Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) in Inducing Weight Loss among Obese Filipino Patients
A Randomized Controlled Trial
Objective. To determine the efficacy of rTMS in decreasing body mass index (BMI) versus sham stimulation among obese Filipino patients.
Methodology. This was a single-center, randomized, sham-controlled, single-blind, parallel group trial. Participants were 15-65 years old with BMI ≥30 kg/m2 and weight stable for 6 weeks. Participants were randomized to receive real rTMS or sham stimulation. Each underwent 4 sessions of stimulation over 2 weeks. Anthropometrics, total caloric intake (TCI), and VAS score for appetite were taken at baseline, 2, 4, 6, and 12 weeks.
Results. A total of 31 patients were randomized with 15 to the treatment and 14 to sham stimulation completing treatment, with 2 lost to follow-up. A significant decrease in BMI was noted after 4 weeks from the start of rTMS in the treatment group, (0.6±0.6, p-value=0.001), with weight change of -1.3±1.3 kg (p-value=0.009), but was no longer observed at 6 weeks onwards. No severe adverse effects were noted.
Conclusion. rTMS to the DLPFC effectively decreased BMI (0.6±0.6) and weight (-1.3±1.3 kg) from baseline to 4 weeks. At 6-12 weeks after rTMS however, there was no longer a significant difference, indicating that 4 sessions of rTMS may not be enough to produce a prolonged effect on weight loss.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies [Erratum in Lancet. 2004; 13;363(9412):902]. Lancet. 2004;363(9403):157‐163. https://www.ncbi.nlm.nih.gov/pubmed/14726171. https://doi.org/10.1016/S0140-6736(03)15268-3.
Lowe CJ, Vincent C, Hall PA. Effects of noninvasive brain stimulation on food cravings and consumption: A meta-analytic review. Psychosom Med. 2017;79(1):2‐13. https://www.ncbi.nlm.nih.gov/pubmed/27428861. https://doi.org/10.1097/PSY.0000000000000368.
Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity. Endocr Pract. 2016;22 Suppl 3:1‐203. https://www.ncbi.nlm.nih.gov/pubmed/27219496. https://doi.org/10.4158/EP161365.GL.
Kim SH, Chung JH, Kim TH, et al. The effects of repetitive transcranial magnetic stimulation on eating behaviors and body weight in obesity: A randomized controlled study. Brain Stimul. 2018;11(3):528‐35. https://www.ncbi.nlm.nih.gov/pubmed/29326022. https://doi.org/10.1016/j.brs.2017.11.020.
Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare's search for effective obesity treatments: Diets are not the answer. Am Psychol. 2007;62(3):220‐33. https://www.ncbi.nlm.nih.gov/pubmed/17469900. https://doi.org/10.1037/0003-066X.62.3.220.
Uher R, Yoganathan D, Mogg A, et al. Effect of left prefrontal repetitive transcranial magnetic stimulation on food craving. Biol Psychiatry. 2005;58(10):840‐2. https://www.ncbi.nlm.nih.gov/pubmed/16084855. https://doi.org/10.1016/j.biopsych.2005.05.043.
Mishra BR, Sarkar S, Praharaj SK, Mehta VS, Diwedi S, Nizamie SH. Repetitive transcranial magnetic stimulation in psychiatry. Ann Indian Acad Neurol. 2011;14(4):245‐251. https://www.ncbi.nlm.nih.gov/pubmed/22346010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271460. https://doi.org/10.4103/0972-2327.91935.
Cooper S, Robison AJ, Mazei-Robison M. Reward circuitry in addiction. Neurotherapeutics. https://www.ncbi.nlm.nih.gov/pubmed/28324454. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509624. https://doi.org/10.1007/s13311-017-0525-z.
Nahas Z, Teneback CC, Kozel A, et al. Brain effects of TMS delivered over prefrontal cortex in depressed adults: Role of stimulation frequency and coil-cortex distance. J Neuropsychiatry Clin Neurosci. 2001;13(4):459‐70. https://www.ncbi.nlm.nih.gov/pubmed/11748315. https://doi.org/10.1176/jnp.13.4.459.
Maizey L, Allen CPG, Dervinis M, et al. Comparative incidence rates of mild adverse effects to transcranial magnetic stimulation. Clin Neurophysiol. 2013;124(3):536‐44. https://www.ncbi.nlm.nih.gov/pubmed/22986284. https://doi.org/10.1016/j.clinph.2012.07.024.
Rossi S, Hallett M, Rossini PM, Pascual-Leone A, Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120(12):2008‐39. https://www.ncbi.nlm.nih.gov/pubmed/19833552. https://doi.org/10.1016/j.clinph.2009.08.016.
Kim SH, Chung JH, Kim TH, et al. The effects of repetitive transcranial magnetic stimulation on body weight and food consumption in obese adults: A randomized controlled study. Brain Stimul. 2019;12(6):1556-64. https://www.ncbi.nlm.nih.gov/pubmed/31378600. https://doi.org/10.1016/j.brs.2019.07.020
Alvarado-Reynoso, B, Ambriz-Tututi, M. The effects of repetitive transcranial magnetic stimulation in combination with a low-carbohydrate diet in overweight or obese patients. A randomized controlled trial. Obesity Medicine 2019;14. https://doi.org/10.1016/j.obmed.2019.100095.
Málly J, Farkas R, Tóthfalusi L, Stone TW. Long-term follow-up study with repetitive transcranial magnetic stimulation (rTMS) in Parkinson's disease. Brain Res Bull. 2004;64(3):259‐63. https://www.ncbi.nlm.nih.gov/pubmed/15464863. https://doi.org/10.1016/j.brainresbull.2004.07.004.
Ferrulli A, Adamo M, Massarini S, Luzi L. Deep transcranial magnetic stimulation acutely modulates neuroendocrine pathways underlying obesity. Endocrine Abstracts. 2018; 56. OC6.2. https://doi.org/10.1530/endoabs.56.OC6.2.
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