Efectos de la estimulación magnética transcraneal repetitiva de la corteza prefrontal dorsolateral izquierda en el trastorno por atracón asociado a la obesidad: un ensayo controlado aleatorizado de doble ciego
Palabras clave:
Ensayo clínico, Estimulación magnética transcraneal repetitiva, Trastorno por atracón, ObesidadResumen
https://hdl.handle.net/11600/72898
Introducción: El trastorno por atracón (TA) se asocia comúnmente con el sobrepeso y la obesidad; se caracteriza por episodios recurrentes de atracones que no conllevan el uso de métodos compensatorios para evitar el aumento de peso, pero que generan un malestar significativo. La evidencia sugiere que el TA y los trastornos por consumo de sustancias (TCS) comparten mecanismos neuronales similares y que la estimulación magnética transcraneal repetitiva (EMTr) puede modular la actividad de redes cerebrales potencialmente implicadas en el TA. Objetivos: Los objetivos principales de este estudio son investigar los efectos de la EMTr sobre los atracones y el deseo intenso de comer (*craving*) en personas con trastorno por atracón (TA) y obesidad. Los objetivos secundarios incluyen la evaluación de los efectos de la EMTr sobre la psicopatología general y específica de los trastornos de la conducta alimentaria (TCA), el peso corporal y el índice de masa corporal (IMC). Métodos: Sesenta individuos fueron asignados aleatoriamente para recibir 20 sesiones de EMTr aplicadas en la corteza prefrontal dorsolateral (CPFDL) izquierda o un tratamiento simulado (*sham*). Las variables principales fueron la frecuencia de los episodios de atracón y el «impulso de comer» (*craving*), evaluados al inicio y al finalizar el tratamiento. Las variables secundarias incluyeron los efectos sobre el IMC, el hambre y la psicopatología general y específica de los TCA. Se realizaron análisis de seguimiento para la mayoría de las variables a las 16 semanas de la aleatorización. Se utilizaron modelos multinivel para evaluar los efectos del grupo, el tiempo y la interacción grupo-tiempo en relación con la asociación entre la exposición a la EMTr y los resultados. Resultados: En comparación con el grupo de estimulación simulada (*sham*), el grupo que recibió rTMS real mostró una mayor disminución en el número de episodios de ingesta compulsiva (BEE, por sus siglas en inglés) al finalizar el tratamiento (media estimada [ME]: 2,41; IC del 95 %: 1,84-3,15 frente a ME: 1,45; IC del 95 %: 1,05-1,99; p = 0,02; tamaño del efecto [TE]: 0,51) y en el seguimiento (ME: 3,79; IC del 95 %: 3-4,78 frente a ME: 2,45; IC del 95 %: 1,88-3,17; p = 0,02; TE = 0,44; análisis de la interacción grupo × tiempo: p = 0,02). No se observaron diferencias entre grupos en otras comparaciones. Conclusión: La rTMS redujo los BEE durante y después del tratamiento, lo que sugiere que se trata de una intervención prometedora.
Citas
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