Baseline and change resting-state functional correlates of rTMS of the DMPFC for medically refractory anorexia and bulimia nervosa
Tuesday, Nov 12, 2013, 8:00 AM - 9:00 AM
++C.17.b. Mood disorders: Human biomarkers and treatment studies
, T. SALOMONS
, N. BAKKER
, J. GERACI
, P. GIACCOBE
, M. OLMSTED
, P. COLTON
, B. WOODSIDE
, J. DOWNAR
Dept. of Psychiatry,
Univ. of Toronto, Toronto, ON, Canada;
Dept. of Psychiatry, Univ. Hlth. Network, Toronto, ON, Canada;
Inst. of Med. Science, Univ. of Toronto, Toronto, ON, Canada;
MRI-Guided rTMS Clinic, Toronto Western Hosp., Toronto, ON, Canada
Transcranial magnetic stimulation (rTMS) has been recently suggested as a potential treatment for anorexia and bulimia nervosa. Previous research has shown modest efficacy with rTMS for eating disorders using the conventional dorsolateral prefrontal cortex target. However, recent neuroimaging research suggests that the dorsomedial prefrontal cortex (DMPFC) is a key region for impulse control and behavior regulation, including bingeing and purging behaviour. Thus, the DMPFC may be a potential rTMS target for the treatment of eating disorders. 20 patients with treatment refractory anorexia and bulimia nervosa underwent 20 sessions of open-label, add-on rTMS to the DMPFC (10 Hz bilateral stimulation, 120% resting motor threshold). Clinical measures, structural and resting-state scans were obtained before and after treatment. Analysis was performed in FSL. Data was first pre-processed (motion corrected, spatially smoothed, regression of global, white matter and cerebrospinal signal, bandpass filtered). Following pre-processing seed-based resting state analysis was performed for
regions-of-interest (bilateral ventral striatum [BVS] and subgenual cortex [sgACC]) and a region in proximity to the area stimulated (DMPFC). Purges/week change (baseline-week 4) categorized subjects into a responder (improvement over 50%) or a non-responder (improvement under 50%). This was used as a regressor for the following group-level analysis: 1) baseline connectivity, and 2) connectivity change. Clinical results showed that purging from baseline to week 4 improved from 25.3±38.8 episodes/week to 17.3±19.2 episodes/week. Baseline DMPFC connectivity was not significantly correlated to response. However, for the BVS seed, high pre-treatment functional connectivity to the precuneus and posterior cingulate cortex (PCC), and for the sgACC seed, high pre-treatment functional connectivity to the precuneus and PCC and low functional connectivity to the right hippocampus and amygdala and midbrain Raphé nuclei, were significantly correlated to clinical response. sgACC connectivity change was not significantly correlated to treatment response. It was found that decreased BVS connectivity to the precuneus and PCC and decreased DMPFC connectivity to the frontopolar cortex were significantly correlated to clinical response. In general, this preliminary study showed altered connectivity in midbrain serotonergic structures and corticostriatal and corticocortical pathways previously implicated in emotion regulation and in the pathophysiology of disordered eating behaviour. A randomized control trial as a next step may be warranted.
B. Contracted Research/Research Grant (principal investigator for a drug study, collaborator or consultant and pending and current grants). If you are a PI for a drug study, report that research relationship even if those funds come to an institution.; Brain Cells Inc., Clera, GSK, St. Jude Medical, Atra-Zeneca, BMS. F. Consulting Fees (e.g., advisory boards); Eli Lilly.
B. Contracted Research/Research Grant (principal investigator for a drug study, collaborator or consultant and pending and current grants). If you are a PI for a drug study, report that research relationship even if those funds come to an institution.; Lundbuck Canada.
TRANSCRANIAL MAGNETIC STIMULATION
Ontario Brain Institute to the Canadian Biomarker Integration Network for Depression
Buchan Family Foundation
Toronto General and Western Hospital Foundation
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