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Deep brain stimulation effective for treatment-resistant anorexia nervosa

Deep brain stimulation improved BMI, depression, anxiety and affective regulation outcomes among individuals with treatment-resistant anorexia nervosa, according to recent findings.

“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,” Nir Lipsman, MD, of University of Toronto, said in a press release.

To assess safety and efficacy of deep brain stimulation for anorexia nervosa, researchers conducted a prospective, open-label trial among 16 individuals with treatment-refractory anorexia nervosa. Study participants received deep brain stimulation of the subcallosal cingulate for 1 year. Participants had a mean age of 34 years and average illness duration of 18 years.

Mean BMI increased from 13.83 at baseline to 17.34 after intervention (P = .0009).

Deep brain stimulation was associated with significant improvements in depression (P = .00015), anxiety (P = .035) and affective regulation (P = .019).

Researchers found significant changes in cerebral glucose metabolism in anorexia nervosa-related brain structure at 6 months and 12 months of ongoing deep brain stimulation.

Two participants asked for their devices to be removed or deactivated during the study.

The most common adverse event was pain related to surgical incision or positioning that required oral analgesics for more than 3 to 4 days after surgery (31%).

Forty-four percent of participants experienced serious adverse events, which were mostly related to underlying illness, according to researchers.

“The progression of symptom changes after deep brain stimulation suggests that mood improved before eating behaviors changed; exploration of other approaches used in treatment-resistant depression, such as ketamine or reverse transcranial magnetic stimulation, might also be worth investigation for treatment-refractory anorexia nervosa,” Carrie J. McAdams, MD, PhD, of University of Texas Southwestern Medical Center, Dallas, wrote in an accompanying editorial. “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 anorexia nervosa, could contribute to the poor outcomes seen with conventional treatments.”– by Amanda Oldt

Disclosure: Lipsman and McAdams report no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.