TMS for Anorexia Nervosa

A pilot study shows promising benefits without the lasting effects of ECT.

Given the lack of highly effective treatments for adults with anorexia nervosa (AN), there is naturally interest in trying strategies used for other treatment-refractory conditions. One example is transcranial magnetic stimulation (TMS), which has been applied to depression. Rather than medications, it uses noninvasive magnetic fields to stimulate brain cells in a way that reduces symptoms of depression. TMS differs from electroconvulsive therapy (ECT) in not requiring anesthesia, not involving a seizure, and being free from the lasting cognitive effects that may occasionally occur following ECT. A recent study by Dalton and colleagues (BMJ Open. 2018; 8:E021531) describes the results of a pilot trial of TMS in AN.

A comparison study shows the benefits and a few limitations of TMS

The study included 17 people who received active TMS and 17 people who were given sham or placebo-like TMS stimulation (a procedure not expected to provide any benefit). Measurements included changes in body mass index (BMI; kg/m2) over time, as well as measures of mood, eating disorder symptoms, and quality of life. Standard-of-care ED treatment was also provided.  A total of 20 treatment sessions were administered over a month, and the treatment target was the left dorsolateral prefrontal cortex. Importantly, this is the brain region typically targeted in the treatment of major depression.

The results shows small effects for BMI and global Eating Disorder Examination scores, with slightly better improvement in the active than in the sham condition. Larger changes were seen in quality of life, and particularly in mood, with both favoring active treatment.

The authors correctly note that this is a pilot study, and that larger studies of TMS are certainly warranted based on these results. It’s interesting to note that when an area usually tied to mood was targeted with TMS, the most prominent changes were seen in mood. This may not be surprising, and it is certainly something that can be seen with other treatments for AN, but the changes associated with TMS exceeded those associated with the sham condition.  One limitation of TMS is that it cannot readily target treatments deep within the brain, and some logical targets in people with AN would be relatively deep. Nonetheless, this work clearly needs further exploration, as it holds some promise in augmenting with the treatment of anorexia nervosa.

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