Inhibitory rTMS to the Right Temporoparietal Junction Improves Depersonalisation and Derealisation

Abstract

Depersonalization - derealisation disorder (DDD) is a psychiatric condition whereby the individual has persistent or recurrent episodes of depersonalization, derealization, or both. Several therapeutic approaches have been suggested for the treatment of DDD. Repetitive transcranial magnetic stimulation (rTMS) is a new non-invasive intervention that has shown promising results in many neuropsychiatric conditions. The role of rTMS as a therapeutic approach in DDD is not extensively investigated. In this paper, we report a case of DDD who presented with depersonalisation and derealisation with prominent, varied visual symptoms and benefited from inhibitory rTMS stimulation to the right temporal-parietal junction (TPJ). The patient received 15 sessions of 1 Hz 1200 pulses/session at 110% of resting motor threshold over a period of 3 weeks. The patient reported improvement in several symptom domains of derealisation as well as complete cessation of some of the visual symptoms, such as visual floaters and grid lines in her visual field. Incremental improvement in symptoms was observed from the 10th session to the 15th session. The level of depressive symptoms did not change following rTMS intervention. The case report highlights the specificity of the right TPJ stimulation in the improvement of DDD symptoms and provides evidence that rTMS should be considered as an intervention approach in DDD.