Deep brain stimulation for patients with chronic anorexia is safe and might improve symptoms

February 24, 2017
Brain activity differences. Credit: Reprinted from The Lancet, http://dx.doi.org/10.1016/S2215-0366(17)30076-7, Lipsman et al, Deep brain stimulation of the subcallosal cingulate for treatment-refractory anorexia nervosa: 1 year follow-up of an open-label trial, Copyright (2017), with permission from Elsevier

Small study in 16 people suggests technique is safe and might help improve mood, anxiety and wellbeing, while increasing weight.

Deep stimulation might alter the brain circuits that drive anorexia nervosa symptoms and help improve ' mental and physical health, according to a small study published in The Lancet Psychiatry.

Despite having the highest mortality rate of any psychiatric disorder, there are few effective ways to manage treatment-resistant anorexia. While the study only included 16 patients, it suggests that the intervention is safe and could help improve some symptoms of anorexia, but more research is needed.

Worldwide, 0.5% of people have anorexia, and teenage girls account for the majority of cases. The eating disorder is characterised by persistent concerns about bodyweight, shape and size, leading patients to maintain a low weight. Many patients experience mood and anxiety disorders, deny their illness and avoid seeking medical help for it.

Chronic anorexia causes severe health problems as a result of malnutrition, including weak bones and muscles, sexual problems, infertility, heart problems and seizures. The condition can be fatal and those who become acutely ill are admitted to specialised hospital units to receive nutritional support, medical stabilisation and behavioural therapy.

The small study followed 16 women aged between 21 and 57 years old who had had anorexia for an average of 18 years and were severely underweight (with an average (BMI) of 13.8). They were selected for the study as all other available treatments did not work for them and they were at risk of early death because of anorexia.

All patients underwent , which involves implanting electrodes and stimulating areas of the brain that control dysfunctional behaviours. The technique is currently used to target the brain circuits involved in Parkinson's disease, dystonia, and tremors, where it has been shown to be highly effective in controlling symptoms.

The study looked at how safe deep brain stimulation was for patients with anorexia, and how it affected their BMI, mood, anxiety and wellbeing. Using PET scans, the researchers also looked at how changed after one year of stimulation.

Electrodes were placed into their subcallosal cingulate, an area located in the centre of the brain that has been shown to have altered serotonin binding in patients with anorexia. Once implanted, the electrodes stimulated the area for one year at a level of 5 - 6.5 volts every 90 micro-seconds.

The treatment had few serious adverse events; however, five patients had pain that persisted for longer than usual following the surgery (more than 3-4 days) and one had an infection at the site of the surgery which resulted in the electrodes needing to be removed and re-implanted. Most adverse events were a result of the patients' chronic anorexia and included having very low sodium and potassium levels. One patient had an unexplained seizure several months after their electrodes were implanted.

During the study, two patients asked to have the electrodes removed, potentially a result of them being uncomfortable with their weight gain. This meant that there were only 14 patients included at follow-up.

For these patients, mental health symptoms improved over the study with mood and anxiety symptoms reducing in five patients and depression reducing in 10 out of 14 patients. They also reported better quality of life.

While psychological symptoms improved soon after the stimulation began, changes in weight started after three months, suggesting that improving mental health symptoms may precede or even enable changes in weight. Over the course of the study, average BMI of the group increased to 17.3 - an increase of 3.5 points - and six patients achieved a normal BMI (of 18.5 or more).

When comparing the scan results for brain activity before treatment and after a year of stimulation, the researchers found that there were changes in the regions linked to anorexia, suggesting that deep brain stimulation was able to directly affect the related . This included less activity in the putamen, thalamus, cerebellum amongst other areas, and more activity in the peripheral cortical areas which are also linked to social perception and behaviour.

