Research press release


Nature Medicine

Health: Brain stimulation aids treatment of binge eating in two patients



今回、C Halpernたちは、過食性障害と治療抵抗性の重度の肥満(クラスIII)と診断された2人の患者(45歳と56歳の女性)で、脳側坐核の腹側領域と背側領域での電気生理活動のパターンを6か月間にわたって記録した。2人の患者の脳活動測定値は、標準的な食事の際の食物への期待に関連する時間帯と、食物渇望とそれに続くLOC摂食に関連する時間帯とで集められた。Halpernたちは、これらの測定データを用いて、両方の患者で食物渇望とLOCに特異的に関連する低周波の脳活動シグネチャーを明らかにした。次に、この新たに見つかった脳バイオマーカーを使い、応答性脳深部刺激または閉ループ脳深部刺激を行う装置を用いて2人の患者の側坐核の脳深部刺激を実施した。この脳刺激の6か月後に、2人の患者の両方でLOC摂食事象の大幅な低下とその後の体重減少が観察された。そして、患者の1人は過食性障害の診断基準を満たさなくなった。この方法では、重篤な副作用の報告はなかった。


Brain stimulation, guided by patterns of neural activity associated with food cravings, improved self-control of food intake and weight loss in two people with binge-eating disorder and severe obesity, according to a paper published in Nature Medicine. These findings — which form part of an ongoing clinical trial — demonstrate the feasibility and safety of treating people with loss-of-control eating through physiologically guided, closed-loop deep brain stimulation.

Loss-of-control (LOC) eating is pervasive in all binges and is characterized by a loss of inhibitory control in response to appetite cues and cravings. Despite the prevalence and severity of LOC eating, most treatments for obesity fail to address it directly, which limits the efficacy of the most aggressive measures, such as bariatric surgery.

Casey Halpern and colleagues recorded electrophysiological activity patterns, over a 6-month period, in the ventral and dorsal region of the nucleus accumbens in the brains of two patients (both female, 45 and 56 years old) diagnosed with binge-eating disorder and treatment-refractory, severe (Class III) obesity. Brain-activity measurements were collected from these patients during periods associated with anticipation of food during standard meals, during food cravings and with LOC eating. Using these data, the authors identified a low-frequency brain-activity signature that was specifically associated with food cravings and LOC in both patients. The authors then used this newly identified brain biomarker to guide deep brain stimulation of the nucleus accumbens in both patients using a device capable of responsive or closed-loop, deep brain stimulation. Significant reductions in LOC eating events and subsequent weight loss were observed in both patients after 6 months of brain stimulation. One of the patients no longer met criteria for binge-eating disorder. No serious adverse side effects were reported.

The preliminary results of this pilot study highlight the potential clinical feasibility of this novel intervention and support the continued study of larger cohorts of patients with binge-eating disorder.

doi: 10.1038/s41591-022-01941-w


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