unanticipated rapid remission of refractory bulimia nervosa, during high-dose repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: a case report

unanticipated rapid remission of refractory bulimia nervosa, during high-dose repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: a case report

;Jonathan eDownar;Jonathan eDownar;Ashwin eSankar;Peter eGiacobbe;Peter eGiacobbe;Blake eWoodside;Blake eWoodside;Patricia eColton;Patricia eColton
journal of experimental psychology general 2012 Vol. 3 pp. -
292
edownar2012frontiersunanticipated

Abstract

A woman with severe, refractory bulimia nervosa underwent treatment for comorbid depression using repetitive transcranial magnetic stimulation (rTMS) of the dorsomedial prefrontal cortex (DMPFC) using a novel technique. Unexpectedly, she showed a rapid, dramatic remission from bulimia nervosa. For 5 months pre-treatment, she had reported two 5-hour binge-purge episodes per day. After rTMS session 2 the episodes stopped entirely for 1 week; after session 10 there were no further recurrences. Depression scores improved more gradually to remission at session 10. Full remission from depression and binge-eating/purging episodes was sustained more than 2 months after treatment completion. In neuroimaging studies, the DMPFC is important in impulse control, and is underactive in bulimia nervosa. DMPFC-rTMS may have enhanced the patient’s ability to deploy previously acquired strategies to avoid binge-eating and purging via a reduction in her impulsivity. A larger sham-controlled trial of DMPFC-rTMS for binge-eating and purging behavior may be warranted.

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