A Narrative Systematic Review of the Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment and Management of Borderline Personality Disorder

Background Borderline Personality Disorder (BPD) is a psychiatric condition that affects approximately 2% of the population worldwide. It can present many challenges and can therefore be difficult to treat successfully by mental health professionals.Aim The aim of this systematic review was to detect whether repetitive Transcranial Magnetic Stimulation (rTMS) is an effective intervention for the management of BPD to the point where there would be a reduction of the BPD symptoms and challenging behaviour.Methods A literature search was conducted systematically using the following databases: PROSPERO, PUBMED, GOOGLE SCHOLAR, WEB OF SCIENCE, COCHRANE LIBRARY, SCOPUS, EMBASE and CLINICALTRIALS.GOV. Included studies were primary research studies of adult patients with a diagnosis of BPD who received rTMS treatment.Results Nine studies were identified which ranged from a case report to a randomised controlled trial (RCT). While rTMS improved certain symptoms of BPD patients, such as affective instability, impulsivity and outbursts of anger; overall, some results lacked statistical significance and, due to the lack of robust evidence, it is uncertain if rTMS is an effective intervention for BPD.Conclusions rTMS treatment showed some promising results in reducing the severity of symptoms for a number of patients. Studies varied with regard to the location of the target stimulation site, including different prefrontal brain regions and the cerebellum, as well as other rTMS protocol characteristics. These methodological differences in the application of the intervention and their impact on BPD symptomatology need to be explored more systematically in future research. Higher quality studies with larger sample sizes are needed in order to assess further the effectiveness of rTMS interventions on BPD symptoms.