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Brain pacemaker reported to benefit anorexia nervosa patients

Robin Wulffson MD's picture
Anorexia nervosa eating disorder treated

Treatment with brain pacemaker reported to restore anorexia nervosa patients to good health.

Anorexia nervosa is a serious eating disorder in which individuals starve themselves due to the mistaken belief that they are overweight. The well-known pop singer, Karen Carpenter died because of the condition. Now, researchers affiliated with the Krembil Neuroscience Center in Toronto and the University Health Network in Canada have found that a procedure known as deep brain stimulation (DBS) can treat the disorder. They published their findings online on March 7 in The Lancet.

The researchers note that early treatment of adolescents with anorexia nervosa, via mobilization of family members to restore normal eating and weight, is successful in 30-60% of patients, However, those with an illness duration of longer than three years (as is often the case in adult patients) change is more difficult. Even with the best available psychological treatments, outcomes in those with an established form of the illness are generally poor.

The researchers evaluated a serious treatment a severe disease: DBS. The procedure, sometimes referred to as a ‘brain pacemaker,’ has been used for nearly 25 years to treat movement disorders such as Parkinson’s disease, tremor, and dystonia (repetitive, involuntary muscle contractions). More recently, DBS has been studied for the treatment of epilepsy, Tourette’s syndrome, and major depression. Inasmuch as the procedure has been proven to be successful for treatment of the aforementioned conditions, the researchers decided to apply it to cases of severe anorexia nervosa. In the first-ever study to treat anorexia with DBS, the investigators focused on a specific region of the brain, a bundle of white matter below the corpus callosum, which divides the left and right sides of the brain. They chose this area because when imaging studies were done on anorexia nervosa patients, it appeared to be implicated in the condition because it is overactive in patients with anorexia nervosa or depression. In addition, it is connected to other areas in the brain that are implicated, such as areas controlling body image, reward, and awareness of one’s internal environment.”

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The researchers surgically implanted electrodes within the target areas of their subjects’ brains. Once in place, the electrodes were attached to a pacemaker-like device, which is placed underneath the skin of the collar bone. The device was then activated, and the electrodes began sending electrical impulses to the areas of the brain in an attempt to control the abnormal impulses. Placement of a DBS electrode in this area turns down the volume and activity in this area of the brain.

The study group comprised six subjects between the ages of 25 and 57; they had been suffering from anorexia nervosa for between four and 37 years. Before surgery, the researchers conducted baseline investigations of the subjects’ moods and body mass index. The researchers also conducted PET (positron emission tomography) scans of the subjects’ brains, which detects what areas are consuming the most and least glucose. Ten days after each subject had been implanted with the device, the ‘pacemaker’ was activated, and the researchers continued to follow their progress over the next nine months. Six months after the surgery, the researchers conducted all of the baseline tests for anorexia nervosa. They found that five or six patients had stabilized or gained weight, and half of the patients experienced significant improvements in their moods or had reduced their obsessive-compulsive disorder. At nine months, the results were even more encouraging, with three patients maintaining a higher weight than before receiving DBS, which was the longest sustained weight any of the patients had since the start of their illness.

The following is the results of one of the patients, Kim Rollins:

Before Kim Rollins had reached the age of 35, she had suffered a severe heart attack, two strokes, developed osteoporosis, and broken up to eight bones in her legs and feet. Her serious health issues all related to anorexia nervosa. She first developed the condition at the age of 15 and struggled with it for the next 20 years of her life, unable to find any type of coping mechanism. At her lowest point, Ms. Rollins weighed as little as 71 pounds. She tried all the conventional therapies and enrolled in nearly 10 treatment facilities. However, her symptoms were so severe that she never followed through and always ended up breaking the rules. Eventually, she became completely isolated from her friends and family, and became even more obsessed with her weight; she focused on eating as little as possible and burning as many calories as she could.

One of her physicians mentioned a study being conducted, in which researchers were recruiting subjects who suffered from severe anorexia and had exhausted all forms of available treatment. Figuring she had no other options left, she decided to reach out and sign up for the small clinical trial. She noted that the study appeared to her as a last resort before succumbing to her disease. The experience was a remarkable turnaround. Since the surgery, she has been able to maintain a weight of 112 pounds, and continues to see a dietician and therapist to help sustain her progress. Ms. Rollins now feels in control of her life and no longer considers herself to be too fat. She is looking forward to a future of good health.

Reference: The Lancet