 ), impulsivity ( 15 , 19 , 20 ) and affective instability ( 16 ). Overall, rTMS treatment had positive effects on some BPD symptoms including anxiety, depression, emotion dysregulation, and impulsivity.…”

“…Overall, rTMS treatment had positive effects on some BPD symptoms including anxiety, depression, emotion dysregulation, and impulsivity. Interestingly, only one study ( 16 ) used high-frequency stimulation of the right DLPFC such as in our study; other studies used low-frequency stimulation of the same area ( 19 ), or high-frequency stimulation of the left DLPFC ( 14 , 15 , 19 , 20 ), or DMPFC stimulation ( 18 , 22 ). Our results are consistent across the previous studies ( 23 ).…”

“…Repetitive transcranial magnetic stimulation (TMS, rTMS) is a potentially innovative method in the treatment of BPD. rTMS was used in patients with BPD in nine studies with a total sample of 72 BPD patients ( 14 – 22 ); two of those studies (24 total patients) were placebo-controlled studies ( 16 , 22 ). Most of the studies targeted the prefrontal cortex because it is hypothesized that high frequency rTMS can increase prefrontal excitability and, subsequently, prefrontal-limbic connectivity.…”

A feasibility trial of conjoint magnetic seizure therapy and dialectical behavior therapy for suicidal patients with borderline personality disorder and treatment-resistant depression

“…At least one study showed that more severe baseline depression lowers the response to evidencebased psychotherapies for BPD, such as dialectical behaviour therapy (DBT) 4 . Further, available evidence does not generally support the use Article https://doi.org/10.1038/s44220-022-00003-x severity and depression commonly observed in suicidal individuals with BPD [16][17][18][19] . In this Article, we present the results from an open-label clinical trial investigating the feasibility, and clinical and cognitive effects, of a 5-week course of conjoint MST plus DBT (n = 9) compared with DBT alone (n = 10) in suicidal patients with comorbid BPD and treatment-resistant depression.…”

Neuromodulation approaches for borderline personality disorder

“…She also had difficulties with self‐esteem and anger management. The second patient was a 20‐year‐old male who had a history of depression and anxiety, low self‐esteem and interpersonal problems 13 …”