Deep brain stimulation may treat binge eating disorder

Well-timed shocks of high-frequency electricity to regions of the brain associated with food cravings appear to suppress heart impulses. binge eating disorderresearchers report.

An uncontrolled diet that causes shame, regret, or health problems is a psychiatric problem Recent Eating DisordersIt is thought to affect 5% of American adults, most (but not all) of whom are obese. Talk therapy and her ADHD drug Vyvanse are offered as treatments, but the condition doesn’t always succumb to either quickly.

Researchers from Stanford University and the University of Pennsylvania have attempted to treat bulimia in a form of deep brain stimulation similar to that used for epilepsy in a feasibility study in two patients. Obsessive-compulsive disorder, depression, Parkinson’s disease.of provisional results It was published this week in Nature Medicine.

Extending research done in mice, the research team found that cravings just before a binge episode trigger specific low-frequency electrical patterns called parts of the brain. nucleus accumbensThis structure plays a key role in one of our most primitive mammalian behaviors: pleasure-seeking.

Two patients who volunteered for this study, women who had struggled with uncontrolled diets for years, willingly allowed researchers to have a set of four electrodes implanted in their brains.

Surgery was no small procedure. After fixing the patient’s head in a stereotaxic cage, the surgeon takes a filament capable of recording and transmitting electrical signals and sinks it through the skull until it reaches the deepest region of the brain, the limbic system. Because the process is so invasive, the researchers allowed a six-week recovery period before beginning the process of measuring patients’ responses to food.

The first task was to wiretap a woman’s brain when she encounters the type of food that causes gluttony. The researchers then used electrodes to interfere with electrical signals generated just before the out-of-control meal began.

Both women were severely obese and both temporarily benefited from gastric bypass surgery before they resumed binge eating and regained much of the weight they had lost. One person told researchers he was “addicted” to chocolate, peanut butter, and fast food.

“They didn’t have full control over their food,” he said. Casey H. Halpern, Ph.D.A neurosurgeon at the University of Pennsylvania and one of the study’s co-authors. “They crave food and were emotional eaters.”

Many Americans struggle with overeating, craving certain foods and eating them to comfort themselves. It is very embarrassing to eat, and often encourages people to hide their behavior away from family and friends.

Volunteers showed similar brain patterns in response to the palatable food, Halpern said. It seems that the brain circuits that inhibit reward-seeking behavior were “really messed up.”

The electrodes were used for a different purpose, once the researchers pinpointed the precise characteristics of women’s brain waves before, during, and after episodes of uncontrolled eating. When the system detects the characteristic electrical pattern of an impending episode, it sends a brief (undetectable to the female) burst of high-frequency electrical stimulation intended to indiscriminately confuse her with “eat me!” did. signal.

If the electrical pattern before bingeing did not respond immediately, the stimulation was repeated until it did. Overall, each woman received an average of approximately 10 minutes of electrical stimulation per day. This is of much more limited use than is commonly used in the treatment of disorders such as OCD.

The intervention was promising in both patients. During his six months in the early stages of the study, the frequency and severity of uncontrolled eating episodes decreased, facilitating weight loss. One patient about 18 pounds, another patient he’s 13 pounds. For one subject, it was 4.5% of her body weight. On the other she is 5.8%.

The weight loss was modest, but occurred without any specific advice or regimen prescribed by the researchers.To the further surprise of the team members, the two women began exercising without any prompting. .

Two subjects, along with four more currently recruited to the study, will continue to receive treatment and will be followed for at least one year.

Scientists worry that when the brain’s pleasure-seeking circuits are weakened, people lose interest in other normal, healthy, pleasurable activities. It didn’t happen to either woman, Halpern said.

“The fact that they were able to lose weight without being directed is amazing,” Halpern said. , and link them tightly to a heightened sense of well-being.

“I don’t think it’s a silver bullet,” says Halpern. But if patients who received deep brain stimulation were also given weight loss and behavioral change guidance, it could be a powerful tool for treatment, he said.

Eating, which is so natural for humans, is a complex behavior to study. The patterns we establish seem to emerge from the deep instincts, practiced behaviors, and emotional cues we surround ourselves with food.

“We had a hard time mapping it — where the binge stops and starts,” he said. Dr. Carrie McAdamsa psychiatrist at the University of Texas Southeastern Medical Center who specializes in treating eating disorders.

For younger people and those who report new or sporadic episodes of uncontrolled eating, binge eating can feel like an unhealthy habit that can be reversed with talk therapy or drugs, McAdams said.A New Generation of Diabetes and Obesity Drugs — a Group Widely Known as GLP-1 agonist This includes Trulicity and Ozempic — not officially approved to treat bulimia, but seem to help.

But for many patients, especially those whose behavior has been entrenched for years, eating is discouraged even if they want it to feel more like a biological problem than a psychological choice. I can’t stop

Many brain circuits are involved in substance addiction and obsessive-compulsive behavior disorder, McAdams said. New research provides insight into how to change the behaviors that keep our brains in unhealthy ruts.

The use of deep brain stimulation for bulimia appears to do this by helping to reboot circuits involved in cognition and behavior, using the brain’s ability to reshape itself in response to new experiences. .

psychologist Stephen WunderrichThe director of behavioral research at the University of North Dakota Sanford Health System agrees. He said stress and negative emotions play a strong role in uncontrolled eating.

“But the fact that they discovered neural signals just gives more people more options,” Wonderlich said.

For those who can change their behavior more invasively, having brain surgery will never be an option, he added.

“I wouldn’t say everyone is pressing an easy button to get out of this situation,” Wonderlich says. “But this is really cool and innovative, and I’m really excited about it.”