1571 – Efficacy Of Rtms Of The Dorsomedial Prefrontal Cortex On Binge-purge Behaviors In Refractory Anorexia And Bulimia Nervosa: a Case Series
Bibliographic record
Abstract
rTMS is currently being explored as a potential adjunctive treatment for anorexia and bulimia nervosa. Previous studies have found, at best, modest efficacy for rTMS in this setting using the conventional target in the dorsolateral prefrontal cortex (DLPFC). However, neuroimaging studies suggest that the dorsomedial prefrontal cortex (DMPFC) may be more central to inhibiting impulsive thoughts and behaviours such as binge and purge episodes. We have previously reported serendipitous rapid, complete, and durable remission of binge and purge behaviours in a patient with severe bulimia nervosa who was undergoing rTMS of the DMPFC for comorbid major depression (Downar et al., 2012). Here we extend this finding in a larger case series of 15 patients with either anorexia or bulimia nervosa and bingeing and purging behaviours refractory to medications and therapy despite several years of treatment. MRI-guided rTMS of the DMPFC (10 Hz stimulation, 120% resting motor threshold, bilateral, 3000 pulses per hemisphere) achieved full remission from binge and purge episodes in a majority of patients, with parallel improvements in mood and anxiety symptoms. Patients with BMI in the normal range showed a more robust response to treatment. Individual cases also spontaneously reported improvement in comorbid impulse control disorder symptoms, such as kleptomania. Individuals with comorbid obsessive-compulsive disorder (OCD) also reported marked improvements in these symptoms. A subset of patients with lower BMIs showed minimal response. rTMS of the DMPFC may represent an effective adjunct to conventional treatment for binge-purge behaviours. A randomized controlled trial of this approach may be warranted.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".