TY - JOUR
T1 - A pilot study exploring the effect of repetitive transcranial magnetic stimulation (rTMS) treatment on cerebral blood flow and its relation to clinical outcomes in severe enduring anorexia nervosa
AU - Dalton, Bethan
AU - Maloney, Erica
AU - Rennalls, Samantha J.
AU - Bartholdy, Savani
AU - Kekic, Maria
AU - McClelland, Jessica
AU - Campbell, Iain C.
AU - Schmidt, Ulrike
AU - O’Daly, Owen G.
N1 - Funding Information:
OGO receives salary support from an NIHR Infrastructure grant for the Wellcome Trust/King’s College London Clinical Research Facility. Ulrike Schmidt is supported by an NIHR Senior Investigator Award. Ulrike Schmidt and Iain C. Campbell receive salary support from the NIHR Mental Health BRC at SLaM NHS Foundation Trust and King’s College London. Savani Bartholdy and Samantha J. Rennalls were supported by studentships awarded by the NIHR Mental Health BRC at SLaM. Maria Kekic was supported by an Institute of Psychiatry, Psychology and Neuroscience/Medical Research Council Excellence Studentship.
Funding Information:
This paper presents independent research funded by the National Institute of Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1013-32049). This work was also supported by Infrastructure Support for Pilot studies from the NIHR Biomedical Research Centre at South London and Maudsley (SLaM) NHS Foundation Trust and King’s College London (KCL). This study was also supported by the United Kingdom Clinical Research Collaboration-registered King’s Clinical Trials Unit at King’s Health Partners, which is part-funded by the NIHR BRC for Mental Health at SLaM NHS Foundation Trust and KCL and the NIHR Evaluation, Trials and Studies Coordinating Centre.
Funding Information:
We would like to thank the individuals who participated in this study for their time and commitment and our patient and public involvement advisors for their valuable feedback. The authors also wish to thank the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at the Maudsley and the Wellcome Trust for their continued support of neuroimaging research at our institution.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment option for people with severe enduring anorexia nervosa (SE-AN), but associated neurobiological changes are poorly understood. This study investigated the effect of rTMS treatment on regional cerebral blood flow (CBF) and whether any observed changes in CBF are associated with changes in clinical outcomes in people with SE-AN. Methods: As part of a randomised sham-controlled feasibility trial of 20 sessions of high-frequency rTMS to the left dorsolateral prefrontal cortex, 26 of 34 trial participants completed arterial spin labelling (ASL) functional magnetic resonance imaging (fMRI) to quantify regional and global resting state CBF before (pre-randomisation baseline) and after real or sham treatment (1-month post-randomisation). A group of healthy females (n = 30) were recruited for baseline comparison. Clinical outcomes, including BMI, and depression and anxiety symptoms, were assessed at baseline, 1-, 4-, and 18-months post-randomisation. Results: No group differences in regional CBF were identified between the SE-AN and healthy comparison participants. A significant treatment-by-time interaction in a medial temporal lobe cluster with the maximal peak in the right amygdala was identified, reflecting a greater reduction in amygdala CBF following real rTMS compared to sham. Participants with the greatest rTMS-related reduction in amygdala CBF (i.e., between baseline and 1-month post-randomisation) showed the greatest sustained weight gain at 18-months post-randomisation. Higher baseline CBF in the insula predicted greater weight gain between baseline and 1-month post-randomisation and between baseline and 4-months post-randomisation. Conclusions: This exploratory pilot study identified rTMS treatment related changes in CBF in adults with SE-AN and these were associated with changes in weight. Our preliminary findings also suggest that CBF (as measured by ASL fMRI) may be a marker of rTMS treatment response in this patient group. Future rTMS studies in AN should employ longitudinal neuroimaging to further explore the neurobiological changes related to rTMS treatment. Trial registration: ISRCTN14329415, registered 23rd July 2015.
AB - Background: Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment option for people with severe enduring anorexia nervosa (SE-AN), but associated neurobiological changes are poorly understood. This study investigated the effect of rTMS treatment on regional cerebral blood flow (CBF) and whether any observed changes in CBF are associated with changes in clinical outcomes in people with SE-AN. Methods: As part of a randomised sham-controlled feasibility trial of 20 sessions of high-frequency rTMS to the left dorsolateral prefrontal cortex, 26 of 34 trial participants completed arterial spin labelling (ASL) functional magnetic resonance imaging (fMRI) to quantify regional and global resting state CBF before (pre-randomisation baseline) and after real or sham treatment (1-month post-randomisation). A group of healthy females (n = 30) were recruited for baseline comparison. Clinical outcomes, including BMI, and depression and anxiety symptoms, were assessed at baseline, 1-, 4-, and 18-months post-randomisation. Results: No group differences in regional CBF were identified between the SE-AN and healthy comparison participants. A significant treatment-by-time interaction in a medial temporal lobe cluster with the maximal peak in the right amygdala was identified, reflecting a greater reduction in amygdala CBF following real rTMS compared to sham. Participants with the greatest rTMS-related reduction in amygdala CBF (i.e., between baseline and 1-month post-randomisation) showed the greatest sustained weight gain at 18-months post-randomisation. Higher baseline CBF in the insula predicted greater weight gain between baseline and 1-month post-randomisation and between baseline and 4-months post-randomisation. Conclusions: This exploratory pilot study identified rTMS treatment related changes in CBF in adults with SE-AN and these were associated with changes in weight. Our preliminary findings also suggest that CBF (as measured by ASL fMRI) may be a marker of rTMS treatment response in this patient group. Future rTMS studies in AN should employ longitudinal neuroimaging to further explore the neurobiological changes related to rTMS treatment. Trial registration: ISRCTN14329415, registered 23rd July 2015.
KW - Anorexia nervosa
KW - Arterial spin labelling
KW - Cerebral blood flow
KW - Eating disorders
KW - Functional magnetic resonance imaging
KW - Repetitive transcranial magnetic stimulation
UR - http://www.scopus.com/inward/record.url?scp=85109746423&partnerID=8YFLogxK
U2 - 10.1186/s40337-021-00420-w
DO - 10.1186/s40337-021-00420-w
M3 - Article
AN - SCOPUS:85109746423
SN - 2050-2974
VL - 9
JO - Journal of Eating Disorders
JF - Journal of Eating Disorders
IS - 1
M1 - 84
ER -
