Evidence map›Paper›PMID 34243816›Full record

ArticleJournal of eating disorders2021

A pilot study exploring the effect of repetitive transcranial magnetic stimulation (rTMS) treatment on cerebral blood flow and its relation to clinical outcomes in severe enduring anorexia nervosa.

Bethan Dalton, Erica Maloney, Samantha J Rennalls, Savani Bartholdy, Maria Kekic, Jessica McClelland, Iain C Campbell, Ulrike Schmidt, Owen G O'Daly

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of eating disorders, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07106398 (The Effectiveness of rTMS on Improving Food Craving and Weight Control in Adults Without Serious Mental Illness), which is not on this map. Cited by 16 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 2 pooled it
1.7field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07106398 narecruitingnot on this mapstarted 2025, after this paper: background citation

The Effectiveness of rTMS on Improving Food Craving and Weight Control in Adults Without Serious Mental Illness

TypeinterventionalSponsorThe University of Hong KongRan2025 to 2028Enrolled30ConditionsFood Cravings, rTMSArmsrepetitive transcranial magnetic stimulation
3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 20 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Review
  6. Article
  7. rTMS Therapy for Eating Disorders: Scoping Review on Efficacy, Safety, Stimulation Parameters and Study Subjects.European eating disorders review : the journal of the Eating Disorders Association · 2026
    Review
  8. Article
  9. Review
  10. Review
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  12. Article
  13. Review
  14. Article
  15. Review
  16. Neuromodulation and Eating Disorders.Current psychiatry reports · 2022
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

Bethan DaltonSection of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. bethan.dalton@kcl.ac.uk.ORCID http://orcid.org/0000-0003-0898-1926
Erica MaloneyDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Samantha J RennallsDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Savani BartholdySection of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Maria KekicSection of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Jessica McClellandSection of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Iain C CampbellSection of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Ulrike SchmidtSection of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Owen G O'DalyDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
King's College London · GB

Funding

National Institute of Health Research PB-PG-1013-32049Wellcome Trust
6 · The paper itself

Abstract

backgroundRepetitive transcranial magnetic stimulation (rTMS) is a novel treatment option for people with severe enduring anorexia nervosa (SE-AN), but associated neurobiological changes are poorly understood. This study investigated the effect of rTMS treatment on regional cerebral blood flow (CBF) and whether any observed changes in CBF are associated with changes in clinical outcomes in people with SE-AN.

methodsAs part of a randomised sham-controlled feasibility trial of 20 sessions of high-frequency rTMS to the left dorsolateral prefrontal cortex, 26 of 34 trial participants completed arterial spin labelling (ASL) functional magnetic resonance imaging (fMRI) to quantify regional and global resting state CBF before (pre-randomisation baseline) and after real or sham treatment (1-month post-randomisation). A group of healthy females (n = 30) were recruited for baseline comparison. Clinical outcomes, including BMI, and depression and anxiety symptoms, were assessed at baseline, 1-, 4-, and 18-months post-randomisation.

resultsNo group differences in regional CBF were identified between the SE-AN and healthy comparison participants. A significant treatment-by-time interaction in a medial temporal lobe cluster with the maximal peak in the right amygdala was identified, reflecting a greater reduction in amygdala CBF following real rTMS compared to sham. Participants with the greatest rTMS-related reduction in amygdala CBF (i.e., between baseline and 1-month post-randomisation) showed the greatest sustained weight gain at 18-months post-randomisation. Higher baseline CBF in the insula predicted greater weight gain between baseline and 1-month post-randomisation and between baseline and 4-months post-randomisation.

conclusionsThis exploratory pilot study identified rTMS treatment related changes in CBF in adults with SE-AN and these were associated with changes in weight. Our preliminary findings also suggest that CBF (as measured by ASL fMRI) may be a marker of rTMS treatment response in this patient group. Future rTMS studies in AN should employ longitudinal neuroimaging to further explore the neurobiological changes related to rTMS treatment.

trial registrationISRCTN14329415 , registered 23rd July 2015.

Indexed as

Anorexia nervosaArterial spin labellingCerebral blood flowEating disordersFunctional magnetic resonance imagingRepetitive transcranial magnetic stimulation

Identifiers

PMID34243816
PMCPMC8268186
OpenAlexW3164443857

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.