Repetitive transcranial magnetic stimulation well-tolerated among patients with BPD

Repetitive transcranial magnetic stimulation was well-tolerated among patients with borderline personality disorder and may improve some of their symptoms, according to results of a systematic review published in Psychiatry Research.

“Repetitive Transcranial Magnetic Stimulation (rTMS) is a noninvasive, safe and effective brain stimulation modality for treatment-resistant depression (TRD),” Gerasimos N. Konstantinou, of the department of psychiatry at the University of Toronto in Canada, and colleagues wrote. “The most common target for depression is the [dorsolateral prefrontal cortex]. The [dorsomedial prefrontal cortex]-rTMS has been proposed to enhance cognitive control and reduce impulsivity and suicidality in patients with depression.”

According to the researchers, the extant literature on the application of rTMS among patients with BPD is limited.; however, its neuromodulatory effects on the underlying neural circuitry related to BPD symptoms suggest that it may be a possible treatment option.

Konstantinou and colleagues aimed to address this research gap by systematically searching three databases for studies of any design that assessed the application of rTMS among adult patients with a precise and primary BPD diagnosis written in English. They screened 41 records and included eight, which had a total of 63 patients (53 women; mean age, 29.1 years).

Results suggested rTMS was well-tolerated among patients with BPD. The researchers noted their findings were consistent with those of previous studies that indicated the overall safety of rTMS for patients with BPD, but they noted the research has been limited and consisted of a variety of different stimulation protocols and treatment parameters. Thus, current research does not allow for a quantitative synthesis.

According to Konstantinou and colleagues, rTMS for BPD may help improve impulsivity and emotion regulation. They noted that the lack of a concomitant psychotherapy intervention across all the studies was a “striking observation.”

“Apart from managing design and methodology issues encountered in previous studies, future work should consider addressing the use of rTMS as an augmentation to evidenced-based psychotherapy with consideration of parallel stimulation of cortical regions,” the researchers wrote. “The combination of neuroimaging, and psychotherapeutic approaches known to engage brain networks affected by BPD could have the potential to improve the precision and therapeutic efficacy of rTMS treatment in this challenging population. Such a multimodal approach holds significant promise yet requires collaborative multidisciplinary efforts and presents technical and implementation challenges.”