Repetitive Transcranial Magnetic Stimulation Versus Theta Burst Stimulation on Impulsivity, Emotional Dysregulation, and Non-Suicidal Self-Injury in Borderline Personality Disorder Patients (TMS and TBS)
Effect of Repetitive Transcranial Magnetic Stimulation Versus Theta Burst Stimulation on Impulsivity, Emotional Dysregulation, and Non-Suicidal Self-Injury in a Sample of Patients With Borderline Personality Disorder: A Randomized Controlled Trial
the goal of this randomized clinical trial is to evaluate the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) in patients with borderline personality disorder (BPD). The study aims to assess whether these brain stimulation techniques can reduce symptoms of emotional dysregulation, impulsivity, and non-suicidal self-injury.
The main questions it aims to answer are:
Does high-frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC) improve emotional dysregulation, impulsivity, and non-suicidal self-injury in patients with BPD? Does intermittent theta-burst stimulation (iTBS) over the left DLPFC produce similar therapeutic effects? How does the efficacy of rTMS and iTBS compare to sham stimulation after completing the treatment course?
Participants will be randomly assigned to one of three groups:
- High-frequency rTMS group
- Intermittent theta-burst stimulation (iTBS) group
- Sham stimulation group Each participant will receive 15-20 stimulation sessions over the left DLPFC. Changes in emotional dysregulation, impulsivity, and non-suicidal self-injury symptoms will be evaluated before and after treatment.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
Borderline Personality Disorder (BPD) is a complex psychiatric condition characterized by emotional dysregulation, impulsivity, and recurrent non-suicidal self-injury (NSSI).
Although psychotherapy and pharmacological interventions remain the mainstay of treatment, many patients continue to experience severe emotional instability and impulsivity. Neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS) have recently shown promise in modulating fronto-limbic circuits involved in emotion regulation.
This prospective, randomized, double-blind, controlled clinical trial aims to evaluate and compare the therapeutic efficacy of high-frequency rTMS and intermittent theta-burst stimulation (iTBS) applied over the left dorsolateral prefrontal cortex (DLPFC) in patients diagnosed with BPD. The interventions are expected to enhance prefrontal modulation of limbic activity, thereby improving emotional regulation, reducing impulsivity, and decreasing non-suicidal self-injury behaviors.
Participants will be randomly assigned to one of three groups:
Group 1: High-frequency rTMS (5 Hz, 1200 pulses/session, 80-110% RMT, 21 min total) Group 2: Intermittent theta-burst stimulation (iTBS, 50 Hz bursts, 600 pulses/session, 80-120% RMT, 21 min total) Group 3: Sham stimulation (matched duration and sound without magnetic output) All participants will continue their standard therapy for BPD, including weekly Dialectical Behavior Therapy (DBT) sessions during the study. Each participant will receive 20 sessions over 4 weeks (5 sessions per week). Allocation concealment will be ensured using sealed, numbered envelopes prepared by an independent administrator, and both participants and assessors will be blinded to group assignment.
Clinical assessments will include:
Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) for BPD diagnosis General Health Questionnaire (GHQ-28) to screen for psychiatric comorbidities Difficulties in Emotion Regulation Scale - Short Form (DERS-16) Barratt Impulsiveness Scale (BIS) Deliberate Self-Harm Inventory (DSHI) Measurements will be taken at baseline (pre-intervention) and after completion of the stimulation sessions (post-intervention).
Safety procedures will follow international TMS safety guidelines (Rossi et al., 2009; Lefaucheur et al., 2020). Adverse effects such as transient headache or scalp discomfort will be monitored, and any serious adverse events (e.g., seizures) will be immediately reported to the Research Ethics Committee.
