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.
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