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rTMS Therapy for Eating Disorders: Scoping Review on Efficacy, Safety, Stimulation Parameters and Study Subjects
Shun Takahashi1,2,3,4, Shunichiro Ikeda5, Masaya Ueda2
1Department of Psychiatry, Graduate School of Medicine, The University of Osaka, Osaka, Japan.
Summary
Repetitive transcranial magnetic stimulation (rTMS) shows promise for eating disorders. While effective for anorexia nervosa symptoms, its efficacy for bulimia nervosa requires further investigation, necessitating optimized stimulation parameters.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Psychology
Background:
- Repetitive transcranial magnetic stimulation (rTMS) is an emerging non-invasive neuromodulation technique.
- Eating disorders represent a significant public health concern with limited effective treatment options.
- Understanding the therapeutic potential of rTMS in eating disorders is crucial for advancing treatment strategies.
Purpose of the Study:
- To conduct a scoping review of clinical interventional studies on rTMS for eating disorders.
- To examine the efficacy and safety of rTMS therapy for various eating disorders.
- To identify optimal stimulation parameters and clinical statuses for rTMS treatment.
Main Methods:
- A systematic search was conducted across four major databases: PubMed, Scopus, Web of Science, and PsycInfo.
- The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework.
- Thirty-two clinical interventional studies involving patients with eating disorders treated with rTMS were included.
Main Results:
- rTMS demonstrated benefits for mood and eating disorder symptoms in patients with anorexia nervosa.
- Improvements in binge eating and impulsivity were observed in patients with bulimia nervosa, though not always statistically significant in randomized controlled trials.
- No serious adverse events were reported, and high-frequency stimulation of the left dorsolateral prefrontal cortex (20,000 stimulations) was commonly used.
Conclusions:
- Current stimulation protocols, particularly the number of pulses to the left dorsolateral prefrontal cortex, may be insufficient.
- The dorsomedial prefrontal cortex is proposed as a potentially effective stimulation site for binge-purge symptoms.
- Future research should prioritize optimizing rTMS parameters such as frequency, intensity, session number, and stimulation site for enhanced efficacy.
