Looking at the Impact of Brain Stimulation in Anorexia Nervosa

Anorexia nervosa is a serious and complex eating disorder. It is marked by weight loss, dietary restriction, and impairing concern about body shape and weight. Research done by colleagues here at Columbia has documented that individuals with anorexia nervosa use a different brain circuitry than those without eating disorders when they are making decisions about what to eat. (To hear more about this line of research, check out Dr. Joanna Steinglass’s interview on the Nature Neuropod podcast.)

These intriguing results led us to wonder whether there might be a way to change activity in the part of the brain used by people with anorexia nervosa. And whether that might in turn change the types of food choices that they make. So we have looked at whether a brain stimulation technique called transcranial magnetic stimulation (TMS) is able to change activity in this brain circuit, with hopes that this might provide the field with exciting new ideas for treatment options.

What is TMS?

TMS is a noninvasive form of brain stimulation. It uses a coil that sits on top of the head in order to apply a magnetic field to send pulses to specific parts of the brain. Pulses can either increase or decrease activity in these specific parts of the brain, depending on what type of TMS is applied.

TMS has already been extensively used in clinical settings. In fact, it is approved by the FDA for the treatment of major depression which has not responded well to therapy or medication. It is also being studied as a potential treatment for other psychiatric conditions, such as PTSD, in addition to neurological conditions and chronic pain.

TMS is generally well-tolerated by most people who have the procedure done. The most common side effects tend to be manageable and include headache and sometimes painful sensations or twitching on the scalp or face near where the TMS is applied. These effects are temporary and go away on their own. Most TMS sessions last about 30-60 minutes.

What does study participation involve?

Procedures for this study take place over the course of three days, each spaced about a week apart. All procedures occur while the participant is receiving standard treatment on our inpatient unit for anorexia nervosa. This study is for adults ages 18 to 50.

On study procedure days, participants undergo a brain imaging technique called functional magnetic resonance imaging (fMRI). fMRI uses a magnet to take a picture of the brain and has the advantage of not involving any radiation. On the second and third study day, participants also complete a TMS session lasting about 45 minutes. One of these sessions involves real, active TMS. The other involves “sham” or placebo TMS, which mimics the active TMS in appearance, sounds, and sensations.

Neither the participants nor the researchers will know whether the participant is receiving active or sham TMS in any given session. Participants also complete a computer task asking them questions about food while they receive the TMS. Of note, this is not a treatment study. Participation will not affect the course of inpatient treatment the participant receives.

Although this is a pilot study, we are excited to see if we are able to use TMS to change brain activity in individuals with anorexia nervosa in a brain circuit that we know is related to decisions about food. Ultimately, this might lead us to devise new, innovative treatments for this pernicious disorder.

Read here learn about the results of this study, our latest brain stimulation research, and other studies of the brain in anorexia nervosa.

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