The Impact of Repetetive Transcranial Magnetic Stimulation (rTMS) Treatment on Borderline Personality Disorder Symptoms: A Case Report

Gündoğmuş, İbrahim; Örnek, Bahar Yeşil; Altinyay, Nursel

doi:10.5455/pbs.20180702035133

Cited by 7 publications

(4 citation statements)

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“…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.…”

Section: Discussionsupporting

confidence: 93%

“…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 ).…”

Section: Discussionmentioning

confidence: 87%

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

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 87%

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

et al. 2022

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“…It is important to underline this, since age is known to affect rTMS response when looking at groups with a wider age range. In line with the previous studies [49][50][51], personality disorders did not have a significant effect at all. Despite the reported overall very positive and highly promising findings of this specific rTMS protocol for treating bipolar disorder, including high efficacy (61% remission directly after treatment and 78% at 1-month follow-up) and tolerability (no adverse effects), it is important to point out that the results of this open-label naturalistic study should be interpreted with caution due to the intrinsic limitations of such designs.…”

Section: Discussionsupporting

confidence: 92%

A Different rTMS Protocol for a Different Type of Depression: 20.000 rTMS Pulses for the Treatment of Bipolar Depression Type II

Koutsomitros

Zee

Evagorou³

et al. 2022

JCM

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In this open-label naturalistic study, we assess the feasibility, tolerability, and effectiveness of a repetitive transcranial magnetic stimulation protocol with a reduced total pulse number for treating patients suffering from bipolar disorder type II. All patients received one rTMS treatment session of 1000 pulses for 20 consecutive working days, accumulating to 20.000 rTMS pulses applied over 4 weeks. We measured the patients’ symptoms before the start, halfway through, directly after, and one month after treatment. We quantified the depression symptoms using both the Beck depression inventory scale and the symptom checklist-90 depression subscale. Patients showed a significant reduction in depression symptoms directly after treatment and an even further reduction one month after treatment. The remission rates were at 26% halfway through treatment (after the 10th session), 61% directly after treatment (after the 20th session), and increased to 78% at the 1-month follow-up. Importantly, the protocol proved to be feasible and highly tolerable in this patient population, with no adverse effects being reported. Considering these positive results, further research should focus on replicating these findings in larger clinical samples with control groups and longer follow-up periods, while potentially adding maintenance sessions to optimize the treatment effect and stability for bipolar disorder type II patients.

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“…For the treatment of BPD its application has been investigated in several studies and estimated in one meta-analysis by Konstantinou et al [ 15 ]. Gündoğmuş et al [ 16 ] reported a reduction in impulsivity, one of the BPD core symptoms, after rTMS in a case report which was later supported in a randomized trial by Lisoni et al [ 17 ]. Overall, a reduction of symptom severity after rTMS stimulation was reported [ 18 ] and Rachid [ 19 ] emphasized that TMS were safe and potentially effective in reduction of symptoms of BPD.…”

Section: Introductionmentioning

confidence: 95%

Theta burst stimulation add on to dialectical behavioral therapy in borderline-personality-disorder: methods and design of a randomized, single-blind, placebo-controlled pilot trial

Kujovic,

Benz,

Riesbeck

et al. 2023

Eur Arch Psychiatry Clin Neurosci

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Specialized psychotherapeutic treatments like dialectical behavioral therapy (DBT) are recommended as first treatment for borderline personality disorder (BPD). In recent years, studies have emerged that focus on repetitive transcranial magnetic stimulation (rTMS) in BPD. Both have independently demonstrated efficacy in the treatment of BPD. Intermitted theta burst stimulation (iTBS), a modified design of rTMS, is thought to increase the excitability of neurons and could be a supplement to psychotherapy in addition to being a standalone treatment. However, no studies to date have investigated the combination of DBT and rTMS/iTBS. This study protocol describes the methods and design of a randomized, single-blinded, sham-controlled clinical pilot study in which BPD patients will be randomly assigned to either iTBS or sham during four consecutive weeks (20 sessions in total) in addition to standardized DBT treatment. The stimulation will focus on the unilateral stimulation of the left dorsolateral prefrontal cortex (DLPFC), which plays an important role in the control of impulsivity and risk-taking. Primary outcome is the difference in borderline symptomatology, while secondary target criteria are depressive symptoms, general functional level, impulsivity and self-compassion. Statistical analysis of therapy response will be conducted by Mixed Model Repeated Measurement using a 2 × 2-factorial between-subjects design with the between-subject factor stimulation (TMS vs. Sham) and the within-subject factor time (T0 vs. T1). Furthermore, structural magnetic resonance imaging (MRI) will be conducted and analyzed. The study will provide evidence and insight on whether iTBS has an enhancing effect as add-on to DBT in BPD.Trial registration: drks.de (DRKS00020413) registered 13/01/2020.

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The Impact of Repetetive Transcranial Magnetic Stimulation (rTMS) Treatment on Borderline Personality Disorder Symptoms: A Case Report

Cited by 7 publications

References 0 publications

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

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

A Different rTMS Protocol for a Different Type of Depression: 20.000 rTMS Pulses for the Treatment of Bipolar Depression Type II

Theta burst stimulation add on to dialectical behavioral therapy in borderline-personality-disorder: methods and design of a randomized, single-blind, placebo-controlled pilot trial

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