Repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex in binge eating disorder: a double-blind randomized controlled trial

Background Binge-eating disorder (BED) is characterized by highly distressing episodes of loss-of-control over-eating. We have examined the use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of people with BED and associated obesity. Such non-invasive brain stimulation (NIBS) techniques are used therapeutically in several psychiatric conditions and there is an associated scientific rationale.Methods Sixty participants were randomly allocated to receive 20 sessions of neuronavigated 10 Hz rTMS administered to the left dorsolateral prefrontal cortex (dlPFC) or sham treatment. Primary outcomes were the frequency of binge eating episodes (BEE) and the 'urge to eat' (craving) evaluated at baseline and end-of-treatment (8 weeks post-randomization). Secondary outcomes included body mass index (BMI), hunger, general and specific eating disorder psychopathology. Follow-up analyses were conducted for most outcomes at 16 weeks post-randomization. Multilevel models were used to evaluate group, time, and group-by-time interactions for the association between rTMS exposure and outcomes.Results The real rTMS group (compared with sham treatment), showed a significantly greater decrease in the number of BEE at the end of treatment (Estimated Mean [EM]: 2.41 95% CI: 1.84-3.15 versus EM: 1.45 95% CI: 1.05-1.99, p = 0.02), and at follow-up (EM: 3.79 95% CI: 3-4.78 versus EM: 2.45 95% CI: 1.88-3.17, p = 0.02; group x time interaction analysis p = 0.02). No group differences were found for other comparisons.Conclusion rTMS was associated with reduced BEE during and after treatment: it suggests rTMS is a promising intervention for BED.