Anorexia

Transcranial Magnetic Stimulation Found Promising for Treating Anorexia

November 15, 2018

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Anorexia Nervosa (AN) is a complex disorder, often unresponsive to treatment and in turn, fatal to many patients suffering from it. Current treatments often partner psychotherapy, in addition to possible medications, and are minimally effective, leaving those suffering with the disorder in lifelong battles with the disease. Recent research has found connections to AN and abnormal neural circuitry, which Transcranial Magnetic Stimulation (TMS) can address.

rTMS delivered to the dorsolateral prefrontal cortex for anorexia treatment. Image courtesy of King's College London via The Conversation

How TMS Works for Anorexia

It has been found that AN impacts the striatal, frontal, and limbic brain networks, resulting in abnormal emotional regulation, habit learning, and cognitive flexibility. The Prefrontal Cortex is the most notable network to be correlated with disorder, because when hypoactive it can result in the AN symptoms of poor impulse control. Therefore restoring balance to the prefrontal cortex shows promise in successfully treating AN by resetting the dysfunctional neural networks through non-invasive brain stimulations with TMS.

brain activity scans in anorexic patients
Brain activity in anorexic patients differs to that of non anorexic subjects, including lower activation in the middle and anterior temporal cortex and in the medial prefrontal cortex. Image courtesy of Science Direct

TMS repeatedly applies magnetic pulses to the scalp targeting the brain region in need of treatment. This changes cortical excitability by inducing electric current in adjacent neurons. TMS is already approved by the FDA to treat depression and OCD, and shows strong promise for treating PTSD, memory issues, addiction, schizophrenia, and now eating disorders.

Research Reveals New Hope for AN Treatment

So far research has focused on treating core symptoms of AN with TMS, such as urges to restrict eating or feelings of fatness or fullness. While core symptoms initially reduced for real and “sham” study participants, suggesting a possible placebo affect, those with real treatment saw strong symptom reduction for longer after treatment, shared lower incidents of “feeling fat”, and showed less impulsivity after TMS.

skinny girl squeezing her stomach
TMS may reduce incidents of "feeling fat," a feeling often reported by individuals with anorexia. Image Courtesy of Wikimedia Commons

Path to Approval

While initial research is promising, as with any path to clinical application approval, more research is needed. The results do show promise they were not overwhelming strong. First more research must target the optimal protocol, in determining which areas to target and how best to find them in patients.

It’s also still unclear if TMS is specifically treating AN, by resetting underactive neural networks, or if it is simple influences health brain activity and behaviors. For example, would TMS impact impulsivity and emotion responses to food in healthy individuals as well?  This calls for the inclusion of healthy individuals in the research to come.  Another variable is the neural mechanisms of the various eating disorder subtypes vary, so the efficacy of TMS will depend on the patient’s specific set of the illness and its duration.  Because the early study only included one treatment, further research will also need to test the impact of frequency and duration of treatment.

All things considered, the early research is promising hope to the millions of Americans currently suffering from anorexia and successful treatment of debilitating disease may be found soon enough.

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