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

Abstract

ObjectivesRepetitive transcranial magnetic stimulation (rTMS) is an innovative method in the treatment of borderline personality disorder (BPD). We hypothesized that prefrontal rTMS in patients with BPD leads to improved BPD symptoms and that these effects are associated with brain connectivity changes.MethodsFourteen patients with BPD received 15 sessions of individually navigated prefrontal rTMS over the right dorsolateral prefrontal cortex. Clinical effects were measured by the Borderline Symptom List 23, UPPS-P, the Difficulties in Emotion Regulation Scale (DERS), the Zung Self-Rating Anxiety Scale (SAS), and the Montgomery and Åsberg Depression Rating Scale (MADRS). Effects of rTMS on brain connectivity were observed with a seed correlation analysis on resting-state fMRI and with a beta series correlation analysis on Go/No Go tasks during fMRI. Assessments were made before and immediately after the treatment.ResultsThe assessments after rTMS showed significant reductions in two subscales of UPPS-P, and in DERS, SAS, and MADRS. The brain connectivity analysis revealed significant decreases in amygdala and insula connectivity with nodes of the posterior default mode network (pDMN; precuneus, posterior cingulate cortex, parietal lobules). Connectivity changes were observed both in the resting state and during inhibition. The decrease of amygdala-pDMN connectivity was positively correlated with reduced depression and lack of premeditation after rTMS.ConclusionsDespite the study limitations (open single-arm study in a small sample), our findings suggest a possible neural mechanism of rTMS effect in BPD, reduced amygdala connectivity with the pDMN network, which was positively associated with symptom reduction.

The Neurobiology of Emotion Regulation in Personality Disorders

“…Using an adapted version of a functional magnetic resonance imaging emotion regulation task, Cremers et al [22] found that BPD participants displayed higher amygdala connectivity strength compared to healthy controls (HC) in their exploratory analyses. When investigating the effects of transcranial magnetic stimulation on BPD participants, Sverak et al [23] observed significant decreases in amygdala and insula connectivity following treatment, which correlated with symptom reduction. In their study using random forest models based on clinical and neuroimaging data to predict the response to dialectical behavior therapy (DBT), Schmitgen et al [24] also identified amygdala-and parahippocampus-activation during a cognitive reappraisal task as central regions related to dysfunctional emotion regulation.…”

Fisiopatologia E Abordagens Terapêuticas Eficazes No Tratamento Do Transtorno De Personalidade Borderline: Uma Revisão Bibliográfica De Literatura

“…Uma das abordagens inovadoras que está ganhando destaque é o uso de técnicas de neurofeedback e estimulação magnética transcraniana (EMT) como terapias adjuvantes no TPB (Konstantinou et al, 2021). O neurofeedback envolve o treinamento do cérebro para autoregular padrões de atividade cerebral específicos, enquanto a EMT utiliza campos magnéticos para modular a atividade neuronal em regiões específicas do cérebro (SVERAK et al, 2022). Estudos preliminares sugerem que essas técnicas podem ser eficazes na redução de sintomas do TPB, como impulsividade e instabilidade emocional, oferecendo novas opções de tratamento para os pacientes (Sverak et al, 2022).…”

The neurobiology of misophonia and implications for novel, neuroscience-driven interventions

“…In MDD and PTSD patients, 5 Hz TMS to the dlPFC was also found to reduce the problematic hyperconnectivity between the sgACC, the insula and the DMN ( Philip et al, 2018 ). In borderline personality disorder, HF-rTMS over the right dlPFC yielded a decrease in connections between the amygdala/insula and precuneus, PCC, and parietal lobules ( Sverak et al, 2021 ). Similarly, tDCS over the left dlPFC led to increased long-term cerebral blood flow to the ACC ( Jog et al, 2021 ), and reduced activation of the amygdala ( Ironside et al, 2019 ).…”