When anorexia is resistant to treatment, medical staff have limited options to help patients stay alive and healthy. Research in Toronto explores the usefulness of deep brain stimulation for severe cases of anorexia.
Anorexia nervosa is responsible for more patient deaths than any other psychiatric condition, and it is often incredibly difficult to treat. Many patients are hospitalized frequently and have a great deal of trouble complying with treatment. Researchers in Toronto implanted electrodes in the brains of patients whose anorexia was resistant to treatment, in the hope that deep brain stimulation would improve their symptoms. Their primary concern was the safety and clinical outcomes of electrical stimulation over a period of one year.
The study was conducted from 2011-2014. Participants were found through the Toronto General Hospital’s Eating Disorders Program, or through referrals from the community. All 16 participants were between the ages of 20 and 60, with an average age of 34. The average length of illness was 18 years, and all the patients were female. 88% of participants had at least one additional psychiatric diagnosis, and all had been hospitalized multiple times in order to be medically stabilized, including episodes of involuntary feeding. 44% of patients were not taking any psychiatric medications at the beginning of the study because they had consistently failed to respond to pharmacological treatment in the past. Participants underwent surgery to implant electrodes into the subcallosal cingulate, a region of the brain associated with some improvements to mood and anxiety when stimulated. Researchers then collected data at regular intervals on the patients’ body mass index (BMI), mood, anxiety, behaviors associated with anorexia, and the impact on regions of the brain associated with anorexia.
Few serious adverse effects were experienced as a result of surgery or stimulation. BMI increased significantly over the 12 months of stimulation, with 43% of those who completed the full study reaching a normal BMI of 185. Weight gain didn’t begin till 3 months after surgery. Patients who exhibited binging and purging behaviors experienced significant reduction of these behaviors, along with other pathologies associated with eating disorders. Mood and anxiety levels also improved, though levels of impulsivity did not change. Brain imaging demonstrated that the activity of various areas of the brain associated with anorexia was significantly changed at 6 months and 12 months post-surgery, indicating that deep brain stimulation can directly affect anorexia-related brain regions.
This study provides crucial information on the impact of deep brain stimulation for patients with anorexia in particular, and psychiatric disorders in general. Since the surgery and stimulation had few adverse effects, it is possible that this could be a safe and effective treatment option for patients who do not respond to conventional treatment. Though improvements in weight are an excellent sign, researchers stress the importance of improving other factors related to the condition in order to achieve improvements that will last in the long term.
Written By: Ashley Shaw