Lipsman and colleagues from Toronto, Canada reporting in the Lancet doi:10.1016/S0140-6736(12)62188-6 outline the results of a phase one pilot trial of deep brain stimulation (DBS) for treatment-refractory anorexia nervosa. A treatment which has been applied to other circuit-based neuropsychiatric diseases, such as Parkinson's disease and major depression, with promising results. The aim of the phase one study was to assess the safety of deep brain stimulation to modulate the activity of limbic circuits and to examine how this might affect the clinical features of anorexia nervosa.
Their prospective trial of subcallosal cingulate DBS in six patients with chronic, severe, and treatment-refractory anorexia nervosa between aged 20-60 years involved implantation of electrodes and pulse generators for continuous delivery of electrical stimulation. Patients were followed up for 9 months after DBS activation and although there were several adverse events, only one (seizure during programming, roughly 2 weeks after surgery) was serious. Other related adverse events were panic attack during surgery, nausea, air embolus, and pain. After 9 months, three of the six patients had achieved and maintained a BMI greater than their historical baselines. DBS was associated with improvements in mood, anxiety, affective regulation, and anorexia nervosa-related obsessions and compulsions in four patients and with improvements in quality of life in three patients after 6 months of stimulation. These clinical benefits were accompanied by changes in cerebral glucose metabolism (seen in a comparison of composite PET scans at baseline and 6 months) that were consistent with a reversal of the abnormalities seen in the anterior cingulate, insula, and parietal lobe inanorexia nervosa. They conclude that subcallosal cingulate DBS seems to be generally safe in this sample of patients with chronic and treatment-refractory anorexia nervosa.
The results provide a hope of a new therapy for those patients and families suffering with a severe and sometimes intractable chronic illness which often starts in adolescence. It remains to be seen whether the treatment will be acceptable to patients in an era when the stigma and fear of ECT and electrical brain treatments, whilst in decline, still persists.