Transcranial magnetic stimulation in in borderline personality disorder: A pilot study

Goal: We present result of a pilot study of individually navigated repetitive transcranial magnetic stimulation in four patients with borderline personality disorder (BPD). Methodology: Four patients with BPD underwent a Go/NoGo Task during fMRI designed for observation of behavioral inhibition neural correlates. Place with individually largest difference in BOLD signal between NoGo and Go condition within the area of right dorsolateral prefrontal cortex (rDLPFC) was assigned as target for rTMS in each patient. Four patients underwent 15 sessions of individually navigated 10 Hz rTMS treatment on 110% of their individual resting motor threshold for three weeks (one session per each working day). One session contained 1500 pulses delivered in 15 trains by 10 seconds, leading to total 22500 pulses delivered during the treatment. Results: Treatment was very well tolerated without any serious side effects. After the treatment, the patients reported that they felt better self-control when under emotions, especially anger, that their urges for self-harm and suicidal thoughts decreased or complete disappeared and their derealization/depersonalization episodes disappeared. Patients also showed less depression symptoms after the treatment. Conclusion: rTMS with individualized neuronavigation by Go/NoGo Task is a promising tool for impulsive behavior reduction and emotion regulation enhancement in BPD patients, however, double-blind placebo-controlled studies in larger samples are necessary to draw further conclusions about rTMS effectivity in BPD.