Effects of rTMS on Food Choice in Anorexia Nervosa

NCT ID: NCT05918835

Last Updated: 2025-09-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

72 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-04-24

Study Completion Date

2028-06-30

Brief Summary

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This study will examine the impact of high-frequency repetitive transcranial magnetic stimulation on food choice behavior and related neural activity.

Detailed Description

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Anorexia nervosa (AN) is a devastating illness with morbidity and mortality rates among the highest associated with any psychiatric disorder. Treatments for adults with AN have limited efficacy due to an inadequate understanding of the mechanisms underlying AN's core symptoms. The salient feature of AN is extreme restriction of food, particularly dietary fat intake, a behavior both highly resistant to change and central to relapse. Neuroimaging research of food restriction in AN has found that compared to healthy controls, patients with AN exhibit greater choice-related dorsal striatum activation and different connection strength within dorsal fronto-striatal circuits, suggesting that activity in this region and associated circuits may underlie maladaptive eating behavior. To confirm the significance of these brain regions in restrictive eating, this study will combine neuronavigation-guided high-frequency rTMS (HF-rTMS), individualized functional TMS targets, fMRI and a computerized food-choice task to test the effects of HF-rTMS on restrictive food choice and associated neural activity.

The study will utilize a double-blinded randomized parallel design: adult inpatients with AN will receive either HF-rTMS or sham to the DLPFC. We will compare group changes in brain and behavior to test whether activity in the dorsal striatum underlies restrictive eating behavior in AN and quantify the effects of HF-rTMS to the DLPFC on restrictive eating behavior. Our use of individualized TMS targets will enable us to identify whether resting-state functional connectivity predicts neural or behavioral response to HF-rTMS.

Conditions

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Anorexia Nervosa

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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High-frequency repetitive transcranial magnetic stimulation (HF-rTMS)

Target: Region of right DLPFC with greatest resting-state functional connectivity to dorsal striatum (individualized functional target) Protocol: 10 pulses/sec, 4s trains, 120% MT, 3000 pulses/session

Group Type EXPERIMENTAL

High-frequency repetitive transcranial magnetic stimulation (active rTMS)

Intervention Type DEVICE

HF-rTMS is applied with a figure-of-8 coil using the Magstim TMS System. Participants receive one administration of HF-rTMS, delivered to the region of the right dorsolateral prefrontal cortex (DLPFC) with greatest resting-state functional connectivity to the dorsal striatum (individualized per participant). HF-rTMS is delivered at a frequency of 10 Hz for approximately 37 minutes (3000 total pulses).

Sham repetitive transcranial magnetic stimulation (sham rTMS)

Target: Region of right DLPFC with greatest resting-state functional connectivity to dorsal striatum (individualized functional target) Protocol: same as HF-rTMS, with sham coil

Group Type SHAM_COMPARATOR

Sham repetitive transcranial magnetic stimulation (sham rTMS)

Intervention Type DEVICE

Sham rTMS is applied with a figure-of-8 sham coil using the Magstim TMS System, which is identical to the active coil, replicates the sounds of HF-rTMS, and is designed to mimic sensations of HF-rTMS. Participants receive one administration of sham rTMS, delivered to the region of the right dorsolateral prefrontal cortex (DLPFC) with greatest resting-state functional connectivity to the dorsal striatum (individualized per participant). Sham rTMS is delivered for approximately 37 minutes (3000 total pulses).

Interventions

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High-frequency repetitive transcranial magnetic stimulation (active rTMS)

HF-rTMS is applied with a figure-of-8 coil using the Magstim TMS System. Participants receive one administration of HF-rTMS, delivered to the region of the right dorsolateral prefrontal cortex (DLPFC) with greatest resting-state functional connectivity to the dorsal striatum (individualized per participant). HF-rTMS is delivered at a frequency of 10 Hz for approximately 37 minutes (3000 total pulses).

Intervention Type DEVICE

Sham repetitive transcranial magnetic stimulation (sham rTMS)

Sham rTMS is applied with a figure-of-8 sham coil using the Magstim TMS System, which is identical to the active coil, replicates the sounds of HF-rTMS, and is designed to mimic sensations of HF-rTMS. Participants receive one administration of sham rTMS, delivered to the region of the right dorsolateral prefrontal cortex (DLPFC) with greatest resting-state functional connectivity to the dorsal striatum (individualized per participant). Sham rTMS is delivered for approximately 37 minutes (3000 total pulses).

Intervention Type DEVICE

Other Intervention Names

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Magstim TMS System active coil High-frequency rTMS Repetitive Transcranial Magnetic Stimulation Magstim TMS System sham coil Sham rTMS

Eligibility Criteria

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Inclusion Criteria

* DSM-5 Diagnosis of Anorexia Nervosa
* Age 18-30 years
* Female
* Right-handed
* Body Mass Index (BMI) ≥ 16.0
* Voluntarily admitted to inpatient eating disorders unit at NYSPI
* Competent to provide informed consent
* English-speaking
* Medically stable

Exclusion Criteria

* High risk of suicide
* Current substance use disorder or other co- morbid psychiatric condition requiring specialized treatment (e.g., psychosis)
* Diagnosis of major medical or neurological problem or taking medication that significantly increases risk for seizure or affects interpretation of findings (e.g., unstable hypertension, seizure disorder)
* Food restrictions (e.g., allergies) which impact greater than 30% of food choice task's choice options
* Indwelling ferromagnetic metallic object (e.g., pacemaker, pump), non- removable metal jewelry, medicinal patch or recent metallic ink tattoo
* History of seizure
* Diagnosis of epilepsy, stroke, multiple sclerosis, traumatic brain injury, Alzheimer's and other neurodegenerative diseases, meningoencephalitis or intracerebral abscess, or parenchymal or leptomeningeal cancers
* Prior exposure to TMS
* Pregnancy
* Currently breast-feeding
* Significant claustrophobia
* Implanted devices or stimulators
* Hearing loss (e.g., currently undergoing treatment with ototoxic medications or those with cochlear implants)
Minimum Eligible Age

18 Years

Maximum Eligible Age

30 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

National Eating Disorders Association

OTHER

Sponsor Role collaborator

Global Foundation for Eating Disorders

UNKNOWN

Sponsor Role collaborator

New York State Psychiatric Institute

OTHER

Sponsor Role lead

Responsible Party

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Alexandra F Muratore, PhD

Assistant Professor of Clinical Medical Psychology (in Psychiatry)

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Alexandra F Muratore, PhD

Role: PRINCIPAL_INVESTIGATOR

New York Sate Psychiatric Institute

Locations

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New York State Psychiatric Institute

New York, New York, United States

Site Status

Countries

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United States

Other Identifiers

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1K23MH128530

Identifier Type: NIH

Identifier Source: secondary_id

View Link

#8338

Identifier Type: -

Identifier Source: org_study_id

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