rTMS and Body Shape Perception
rTMS and Body Shape Perception
Anorexia nervosa (AN) is a frequent, potentially life-threatening eating disorder
 characterized by a resistance to maintaining body weight at or above a minimally normal
 weight for age and height, an intense fear of weight gain or being "fat" even though
 underweight, a loss of menstrual periods in girls and women post-puberty and a disturbance in
 the experience of body weight or shape. Body weight and shape dissatisfaction is linked to
 the development, maintenance and relapse of AN. Neuroimaging studies have shown that the
 inferior parietal cortex is involved in body image perception and less activated in patients
 with AN compared with healthy subjects. Repetitive transcranial magnetic stimulation (rTMS)
 is used to modulate cortical excitability, and particularly to increase excitability with
 high-frequency rTMS. The aim of this study was to investigate the effect of "excitatory"
 high-frequency rTMS over the "hypoactive" inferior parietal cortex of 54 patients with AN.

 This randomized, double-blind, placebo-controlled study will compare effective rTMS (2000
 ten-Hz stimulations per session, applied at 90% of the resting motor threshold, with 10
 sessions in two weeks) versus placebo rTMS.

 Assessments will be performed before rTMS and after the last rTMS session (immediately after,
 at 15 days and three months). The principal criteria for judgement is a body image
 satisfaction scale (Boby Shape Questionnaire, BSQ-34). The secondary criteria for judgement
 are eating behaviour scales (Eating Attitude Test, EAT-40; Bulimia test, BULIT and Eating
 Disorders Inventory, EDI-2), the Hamilton depression rating scale and Hamilton anxiety rating
 scale, a quality of life scale (Short-Form Health Survey, SF-36), a body composition analysis
 using a Dual-energy X-ray absorptiometry and the alpha-MSH autoantibodies levels (biomarker
 for eating disorders recently described).

 Inferior parietal cortex rTMS could not only improve body image perception, but also help in
 the treatment of eating disorders, allowing weight gain with a decreased anxiety and
 improving patients' quality of life. Also positive results could have direct therapeutic
 implications with the possibility to complete regular rTMS sessions, or to implant extradural
 electrodes for chronic parietal cortex stimulation.
Inclusion Criteria:

 -  Female

 -  Age above 18

 -  Restrictive anorexia nervosa with a disease duration more than one year and less than
 three years.

 -  Body Mass Index below 16

 -  Patient receiving or having received optimal treatment for anorexia nervosa

 -  Right-handed

 -  Normal blood ionogramme

 -  Previous stable antidepressor treatment for one month and no expected modification in
 the three following months

 -  Patients arriving by car with someone else or by public transportation

 Exclusion Criteria:

 -  Pregnancy

 -  Contraindication to transcranial magnetic stimulation i.e. pace-maker, cardiac valve
 protheses, metallic protheses etc.

 -  History of epileptic seizure

 -  Cerebral lesion of any etiology (post-traumatic, tumoral, vascular etc.)

 -  History of previous rTMS