This study seeks to determine whether rTMS or iTBS is more effective than sham stimulation in improving emotion regulation, reducing impulsivity, and decreasing self-harm behaviors. It will also explore whether iTBS, with its shorter session duration, provides a comparable or superior therapeutic benefit to conventional rTMS.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: dina h abouelleil, Masters of neuropsychiatry
- Telefonnummer: +201062229030
- E-mail: dinahussein@med.asu.edu.eg
Studiesteder
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Cairo Governorate
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Cairo, Cairo Governorate, Egypten, 11252
- Rekruttering
- Ainshams University Hospitals
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Kontakt:
- dina h abouelleil, msc of neuropsychiatry
- Telefonnummer: +201062229030
- E-mail: Dinahussein@med.asu.edu.eg
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- 1. Age range: 21-50 years old. 2. Gender: males and females 3. Borderline personality disorder diagnosis
Exclusion Criteria:
- 1. Presence of other uncontrolled mental illness that precludes the ability to provide informed consent (e.g.; acute psychosis, bipolar disorder currently in manic episode, major depressive disorder with recent suicidal attempt).
2. Patients with contraindications to TMS as cardiac patients with pacemakers, metallic implants as cochlear implants, aneurysm clips, stents, and deep brain stimulation electrodes.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Dobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Aktiv komparator: Repetitive Transcranial Magnetic Stimulation
Participants receive 15-20 sessions of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC). Each session lasts approximately 21 minutes. |
rTMS will be delivered at 5 Hz frequency, 1200 pulses per session, at 80-110% of the individual's resting motor threshold (RMT). Stimulation will be applied to the left DLPFC (F3 according to the 10-20 EEG system) using a figure-of-eight coil. Each session includes 18 minutes of active stimulation followed by 3 minutes of sham stimulation on the target site. Sessions are administered 5 days per week for 4 weeks (total 20 sessions).
Andre navne:
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Aktiv komparator: Intermittent Theta-Burst Stimulation Group
Participants receive 15-20 sessions of intermittent theta-burst stimulation (iTBS) over the left dorsolateral prefrontal cortex (DLPFC). Each session lasts approximately 21 minutes. |
iTBS will be delivered as 50 Hz bursts (three pulses per burst, 5 Hz bursts) at 80-120% of resting motor threshold, totaling 600 pulses per session. Stimulation will be applied over the left DLPFC (F3 site, 10-20 EEG system). Each session includes 3 minutes of active iTBS and 18 minutes of sham stimulation. Sessions are administered 5 days per week for 4 weeks (total 20 sessions).
Andre navne:
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Sham-komparator: Sham Stimulation Group
Participants receive sham stimulation sessions identical in duration and sound to the active conditions but without active magnetic output. |
Sham stimulation will be delivered using the same coil orientation and acoustic cues as the active conditions, but with the magnetic field output disabled. Each session includes 18 minutes of sham rTMS and 3 minutes of sham TBS over the left DLPFC (F3 site). Sessions are administered 5 days per week for 4 weeks (total 20 sessions). |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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improvement of impulsivity in BPD as assessed by barratt impulsivity scale (BIS)
Tidsramme: 20 sessions given over 1 month
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Improvement of results of The barratt impulsivity scale (BIS) measured before starting sessions and after finishing 20 sessions |
20 sessions given over 1 month
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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improvement of emotional dysregulation as per Difficulties in Emotion Regulation Scale(DERS)
Tidsramme: 20 sessions1 month
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Improvement of results of DERS measured before starting sessions and after finishing 20 sessions |
20 sessions1 month
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improvement of non-suicidal self injury
Tidsramme: 20 sessions given in 1 month
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Improvement of results of The Deliberate Self-Harm Inventory (DSHI) measured before starting sessions and after finishing 20 sessions |
20 sessions given in 1 month
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Studieleder: mohamed F professor Dr, MD of psychiatry, ainshams university
Publikationer og nyttige links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- FMASU MD169/2025
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
de-identified individual participant data will be available upon reasonable request after publication of the primary results
IPD-delingstidsramme
5 years after publication
IPD-deling Understøttende informationstype
- STUDY_PROTOCOL
- ICF
- CSR
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