IMPROVEMENT IN BORDERLINE PERSONALITY DISORDER SYMPTOMS WITH DORSOMEDIAL PREFRONTAL CORTEX rTMS: TWO CASES

Abstract

Borderline Personality Disorder (BPD) is a mental illness characterized with impulsiveness, both interpersonal relationships and emotional disturbance. Symptoms are related to hypofunction of frontal areas like Dorsomedial Prefrontal Cortex (DMPFC). Psychotherapy is the base treatment in this disease, but economic costs and long-time therapy have difficulted the attachment. Repetitive Transcranial Magnetic Stimulation(rTMS), authorized by Food&Drug Administration (FDA) on Major Depressive Disorder (MDD) treatment has proven good results in previous works in BPD clinical characteristics on both dorsolateral prefrontal cortex (DLPFC) and enhancement in depressive symptoms stimulating DMPFC. We present two clinical cases with BPD symptomatology improvement.Case I: A, 20-year-old woman, diagnosed with BPD five years ago, history of impulsiveness, self-harm and suicidal attempts. Referred depressive and binge episodes, low self-esteem and anger trouble management. Substance use history, suspended a year ago. Not psychotic symptoms presented.Case II: J, 20-year-old man, recent BPD diagnosis, history of high depressive and anxiety episodes, low self-esteem and unstable interpersonal relationships. No history of substance abuse or psychotic symptoms. Both patients got diagnosis confirmed and baseline clinical evaluations. No abnormal brain electrical activity was presented. They underwent through 5 Hz rTMS 30 sessions, one per weekday, 30 trains, 50 pulses each, with 10s inter-train interval; first half was an active modality, second half in a placebo mode. Both patients got symptoms severity evaluation, showing improvement from Baseline to Final (BvsF) scores in BPD clinical areas (Global Clinical Impression, CGI-BPD: A(39 vs 14), J(20 vs 15); Borderline-Symptoms-List, BSL:A(48 vs 12), J(10 vs 9)), depression and anxiety symptoms through Hamilton Depression (HDRS; A(23 vs 8), J(14 vs 5)) and Anxiety Rating-Scale (HARS; A(24 vs 3), J(9 vs 3)), respectively. CONCLUSIONS: Although rTMS proved enhancement on BPD symptoms, evidence is limited on the efficacy of this technique in this pathology.