Estimulación magnética transcraneal repetitiva (EMTr) en el tratamiento y diagnóstico de trastornos alimentarios en atletas y pacientes: una revisión sistemática (Repetitive transcranial magnetic stimulation (rTMS) in the treatment and diagnosis of eating disorders in athletes and patients: a systematic review)
DOI:
https://doi.org/10.47197/retos.v60.107431Palabras clave:
Trastornos alimentarios, Neurología, Neuromodulación, Psicología, Psiquiatría, Estimulación cerebral no invasivaResumen
La Estimulación Magnética Transcraneal Repetitiva (EMTr) es una técnica no invasiva utilizada para tratar y diagnosticar trastornos alimentarios (TAs) al dirigir regiones del cerebro como la corteza prefrontal dorsolateral, involucrada en el control de los impulsos y la regulación de las emociones. Particularmente beneficiosa para los atletas, la EMTr puede reducir los síntomas de los TAs. Por lo tanto, este estudio tuvo como objetivo realizar una revisión sistemática de la literatura científica sobre el uso terapéutico o diagnóstico de la EMTr en atletas y pacientes con TAs, con énfasis en el trastorno por atracón (TA), anorexia nerviosa (AN) y bulimia nerviosa (BN). Se realizó una búsqueda bibliográfica en el Directory of Open Access Journals (DOAJ), Medline, Directory of Open Access Scholarly Resources (ROAD), Academic Search Premier, Wiley-Blackwell Full Collection, Nature Open Access, BioMed Central Open Access y Cumulative Index to Nursing and Allied Health Literature (CINAHL). Se incluyeron un total de 26 artículos originales publicados hasta el 21 de noviembre de 2021. Los estudios seleccionados se agruparon para cada protocolo respectivo: número total de pacientes, aspectos sociodemográficos de los participantes, parámetros realizados en la EMTr: tipo de bobina, intensidad, frecuencia, número de pulsos, lugar de estimulación, resultados preliminares e incidencia de efectos adversos. La evidencia reciente sugiere una baja tasa de efectos secundarios con la técnica y una respuesta sustancial de EMTr de alta frecuencia tanto en la corteza prefrontal dorsolateral como en la región ventromedial, especialmente en estudios donde se realizó comparación interna. La gran tolerancia y seguridad del tratamiento neuromodulador con EMTr fomentan la aplicación de la técnica, especialmente en pacientes con trastornos alimentarios refractarios. Además del potencial terapéutico, la EMTr es una herramienta diagnóstica esencial para dilucidar la compleja neurobiología de los trastornos alimentarios. Se espera un aumento significativo en las publicaciones sobre el tema de manera controlada, ciega y aleatorizada, lo que llevará a una homogeneización de los resultados y a la generalización de su uso potencial.
Palabras clave: Trastornos alimentarios, Neurología, Neuromodulación, Psicología, Psiquiatría, Estimulación cerebral no invasiva.
Abstract. Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive technique used to treat and diagnose eating disorders (EDs) by targeting brain regions like the dorsolateral prefrontal cortex, which is involved in impulse control and emotion regulation. Particularly beneficial for athletes, rTMS can reduce symptoms of EDs. Therefore, this study aimed to carry out a systematic review of the scientific literature on the therapeutic or diagnostic use of rTMS in athletes and patients with EDs, with an emphasis on binge eating disorder (BED), anorexia nervosa (AN), and bulimia nervosa (BN). A literature survey was carried out in the Directory of Open Access Journals (DOAJ), Medline, Directory of Open Access Scholarly Resources (ROAD), Academic Search Premier, Wiley-Blackwell Full Collection, Nature Open Access, BioMed Central Open Access, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). A total of 26 original papers published until November 21, 2021, were included. The selected studies were grouped for each respective protocol: total number of patients or athletes, sociodemographic aspects of the participants, parameters performed in rTMS: type of coil, intensity, frequency, number of pulses, stimulation site, preliminary results, and incidence of adverse effects. Recent evidence suggests a low rate of side effects with the technique and a substantial high frequency rTMS response in both the dorsolateral prefrontal cortex and the ventromedial region, especially in studies where internal comparison was performed. The great tolerance and safety of neuromodulatory treatment with rTMS encourage the application of the technique, especially in patients with refractory eating disorders. In addition to the therapeutic potential, rTMS is an essential diagnostic tool in elucidating the complex neurobiology of eating disorders. A more significant increase in publications on the subject is expected in a controlled, blind, and randomized manner, leading to a homogenization of results and generalization of its potential use.
Keywords: Eating disorders, Neurology, Neuromodulation, Psychology, Psychiatry, Noninvasive brain stimulation.
Citas
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