High frequency TMS for the management of Borderline Personality Disorder: A case report

Objective: To assess the effect of repetitive trans-cranial magnetic stimulation (rTMS) therapy in the management of Borderline Personality Disorder (BPD). Method: The subject was a 22 years old girl. She was first diagnosed with BPD after one of her suicidal attempts about two years ago. She received 10 sessions of high-frequency TMS over her left dorsolateral prefrontal cortex. Assessment was done before treatment, exactly after the last session, one and three months after treatment. Functional Scanning was performed before and after the TMS sessions and one month after the last session. Results: Results of block design analysis revealed increased activity in amygdala, Superior Temporal Gyrus, Superior Frontal Gyrus, Middle Frontal Gyrus and parahippocampus in negative-neutral and negative-rest contrasts. In contrast to the mentioned areas that exhibited decrease in activity after treatment, we found that middle temporal gyrus and post central gyrus were activated by the emotional stimuli. The changes in brain activity were associated with decrease in BPD severity (measured by BPD severity index) and depression and impulsivity level. Conclusion: Regardless of the limitations of this study, our findings suggest a positive role for rTMS in the management of BPD. (C) 2013 Elsevier B.V. All rights reserved.