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Title: Brain-directed interventions for eating disorders : the potential of repetitive transcranial magnetic stimulation in the treatment of anorexia nervosa
Author: McClelland, Jessica Kate
ISNI:       0000 0004 5368 4821
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2015
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Background: Advances in neuroscience have led to a deeper understanding of the neuro-circuitry associated with eating disorders (ED). There is however, a lack of brain-directed treatment options. Neuromodulatory techniques have therapeutic efficacy in other psychiatric disorders and evidence in ED is promising. There is a need for further studies of neuromodulation in ED, to probe disease mechanisms and to develop novel treatments. The aim of this research is to explore the use of neuromodulation in ED and specifically assess the utility of repetitive transcranial magnetic stimulation (rTMS) in anorexia nervosa (AN). Methods: An overview of ED and their neurocircuitry underpinnings is presented. A systematic review of the literature regarding the effects of neuromodulation on eating related outcomes was also conducted. The effects of neuronavigated (MRI-guided) rTMS in AN is explored in a single-session randomised control trial (RCT) and in a 20-session therapeutic case series. Results: The systematic review supports further research on neuromodulation in ED. The single-session RCT of real versus sham rTMS in 51 individuals with AN demonstrated that following real rTMS, individuals report reduced AN symptoms and an increased liking of specific foods. Real/sham rTMS did not alter salivary cortisol concentrations and levels of cortical excitability were associated with AN symptomatology. Lastly, rTMS proved to be safe, tolerable and acceptable in people with AN. A neurocognitive measure of intertemporal choice showed that rTMS encourages prudent decision making in AN: this may underlie the effects of rTMS on AN symptoms. Whilst a therapeutic case series of five individuals with enduring AN did not lead to weight gain, significant improvements in ED and general psychopathology were reported and sustained. Conclusions: rTMS has the ability to improve core symptomatology in AN and alter decision making processes. Therefore, neuromodulation may be a viable treatment adjunct for people with an ED.
Supervisor: Campbell, Iain Cameron ; Schmidt, Ulrike Hermine Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available