A Randomised Controlled Trial of Neuronavigated Repetitive Transcranial Magnetic Stimulation (rTMS) in Anorexia Nervosa.
A Randomised Controlled Trial of Neuronavigated Repetitive Transcranial Magnetic Stimulation (rTMS) in Anorexia Nervosa.
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DOI：
10.1371/journal.pone.0148606
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Schmidt U
中科院分区：
文献类型：
--
作者：
McClelland J;Kekic M;Bozhilova N;Nestler S;Dew T;Van den Eynde F;David AS;Rubia K;Campbell IC;Schmidt U
神经性厌食症(AN)与对肥胖的病态恐惧、极端的食物限制和自我调节的改变有关。神经成像数据牵涉到额纹状体回路，包括背外侧前额叶皮质(DLPFC)。在这项双盲平行研究中，我们观察了一次假控制高频重复经颅磁刺激对60例AN患者左侧DLPFC(L-DLPFC)的影响。在手术前后进行食物暴露任务，以引发AN相关症状。主要的结果衡量标准是‘核心AN症状’，这是一个结合了几个主观AN相关经历的变量。还研究了rTMS对其他精神病理学指标(如情绪)、时间折扣(TD；跨期选择行为)和唾液皮质醇浓度的影响。对安全性、耐受性和可接受性进行评估。49名参与者完成了这项研究。虽然rTMS对核心AN症状没有交互作用，但有一种组间差异的趋势(p=0.056)：在控制rTMS前评分后，与接受假刺激的人相比，接受rTMS治疗后和24小时随访时的症状有所减轻。真/假rTMS后，其他精神病理学改变不明显。与TD相关，存在交互作用趋势(p=0.060)：真实与虚假rTMS导致TD(更具反思性选择行为)的比率降低。唾液皮质醇浓度在刺激后没有变化。RTMS是安全的，耐受性良好，被认为是一种可接受的干预措施。这项研究提供了适度的证据，表明L-DLPFC的rTMS暂时缓解了AN的核心症状，并鼓励谨慎的决策。重要的是，rTMS患者被认为是一种可行的治疗选择。这些发现需要在多个疗程的研究中重复，以评估治疗效果。Www.ControlLED-trials.com ISRCTN22851337
Anorexia nervosa (AN) is associated with morbid fear of fatness, extreme food restriction and altered self-regulation. Neuroimaging data implicate fronto-striatal circuitry, including the dorsolateral prefrontal cortex (DLPFC). In this double-blind parallel group study, we investigated the effects of one session of sham-controlled high-frequency repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC (l-DLPFC) in 60 individuals with AN. A food exposure task was administered before and after the procedure to elicit AN-related symptoms. The primary outcome measure was ‘core AN symptoms’, a variable which combined several subjective AN-related experiences. The effects of rTMS on other measures of psychopathology (e.g. mood), temporal discounting (TD; intertemporal choice behaviour) and on salivary cortisol concentrations were also investigated. Safety, tolerability and acceptability were assessed. Fourty-nine participants completed the study. Whilst there were no interaction effects of rTMS on core AN symptoms, there was a trend for group differences (p = 0.056): after controlling for pre-rTMS scores, individuals who received real rTMS had reduced symptoms post-rTMS and at 24-hour follow-up, relative to those who received sham stimulation. Other psychopathology was not altered differentially following real/sham rTMS. In relation to TD, there was an interaction trend (p = 0.060): real versus sham rTMS resulted in reduced rates of TD (more reflective choice behaviour). Salivary cortisol concentrations were unchanged by stimulation. rTMS was safe, well–tolerated and was considered an acceptable intervention. This study provides modest evidence that rTMS to the l-DLPFC transiently reduces core symptoms of AN and encourages prudent decision making. Importantly, individuals with AN considered rTMS to be a viable treatment option. These findings require replication in multiple-session studies to evaluate therapeutic efficacy. www.Controlled-Trials.com ISRCTN22851337