August 29, 2022

expert reaction to pilot study in two individuals of brain stimulation for binge-eating disorder

A study published in Nature Medicine looks at the use of deep brain stimulation for loss-of-control eating.

Dr Alexandra Pike, Lecturer in Mental Health, University of York, said:

“In this paper, the authors report promising early-stage results that speak to the potential benefits of personalised deep-brain stimulation in those with binge-eating disorder, an eating disorder characterised by episodes of eating objectively large amounts of food whilst feeling like you are out of control. This technique uses a type of ‘brain pacemaker’ to detect specific patterns of brain activity, at which point it sends electrical stimulation to the brain. The use of this device for six months reduced the patients’ feelings of loss-of-control, and less binges. However, there are a few limitations and notes of caution for this early stage research. This is a small sample (only two participants were tested). Despite the promising results, and due to its invasiveness and side effects, this is unlikely to ever be a treatment that is widely available beyond severe cases, as shown by the criteria patients had to meet to be included (a diagnosis of binge eating disorder and severe obesity, along with no long-term benefit from bariatric surgery, or at least one type of weight-loss medication).  Additionally, most of the results are from non-blinded treatment (i.e. the patients knew that they were receiving stimulation), and the fully blinded part of the study has not yet started. This means that some of the effects could be due to a ‘placebo effect’. Finally, the results suggest that the pattern of brain activity detected happens around 50-60% of the time when patients are awake, not only when the patients are experiencing loss-of-control eating, which means they are being stimulated perhaps more than is necessary (roughly 400 times per day) with the current settings. ”

‘Pilot study of responsive nucleus accumbens deep brain stimulation for loss-of-control eating’ by Rajat S. Shivacharan et al. was published in Nature Medicine at 16:00 UK time on Monday 29^th August.

DOI: https://doi.org/10.1038/s41591-022-01941-w

Declared interests

Dr Alexandra Pike: “I have previously written about the ethics of deep brain stimulation in anorexia nervosa (DOI: 10.3389/fpsyt.2017.00044) and have also written blogs aimed at clinicians summarising other papers on deep brain stimulation (e.g. [https://www.nationalelfservice.net/mental-health/depression/deep-brain-stimulation-depression/](https://www.nationalelfservice.net/mental-health/depression/deep-brain-stimulation-depression/).”