For more than half her life, Kim Rollins had struggled with anorexia nervosa.
The 36-year-old from Kitchener, Ont., tried one treatment program after another, in the hopes of maintaining a normal weight. But she could not get rid of the obsessive thoughts that drove her to be thin. Not only would she eat just the bare minimum – a piece of fruit a day, for example – but Rollins exercised excessively to burn off every calorie that entered her mouth.
Malnutrition took its toll. She suffered a heart attack, two strokes and the early onset of osteoporosis, leading to multiple broken bones. At times, her weight dipped as low as 71 pounds.
“I was at the point where I knew that if I didn’t find a treatment that worked, I wasn’t going to be around for much longer,” she said. So, about a year ago, she volunteered to be among the first group of patients in the world to undergo deep-brain electrical stimulation for severe anorexia.
The findings of the pilot study, published Wednesday in The Lancet, suggest this treatment can help at least some patients. Rollins is one of them.
“I am now 120 pounds – which is a healthy body weight for a person my age and height of five feet, 21/2 inches,” she said. Before the brain surgery, she weighed 90 pounds. And perhaps even more significant, she is no longer troubled by the same degree of anxiety, depression and obsessive behaviour that caused her to put her own life in jeopardy with excessive dieting.
For the trial, a team of Toronto neurosurgeons and psychiatrists worked with six women. Three of the patients have gained weight, and all showed some improvement in mood nine months after the surgery.
“What we find particularly exciting about the study is that the treatment was associated with a very significant improvement in their mood and a reduction in their obsessional symptoms. And we think that is the key if we are going to have an enduring effect on this illness,” said one of the researchers, Dr. Andres Lozano, a neurosurgeon at the Krembil Neuroscience Centre of Toronto Western Hospital and a professor at the University of Toronto.
The treatment, though, will require patients to live with an electrode permanently lodged in their brains. The probe is connected through wires under the skin (beneath the scalp, neck and upper chest) to a replaceable battery unit implanted beneath the collarbone. The device works something like a cardiac pacemaker, sending a steady current of electricity to a specific region deep in the brain.
Deep-brain stimulation is part of a growing trend in the treatment of a wide variety of neurological disorders, such as Parkinson’s disease, Alzheimer’s disease and depression. Worldwide, more than 100,000 patients have received the implants – mostly for Parkinson’s.
The treatment takes advantage of the fact that the brain resembles a complex electrical circuit. When these electrical impulses are not working properly, a neurological disorder can result. By applying a current to the right spot, neurosurgeons have found they can compensate for a part of the brain that is misbehaving.
“By using electricity, one can adjust the activity of these areas very much like adjusting the dial on your thermostat at home,” said Lozano, who is recognized as a world leader in the burgeoning field. In the case of anorexia, he noted, high-tech scans have shown that patients who didn’t respond to conventional therapy have abnormal activity in two key regions of the brain.
The subcallosal cingulate, an area of the brain involved in mood, anxiety and depression, is overactive. At the same time, the parietal cortex – linked to body image – is virtually shut down.
So the research team sought to correct these malfunctions in the brain. During the procedure, the patients remain awake, to help guide the electrical probes to the precise spot. A local anesthetic is used to deaden surface pain.
“You can hear the saw going, so you know they are drilling into the skull. But since the brain has no pain receptors you can’t feel anything except for some pressure,” said Rollins. She recalls two of the researchers – Dr. Nir Lipsman and Dr. Blake Woodside – asking her a series of questions about her feelings and food, as Lozano adjusted the probe.
Although the researchers originally thought they would need to implant two separate probes – one to modify the subcallosal cigulate and the other to fix the parietal cortex – just one did the trick. “These areas are interconnected. So when you adjust the activity in one, it affects the other,” explained Lozano.
After the operation, “I really noticed my thinking was changing,” Rollins recalled. “I was not thinking about food all the time … and I wasn’t as obsessed with exercising.” She joined a cognitive therapy program to help her gain weight – it was the first time she was able to successfully complete such a program. She has maintained a stable weight for about seven months.
The researchers stressed that the results are preliminary and they plan to monitor this first group of patients for several years. In the meantime, they have performed the procedure on another six patients, said Woodside, who is the medical director of the eating disorders program at Toronto General Hospital and a U of T professor.
“New treatments for anorexia are very rare and this is a totally novel approach,” said Woodside, who noted that eating disorders tend to be an underfunded area of medical research. “If we continue to get good results, it’s potentially a breakthrough in the treatment of chronic anorexia – which kills people. About 15 per cent of these people die.”
Yet even if it does prove to be highly effective, it will likely be used only in extreme cases – the patients who fail to respond to conventional therapy. It is brain surgery, after all.