Andres Lozano (University of Toronto)
Researchers at the University Health Network in Toronto found deep brain stimulation to help some patients with severe anorexia increase their body mass index and reduce related obsessions and compulsions. Results of the small-scale clinical trial were published online in today’s issue of the journal The Lancet (paid subscription required).
Anorexia nervosa is an eating disorder where people feel compelled to lose more weight than is healthy for their age and height. While the exact causes are not known, factors influencing the onset of anorexia include anxiety disorders and eating problems in childhood, worries about weight or physical shape, and negative self-image. People with anorexia exhibit an intense fear of gaining weight, refuse to keep a normal weight, and exercise continuously or compulsively. It is considered a challenging and chronic disorder with the highest mortality rate of any psychiatric condition.
The trial, led by University Health Network neuroscientist Andres Lozano (pictured left), aimed to test the safety and gauge the early efficacy of deep brain stimulation as a treatment for anorexia. Deep brain stimulation is a neurosurgical procedure where electrodes are attached to the affected regions of the brain and submitted to stimulation by an electrical current. The technique has been tested as a treatment for Parkinson’s disease and as a way of managing depression.
The trial enrolled six patients in Toronto, age 20 to 60, with chronic and severe cases of anorexia that had resisted other types of treatment. In addition to anorexia, all but one of the patients suffered from psychiatric conditions, including deprerssion and obsessive-compulsive disorder. The patients together had a total of almost 50 hospitalizations, in some cases due to medical complications from anorexia.
The six patients were fitted with electrodes implanted in the region of the brain involved with emotion, and closely associated with disorders such as depression. The electrodes were then connected to an electronic pulse generator implanted below the right collar-bone, much like a heart pacemaker. The researchers looked for immediate adverse effects of the procedure, and tracked the patients at one, three, six, and nine months after the procedure, with psychometric assessments, body mass index measurements, and neuroimaging tests.
Nine months after the procedure, three of the six patients reported weight gains, measured by increases in their body mass indexes. In addition, four of the six patients had improvements in mood, anxiety, control over their emotional responses, including binging and purging urges and other symptoms related to anorexia, such as obsessions and compulsions. The treatment helped convince two patients to enroll in and complete an in-patient eating disorders program.
The procedure resulted in a serious adverse event in one patient, a seizure some two weeks following the surgery. Other adverse effects reported were a panic attack during surgery, nausea, air embolism, and pain.
Lozano says the research not only provides another potential form of therapy, it can help build more understanding of anorexia and the factors behind it. “We are truly ushering in a new of era of understanding of the brain and the role it can play in certain neurological disorders,” says Lozano. “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.”
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