Ventrolateral prefrontal cortex repetitive transcranial magnetic stimulation in the treatment of depersonalization disorder: A consecutive case series.
Case reports and an open trial have reported promising responses to repetitive transcranial magnetic stimulation (rTMS) to prefrontal and temporo-parietal sites in patients with depersonalization disorder (DPD). We recently showed that a single session of rTMS to the ventrolateral prefrontal cortex (VLPFC) was associated with a reduction in symptoms and increase in physiological arousal. Seven patients with medication-resistant DSM-IV DPD received up to 20 sessions of right-sided rTMS to the VLPFC for 10 weeks. Stimulation was guided using neuronavigation software based on participants' individual structural MRIs, and delivered at 110% of resting motor threshold. A session consisted of 1Hz repetitive TMS for 15min. The primary outcome measure was reduction in depersonalization symptoms on the Cambridge Depersonalization Scale (CDS). Secondary outcomes included scores on the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). 20 sessions of rTMS treatment to right VLPFC significantly reduced scores on the CDS by on average 44% (range 2-83.5%). Two patients could be classified as "full responders", four as "partial" and one a non-responder. Response usually occurred within the first 6 sessions. There were no significant adverse events. A randomized controlled clinical trial of VLPFC rTMS for DPD is warranted.
Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK.
Emma-Louise
EL
Jay
Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK.
Steffen
S
Nestler
Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK.
Mauricio
M
Sierra
Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK.
Jessica
J
McClelland
Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK.
Maria
M
Kekic
Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, UK. Electronic address: anthony.david@kcl.ac.uk.
Anthony S
AS
David
D000328:Adult; D003861:Depersonalization / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008131:London; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011569:Psychiatric Status Rating Scales; D012107:Research Design; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
Case series; Depersonalization disorder; Prefrontal cortex; Repetitive transcranial magnetic stimulation