Repetitive transcranial magnetic stimulation in borderline personality disorder: clinical and brain connectivity changes



Year of publication 2021
Type Conference abstract
MU Faculty or unit

Faculty of Medicine

Description Introduction: Repetitive transcranial magnetic stimulation (rTMS) is an innovative method in the treatment of BPD. Only several studies so far explored the effect of rTMS on BPD symptoms. We hypothesized that prefrontal rTMS in patients with BPD leads to improvement of symptoms with specific brain connectivity changes. Method: Fourteen patients with BPD received 15 sessions of individually navigated prefrontal rTMS over the right dorsolateral prefrontal cortex. Clinical effect was measured by Borderline Symptom List 23 (BSL-23), UPPS-P impulsive behavior scale, Difficulties in emotion regulation scale (DERS), Zung self-reported anxiety scale (SAS), and Montgomery and Asberg Depression Rating Scale (MADRS). Brain connectivity changes after rTMS were assessed with seed connectivity analysis at resting-state fMRI and with beta series connectivity analysis during an fMRI Go/No Go task. Results: Comparison after vs. before rTMS showed a significant decrease in impulsivity, emotion dysregulation, depression, and anxiety. Brain connectivity analysis showed significant decreases in connectivity of the amygdala and insula with nodes of the posterior default mode network (pDMN; precuneus, posterior cingulate cortex, parietal lobules). Changes in connectivity were observed both in the resting state and during inhibition (Go/NoGo task). Moreover, the decrease of amygdala-pDMN connectivity was positively correlated with the reduction of depression and impulsivity after rTMS. Discussion: Despite the study limitations (open single-arm study in a small sample), our findings suggest that reduction of amygdala connectivity with pDMN network, which was positively associated with symptom reduction, is a candidate neural mechanism of rTMS effect in BPD. The observed effect might reflect the reduction of negative self-referential thinking in BPD patients after the rTMS treatment.
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