Deep Brain Stimulation (DBS) in patients with treatment-resistant anorexia nervosa may help improve body weight, mood and anxiety, according to new research.
A team of researchers from Krembil Neuroscience Centre at Toronto Western Hospital and the University Health Network in Toronto investigated the use of DBS in six patients afflicted with the chronic illness.
The patients, who had an average age of 38, had dealt with the illness for years. In addition to anorexia, all of the patients, except one, also suffered from psychiatric conditions such as depression and obsessive-compulsive disorder.
All of the patients also had suffered various medical complications related to their anorexia. The researchers report that, between them, the six patients had about 50 hospitalizations during their illnesses.
During the phase one safety trial, the patients were treated with DBS, a neurosurgical procedure that moderates the activity of dysfunctional brain circuits. Neuroimaging has shown that there are structural and functional differences in brain circuits that regulate mood, anxiety, and body perception in anorexia patients compared to healthy subjects, according to the researchers.
Patients were awake when they underwent the procedure, which implanted electrodes into a specific part of the brain involved with emotion. During the procedure, each electrode was stimulated to look for changes in mood, anxiety or adverse effects, the researchers noted.
Once implanted, the electrodes were connected to a pulse generator implanted below the right clavicle, much like a heart pacemaker.
Testing was repeated at one, three, and six-month intervals after activation of the pulse generator device. After nine months, three of the six patients had gained weight, with a body-mass index (BMI) significantly greater than they had ever experienced. For these patients, this was the longest period of sustained weight gain since the onset of their illness, the researchers reported.
Four of the six patients also experienced changes in mood, anxiety, urges to binge and purge, and other symptoms related to anorexia, such as obsessions and compulsions. As a result of these changes, two of the patients completed an inpatient eating disorders program for the first time in the course of their illness, according to the researchers.
“We are truly ushering in a new of era of understanding of the brain and the role it can play in certain neurological disorders,” said Dr. Andres Lozano, a neurosurgeon at the Krembil Neuroscience Centre and chairman of neurosurgery at the University of Toronto. “By pinpointing and correcting the precise circuits in the brain associated with the symptoms of some of these conditions, we are finding additional options to treat these illnesses.”
The treatment, still considered experimental, is believed to work by stimulating a specific area of the brain to reverse abnormalities linked to mood, anxiety, emotional control, obsessions and compulsions, the researchers explained.
The research may provide an additional therapy option in the future, as well as further the understanding of anorexia and the factors that cause it to be persistent, the scientists claim.
“There is an urgent need for additional therapies to help those suffering from severe anorexia,” said Dr. Blake Woodside, medical director of Canada’s largest eating disorders program at Toronto General Hospital and a professor of psychiatry at the University of Toronto. “Eating disorders have the highest death rate of any mental illness and more and more women are dying from anorexia. Any treatment that could potentially change the natural course of this illness is not just offering hope, but saving the lives of those that suffer from the extreme form of this condition.”
The study was published in the medical journal The Lancet.
Source: University Health Network