Transcranial magnetic stimulation in borderline personality disorder – case series

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We present the results of a case series study of individual ly navigated repetitive transcranial magnetic stimulation (rTMS) in four patients with borderline personality disorder (BPD). Patients and methods: Four patients with BPD performed a Go/NoGo task dur ing functional MRI (fMRI) designed for observ ing behavioural inhibition neural cor relates. The site within the right dorsolateral prefrontal cortex with the largest diff erence in BOLD signal between the NoGo and Go conditions was as signed as a target for rTMS in each patient. Four patients underwent 15 ses sions of individual ly navigated 10-Hz rTMS treatment at 110% of their individual rest ing motor threshold for 3 weeks (one ses sion per work ing day). One ses sion contained 1,500 pulses delivered in 15 trains by 10 s, lead ing to a total of 22,500 pulses dur ing the treatment. Results: The treatment was very well tolerated without any serious side eff ects. After the treatment, the patients reported that they felt better self-control of their emotions, especial ly anger; that their urges for self-harm and suicidal thoughts decreased or disappeared; and that their derealisation/depersonalisation episodes disappeared. Patients also showed less depres sion symp toms after the treatment. Conclusion: rTMS with neuronavigation individualised by a fMRI Go/NoGo task is a promis ing tool for reduc ing impulsive behaviour and enhanc ing emotion regulation in BPD patients. Double-blind placebo-control led studies in larger samples are neces sary to draw further conclusions about rTMS eff ectiveness in BPD.