<p>Insula H-coil deep transcranial magnetic stimulation in severe and enduring anorexia nervosa (SE-AN): a pilot study</p>

Abstract

Introduction Anorexia nervosa (AN) is a complex disorder of unknown etiology, characterized by obsessions and compulsions around body shape, weight, and calorie intake. In the course of AN, 10%–30% will recover, while the rest will develop a treatment-resistant course with a high mortality rate due to AN-related complications. The insula is a region in the brain of considerable interest to its role in gustatory modulation, feeding behavior, and processing of interoceptive stimuli. Objective Recent advances in the neurophysiology of AN suggest insula dysfunction as a potential biomarker for people with severe and enduring AN (SE-AN). Deep transcranial magnetic stimulation (dTMS) is of particular interest in SE-AN because of its ability to target deep areas of the brain. Design We conducted a pilot study to investigate the feasibility and safety of insula dTMS in subjects with SE-AN. Results We found that dTMS is a safe and well-tolerated treatment. We also found a reduction in AN-related obsessions and compulsions, as well as depression and anxiety scores from baseline to the end of the trial. Due to small sample size, the results of this study should be interpreted with great caution. Discussion The results suggest that dTMS is safe and well tolerated and may be of some clinical interest in patients with SE-AN. However, to determine the true efficacy of dTMS for SE-AN, there is a need to conduct a randomized controlled trial comparing real versus sham dTMS in a larger number of AN subjects.

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

“…Therefore, it is possible that strategies used for treatment-resistant depression might be of benefit for people with severe enduring AN. Proof-of-concept studies of neuromodulation such as deep brain stimulation [124] and repetitive transcranial magnetic stimulation have shown potential [125][126][127]. Interestingly, the trajectory of symptom change following these neuromodulation techniques shows differences to that found with more traditional eating disorder treatment, in that an improvement in mood is the main initial effect, whereas improvements in eating disorder psychopathology follow later [125,126,128].…”

Repetitive transcranial magnetic stimulation treatment in severe, enduring anorexia nervosa: An open longer‐term follow‐up

“…Repetitive transcranial magnetic stimulation (rTMS) is a non‐invasive brain stimulation method which has been used successfully to treat psychiatric disorders, such as depression (Sehatzadeh et al, 2019). rTMS has shown promise in proof‐of‐concept studies and small case series in AN and other eating disorders (EDs) (Dalton, Bartholdy, Campbell, & Schmidt, 2018; Dalton, Campbell, & Schmidt, 2017; Knyahnytska, Blumberger, Daskalakis, Zomorrodi, & Kaplan, 2019).…”

Brain Stimulation in Eating Disorders: State of the Art and Future Perspectives

“…Another pilot case series (n = 8 patients with long-lasting AN) used deep rTMS to target the insula and found that this approach was safe and well-tolerated. At the end of the 42 sessions, AN-related obsessions and compulsions were reduced, as were the depression and anxiety scores [30].…”

“…For instance, many findings support a specific disease trajectory, and preliminary evidence suggests that interventions should be matched to the disease stage [134]. Interventions tailored according to ED stage or to the developmental trajectory were tested in a recent pilot study [30]. Some clinical features could also be considered because they are associated with a specific disease form or poorer prognosis, such as ED subtype (restrictive versus binge), age, gender, associated personality traits, psychiatric comorbidities, or history of childhood abuse.…”