Evaluation of fMRI analysis to study treatment effect of TMS in borderline personality disorder

摘要

Borderline Personality Disorder (BPD) is a common psychiatric condition which is characterized by high rate of suicidal attempts and self-harm, impulsive and aggressive behavior, interpersonal relation hardship and affective dysregulation. According to epidemiological studies, this condition affect between 0.5 to 5.9 percent of general population. Although previous studies, have reported some structural and functional changes in affected patients which were associated with this disorder, but the exact regional dysfunctions of the affected patients are still somehow controversial according to current literature. This study is a part of larger study which aimed to assess the effect of Transcranial Magnetic Stimulation (TMS) in the management of BPD patients using functional magnetic resonance imaging (fMRI). 20 BPD patients were administered 10 sessions of high- frequency TMS over left dorsolateral prefrontal cortex (DLPFC) (superior and middle frontal gyrus according to talairach atlas). fMRI scan performed before and after the treatment period. A visual emotional task employing neutral and unpleasant images of international Affective Picture System (IAPS) were used during the brain scanning. fMRI data were analyzed with GLM models using FSL software to derive the effects from stimuli types. Group analysis was carried out using FLAME (FMRIB's Local Analysis of Mixed Effects, to obtain comparison between before and after treatment (pairedsample t-test). Z (Gaussianised T/F) statistic images were thresholded using clusters determined by Z＞2 and a (corrected) cluster significance threshold of P=0.05Our preliminary fMRI Results showed reduction in brain activity in amygdala, Superior temporal gyrus and superior frontal gyrus and increased in activation in middle temporal gyrus after the treatment. According to the results TMS appears to be effective in the management of BPD patients. There are still a lot of question about applicability and the most efficient way of employing the TMS in the management of BPD patients.