Non-invasive brain stimulation in eating disorders

Eating Disorders (EDs) are deadly, disabling disorders affecting 15 per cent of women and 5 per cent of men. There is a need to better understand what is happening in the brain and develop innovative treatments based on this knowledge.

Improved understanding of the brain processes involved in eating disorders has enabled development of more targeted, brain-directed interventions. Non-invasive brain stimulation (NIBS), such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), allow safe, pain-free stimulation of specific brain areas from outside of the head, using magnetic fields and electrical currents respectively.

NIBS are increasingly used to treat a range of psychiatric disorders and early studies in eating disorders have shown that NIBS can improve problematic eating behaviours and mood. NIBS studies in eating disorders have mainly targeted the dorsolateral prefrontal cortex (DLPFC), a brain area involved in controlling one’s social/emotional reactions and cognitive processes (e.g., planning, decision making, inhibiting unhelpful behaviours).

First clinical trial of repetitive transcranial magnetic stimulation

We completed the first high quality randomised clinical trial of repetitive transcranial magnetic stimulation  (rTMS) to the prefrontal cortex in patients with severe enduring anorexia nervosa. This compared it to a control procedure that looked like rTMS but did not stimulate the brain.

Repetitive transcranial magnetic stimulation (rTMS) resulted in major early improvements in mood and quality of life. In the longer term, 45.5 per cent of the patients who had received rTMS were weight recovered (BMI>18.5 kg/m2) compared to only 9.0 per cent of the control group. Patients’ experiences of rTMS were also positive.

Using sophisticated brain imaging techniques, we found a significant decrease in activity in part of the brain involved in fear and stress (amygdala) after rTMS compared to the control group. This was related to reduced patient-reported anxiety/stress and unhelpful behaviours towards food (i.e., excessive control around food choices).

Assessing brain stimulation techniques in young people

We have built on this adult research and will now conduct a clinical trial of a variant of rTMS in young people with treatment resistant anorexia nervosa which is funded by the UK Research and Innovation (UKRI). We are also exploring the use of non invasive brain stimulation in the treatment of bulimic disorders, combining this with cognitive training to maximise effects.

All our NIBS studies have been designed and conducted with patient and public involvement. Patients are very clear that they see this area of study as important to pursue, as they have the potential to be highly effective additional treatment options for those with enduring eating disorders.



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