"Anorexia remains the psychiatric disorder with the highest mortality rate, and there is an urgent need to develop safe, effective, evidence-driven treatments that are informed by a growing understanding of brain circuitry," said study author, Professor Andres Lozano, University of Toronto, Canada. "While our results show some early promise, more research will be needed before this becomes available for patients with anorexia. Our findings emphasise the need for continued research into novel neuromodulation strategies for anorexia nervosa, and for more broadly." [1]

"Our study suggests that a focal brain intervention, deep brain stimulation, may have an impact on the circuitry of symptoms that serve to maintain anorexia and make it so difficult to treat." said lead author, Dr Nir Lipsman, Sunnybrook Health Sciences Centre, Canada. [1]

The researchers note some limitations within their work, including that the group was small and there was no control group. In addition, all patients were aware they were being given treatment so the results seen could be affected by placebo effect. However, the authors note this is unlikely as the results lasted for a year and were confirmed with the brain activity scans.

Writing in a linked Comment Dr Carrie McAdams, University of Texas, USA, said: "Conventional treatment of anorexia nervosa includes behavioural modifications to improve feeding, combined with psychological therapy to address cognitive distortions related to self-esteem, eating, and body dissatisfaction. Nevertheless, after intensive treatment, nearly half of adult women with anorexia nervosa relapse within a year... This work shows how modern neuroscience can lead to a new treatment and simultaneously improve understanding of perpetuating factors in a complex, multifactorial disease... Both mood and social function warrant further examination as potential neural factors that might perpetuate anorexia nervosa in adults. Difficulty in changing these factors, which are not part of the diagnostic symptoms of nervosa, could contribute to the poor outcomes seen with conventional treatments."

Explore further: Study points to treatment strategy for anorexia

More information: Nir Lipsman et al. Deep brain stimulation of the subcallosal cingulate for treatment-refractory anorexia nervosa: 1 year follow-up of an open-label trial, The Lancet Psychiatry (2017). DOI: 10.1016/S2215-0366(17)30076-7

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SkyLy
3 / 5 (1) Feb 24, 2017
The beginning of augmented humanity, we now have to check if stimulating dopaminergic pathways is also safe, and we could trigger cocaine-like effects from an iphone app. (n.n)/
BubbaNicholson
1 / 5 (1) Feb 25, 2017
Anorexia Nervosa, exactly like the well-documented phenomenon in animals, is a pheromone-caused puberty delay. It is initiated and continued by auto emissions by a subordinate female axillary airborne pheromone emission and reception by the AN victim. Break up dangerous pheromone plumes (of high enough concentration to perpetuate the disease) by oscillating fans. Such fans have diminished SIDS risk in 6 week old babies by the same cause. Treat with 250mg po of healthy adult male facial skin surface sebaceous pheromone. Collected pheromone emits biohazard airborne pheromone, so staff to wear respirators, keep paternal facial skin surface pheromone gum under hood in sealed containers with activated charcoal dunnage. Isolate patient 40 days. No osculation (to avoid jealousy in partner). Shave and occlude axillary pheromone-emitting glands with petroleum jelly 24/7 at 4 hour intervals for patients near death or activated charcoal pads underarms for comfort if improving.
Nik_2213
not rated yet Feb 25, 2017
Next, could they try *non-invasive* stuff such as TMS, 'Transcranial magnetic stimulation' ??
TheGhostofOtto1923
5 / 5 (1) Feb 26, 2017
Humans have been plagued with chronic overpopulation ever since technology enabled them to hunt the predators that had served to keep their numbers in check.

Many species have natural responses to perceived overcrowding. Rabbit females in overcrowded warrens will absorb unborn fetuses.

As bubba noted above, the major effect of anorexia is that it delays or interrupts puberty. It returns females to a pre-pubescent state which prevents conception.

The preoccupation with body image may be reflect the desire to witness this return, or it could be a rationalization by therapists seeking to explain something they are powerless over in some acceptable cultural context.

Epigenetic influence by the mother over her offspring could be the genesis of this condition. It also could explain homosexuality as another wholly natural response to unnatural overcrowding.
Cont>
TheGhostofOtto1923
5 / 5 (1) Feb 26, 2017
Do homosexuality and eating disorders occur more frequently in urban areas? Does a religious context alter the perception that ones tribe is overcrowded when in direct competition with other tribes?

The possible link to reproduction suggests that an effective treatment for anorexia might be hormones or in extreme cases removal of the sex organs.

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