title: Unanticipated Rapid Remission of Refractory Bulimia Nervosa, during High-Dose Repetitive Transcranial Magnetic Stimulation of the Dorsomedial Prefrontal Cortex: A Case Report.
abstract: A woman with severe, refractory bulimia nervosa (BN) 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 BN. For 5 months pre-treatment, she had reported two 5-h 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 BN. 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.
authors.affiliation: MRI-Guided rTMS Clinic, University Health Network Toronto, ON, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Downar
authors.forename: Ashwin
authors.initials: A
authors.lastname: Sankar
authors.forename: Peter
authors.initials: P
authors.lastname: Giacobbe
authors.forename: Blake
authors.initials: B
authors.lastname: Woodside
authors.forename: Patricia
authors.initials: P
authors.lastname: Colton