Repetitive Transcranial Magnetic Stimulation Treatment In Severe, Enduring Anorexia Nervosa: An Open Longer-Term Follow-Up

Objective This study assessed longer-term outcomes from a randomised controlled feasibility trial of 20 sessions of real versus sham high-frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex in adults with severe, enduring anorexia nervosa (SE-AN). Methods Thirty participants who completed the original study protocol were invited to take part in an open follow-up (18-months post-randomisation), assessing body mass index (BMI), eating disorder (ED) symptoms and other psychopathology. Results Twenty-four participants (12 each originally allocated to real/sham) completed the 18-month follow-up. Ten of 12 participants who originally received sham treatment had real rTMS at some stage during the follow-up. A medium between-group effect size was seen for BMI change from baseline to 18-months, favouring those originally allocated to real rTMS. In this group at 18-months, five participants were weight recovered (BMI >= 18.5 kg/m(2)), compared with one participant in the original sham group. Both groups showed further improvement in ED symptoms during the follow-up. Effects on mood were largely maintained at follow-up, with catch-up effects in the original sham group. Conclusions Findings suggest that rTMS treatment effects on mood are durable and that BMI and ED symptom improvements need time to emerge. Large-scale trials are needed. HighlightsAt 18-months post-randomisation, mood improvements seen in the real rTMS group at 4-months post-randomisation remained broadly stable. In relation to body mass index (BMI) change, whilst there were further improvements in both groups up to the 18-month follow-up, change in the original real rTMS group was larger. Participants in both the real rTMS and sham rTMS groups showed further improvements in eating disorder symptoms and associated psychosocial impairment during the follow-up with small between-group differences at 18-months.