title: A Randomised Controlled Trial of Neuronavigated Repetitive Transcranial Magnetic Stimulation (rTMS) in Anorexia Nervosa.
abstract: BACKGROUND
  Anorexia nervosa (AN) is associated with morbid fear of fatness, extreme food restriction and altered self-regulation. Neuroimaging data implicate fronto-striatal circuitry, including the dorsolateral prefrontal cortex (DLPFC).
  
  
  METHODS
  In this double-blind parallel group study, we investigated the effects of one session of sham-controlled high-frequency repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC (l-DLPFC) in 60 individuals with AN. A food exposure task was administered before and after the procedure to elicit AN-related symptoms.
  
  
  RESULTS
  The primary outcome measure was 'core AN symptoms', a variable which combined several subjective AN-related experiences. The effects of rTMS on other measures of psychopathology (e.g. mood), temporal discounting (TD; intertemporal choice behaviour) and on salivary cortisol concentrations were also investigated. Safety, tolerability and acceptability were assessed.
  
  
  RESULTS
  Fourty-nine participants completed the study. Whilst there were no interaction effects of rTMS on core AN symptoms, there was a trend for group differences (p = 0.056): after controlling for pre-rTMS scores, individuals who received real rTMS had reduced symptoms post-rTMS and at 24-hour follow-up, relative to those who received sham stimulation. Other psychopathology was not altered differentially following real/sham rTMS. In relation to TD, there was an interaction trend (p = 0.060): real versus sham rTMS resulted in reduced rates of TD (more reflective choice behaviour). Salivary cortisol concentrations were unchanged by stimulation. rTMS was safe, well-tolerated and was considered an acceptable intervention.
  
  
  CONCLUSIONS
  This study provides modest evidence that rTMS to the l-DLPFC transiently reduces core symptoms of AN and encourages prudent decision making. Importantly, individuals with AN considered rTMS to be a viable treatment option. These findings require replication in multiple-session studies to evaluate therapeutic efficacy.
  
  
  BACKGROUND
  www.Controlled-Trials.com ISRCTN22851337.
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Jessica
authors.initials: J
authors.lastname: McClelland
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Kekic
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Natali
authors.initials: N
authors.lastname: Bozhilova
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Steffen
authors.initials: S
authors.lastname: Nestler
authors.affiliation: Department of Clinical Biochemistry, King's College Hospital, London, United Kingdom.
authors.forename: Tracy
authors.initials: T
authors.lastname: Dew
authors.affiliation: Neuromodulation Research Clinic, Douglas Mental Health University Institute, Montréal, Québec, Canada.
authors.forename: Frederique
authors.initials: F
authors.lastname: Van den Eynde
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Katya
authors.initials: K
authors.lastname: Rubia
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Iain C
authors.initials: IC
authors.lastname: Campbell
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology; D000856:Anorexia Nervosa / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008297:Male; D017397:Prefrontal Cortex / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D055815:Young Adult
chemical_list: D006854:Hydrocortisone