A cure for chronic anorexia nervosa?

A study published in The Lancet this week suggests that deep brain stimulation (DBS) could offer a cure for chronic and difficult-to-treat anorexia nervosa. Researchers in Canada investigated the effects of such a controversial treatment in six patients aged 20-60 with a history of this pernicious and life-threatening condition.

Just 9 months after treatment was initiated, half of the patients had achieved and maintained a significant increase in bodyweight and reported improvements in their quality of life. Furthermore, four of the six patients experienced improvements in mood, reduced anxiety and a marked decrease in obsessions and compulsions associated with the condition.

DBS was partially developed in Oxford during the 1990s. The technique is reliant on a network of surgically implanted electrodes which are driven to signal electrical impulses to small areas of the brain by a pacemaker. Although the medical profession remains somewhat ignorant of how DBS actually works, this procedure has long been used to treat Parkinson’s disease. In recent years, researchers have adapted DBS for the treatment of severe depression by targeting the subcallosal cingulate gyrus, a key component of the circuit linking brain areas involved in planning and emotion. The similarities between depression and anorexia nervosa inspired researchers led by Dr Nir Lipsman to target this area in the six anorexic volunteers.

Anorexia nervosa is notoriously difficult to treat. Whilst rare, this condition is important clinically due to an association with poor quality of life and startlingly high death rates. Patients with this condition display an intense fear of weight gain and often severely restrict their daily food intake. The current treatments available to patients – cognitive behavioural and family therapies – often have little impact on the disease and 5-10% of anorexic patients will die due to starvation and its consequences. The lack of side effects associated with subcallosal DBS – and its remarkable positive effects on weight gain, mood and quality of life – imply that this technique could become widely implemented in years to come.