View Count: 305 |  Publish Date: March 07, 2013
'Brain pacemaker' may help treat patients with severe anorexia

Before Kim Rollins had reached the age of 35, she had suffered a severe heart attack, two strokes, developed osteoporosis and broken up to eight bones in her legs and feet.  
Rollins’ health issues, while seemingly extraordinary, all related to her biggest health issue of all – anorexia nervosa.  Rollins first developed the eating disorder at the age of 15 and struggled with it for the next 20 years of her life, unable to find any type of coping mechanism.  At her lowest point, Rollins weighed as little as 71 pounds.
She tried all the ‘conventional’ therapies, entering herself in nearly 10 treatment facilities.  But Rollins’ symptoms were so severe that she never followed through and always ended up breaking the rules.  Eventually, she became completely isolated from her friends and family, and became even more obsessed with her weight – focusing on eating as little as possible and burning as many calories as she could.
“It continued like that for years and years,” Rollins, 36, of Kitchener, Ontario, told “My health got worse and my weight got lower, to the point where I thought I was going to die from this.  My mom has even told me she was planning my funeral a couple of times.”
Then, one of her doctors mentioned a study being conducted, in which researchers were recruiting subjects who suffered from severe anorexia and had exhausted all forms of available treatment.  Figuring she had no other options left, she decided to reach out and sign up for the small clinical trial.
“It came down to a choice between almost certain death or taking a chance on this,” Rollins said. “I thought the worst that could happen was that it didn’t have any effect.”
Not only did the procedure have an effect, but her involvement with the study would completely change her life.
Deep brain stimulation
For the phase I safety trial, researchers from the Krembil Neuroscience Center in Toronto and the University Health Network in Canada were looking to experiment with a technique that has been used to treat various nervous system disorders – deep brain stimulation (DBS).
Fairly well established in the surgical world, DBS – sometimes referred to as a ‘brain pacemaker’ – has been used for nearly 25 years to treat movement disorders such as Parkinson’s disease, tremor and dystonia.  More recently, DBS has been experimented with in regards to treatment for epilepsy, Tourette’s syndrome and even major depression.
Given the treatment’s success when it came to treating depression, the researchers decided to take it one step further.  In the first-ever study to treat anorexia with DBS, the scientists decided to target a specific portion of the patient’s brain – a bundle of white matter below the corpus callosum, which divides the left and right sides of the brain.
“When you do imaging studies of patients with anorexia, this area is directly implicated,” Dr. Nir Lipsman, neurosurgery resident and Ph.D. student at the Krembil Neuroscience Center, told  “… It’s also connected to other areas in the brain that are implicated, such as areas controlling body image, reward and awareness of one’s internal environment.”
Lipsman surgically implanted electrodes within the target areas of their subjects’ brains – including that of Rollins.  Once in place, the electrodes were attached to a pacemaker-like device, which is placed underneath the skin of the collar bone.  The device was then activated, and the electrodes began sending electrical impulses to the areas of the brain in an attempt to control the abnormal impulses.
“We know that in patients with depression and anorexia, this area is overactive,” Lipsman said. “Putting a DBS electrode in this area turns down the volume and activity in this area of the brain.”
Rollins and the other five subjects in the study were between the ages of 25 and 57, and had been suffering from anorexia for between four and 37 years.  Ten days after each subject had been implanted with the device, the ‘pacemaker’ was activated, and the researchers continued to follow their progress over the next nine months.
Stunning results
Before surgery, Lipsman and researchers conducted baseline investigations of the subjects’ moods and body mass index.  The researchers also conducted PET (positron emission tomography) scans of the subjects’ brains, which detects what areas are consuming the most and least glucose.
After seeing the subjects every two to three weeks throughout the study, the team conducted all of these baseline tests again six months after surgery – and they were amazed with what they found.  Five or six patients had stabilized or gained weight, and half of the patients experience significant improvements in their moods or had reduced their obsessive-compulsive disorder.
At nine months, the results were even more encouraging, with three patients – Rollins included – maintaining a higher weight than before receiving DBS, which was the longest sustained weight any of the patients had since the start of their illness.
“All these changes allowed them to potentially engage in conventional treatment more effectively,” Lipsman said of the results.  “It wasn’t the case that DBS was directly influencing weight; they didn’t report more hunger or appetite.  It focused on getting the foot in the door of a very serious, chronic illness in order to reduce the obstacles in a way so they could get benefit from conventional therapy.”
As for Rollins, the experience has been nothing short of amazing.  Since the surgery, she has been able to maintain a weight of 112 pounds, and continues to see a dietician and therapist to help sustain her progress.
“I feel like taking care of myself,” Rollins said. “I feel like I like my body, and my body image is pretty good.  I no longer think I’m too fat… I’ve really started concentrating on different areas of my life, like going back to school, getting back in touch with my friends, getting a better job.  Things I really ignored for 20 years are becoming important for me again.  It’s been an incredible experience.”
The study was published online in the medical journal The Lancet.

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