AUTHOR=Downar Jonathan , Sankar Ashwin , Giacobbe Peter , Woodside Blake , Colton Patricia 

TITLE=Unanticipated Rapid Remission of Refractory Bulimia Nervosa, during High-Dose Repetitive Transcranial Magnetic Stimulation of the Dorsomedial Prefrontal Cortex: A Case Report

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 3 - 2012

YEAR=2012

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2012.00030

DOI=10.3389/fpsyt.2012.00030

ISSN=1664-0640

ABSTRACT=A woman with severe, refractory bulimia nervosa underwent treatment for comorbid depression using repetitive transcranial magnetic stimulation (rTMS) of the dorsomedial prefrontal cortex (DMPFC) using a novel technique.  Unexpectedly, she showed a rapid, dramatic remission from bulimia nervosa. For 5 months pre-treatment, she had reported two 5-hour binge-purge episodes per day.  After rTMS session 2 the episodes stopped entirely for 1 week; after session 10 there were no further recurrences.  Depression scores improved more gradually to remission at session 10.  Full remission from depression and binge-eating/purging episodes was sustained more than 2 months after treatment completion.  In neuroimaging studies, the DMPFC is important in impulse control, and is underactive in bulimia nervosa.  DMPFC-rTMS may have enhanced the patient’s ability to deploy previously acquired strategies to avoid binge-eating and purging via a reduction in her impulsivity.  A larger sham-controlled trial of DMPFC-rTMS for binge-eating and purging behavior may be warranted.