Neuromodulation in eating disorders and obesity: a promising way of treatment?

Abstract

Neuromodulation can affect the functioning of the central nervous system (CNS), and emotional/eating behavior is an exciting facet of that functioning. Therefore, it would be possible to offer an alternative (or complement) treatment to psychotropic medications and different psychological and nutritional approaches to both eating disorders (EDs) and obesity. Although there are a number of publications in these areas, a systematic review has not been conducted to date. Abstracts, letters, conference reports, dissertations, and reviews were excluded. Clinical trials and controlled human clinical trials were filtered and included in this study. Articles included were based on the population suffering from anorexia nervosa, bulimia nervosa, binge ED, overweight, and obesity. No restrictions were placed on the sample size. Only trials investigating the effect of neuromodulation by means of deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), and transcranial magnetic stimulation (TMS) were included. The following databases were used to conduct the search: MEDLINE/ PubMed, PsycINFO, PsycArticles, and Cochrane (Search Trials, CENTRAL). Study selection was performed following the PRISMA process (PRISMA 2009 Checklist). The total number of participants in all the trials was 562 (DBS, 25; tDCS, 138; TMS, 399; range, 3–90; median, 23.5). As a result, 50% of the studies had samples of between 14 and 38 participants. Neuro-modulation in ED seems to have certain clinical potential, and therefore, this is a promising area for further research. Developments in ED neuromodulation will be linked to neuroimaging to identify potential stimulation targets and possible biomarkers of treatment response. To date, TMS and/or direct current stimulation (DCS) is not the first-line treatment yet, but it could become a preferred option of treatment in the future. Further studies should avoid small sample sizes and the use of different methodologies. Currently, neuromodulation techniques are in the experimental phase, and they are not an evidence-based treatment for ED.

Nicht-invasive Hirnstimulation als Behandlungsverfahren bei Essstörungen – ein narrativer Überblick

“…NIHS-Verfahren sind eine Gruppe von Behandlungstechniken, mit der gezielt die Aktivität des Zentralen Nervensystems beeinflusst werden kann. Das Hauptziel ist dabei, die neuronale Erregbarkeit durch die Anwendung von schwachem elektrischen Strom oder sich schnell verändernden Magnetfeldern zu modulieren [6]. Im Gegensatz zu invasiven Verfahren, die eine Operation erfordern, wird das Gehirn bei NIHS durch die Schädeloberfläche erreicht [7].…”

“…Wie auch in früheren Übersichtsarbeiten [4][5][6] betont wurde, scheinen sich Studien über NIHS bei ES v. a. auf kognitive Kontrolle und Sensitivität gegenüber belohnenden Nahrungsreizen zu konzentrieren. Der Einfluss auf die Unzufriedenheit mit dem Körper als einen der wichtigsten Risikofaktoren und Erhaltungsmechanismen von ES ist bislang allerdings kaum untersucht.…”

Obesity and Related Type 2 Diabetes: A Failure of the Autonomic Nervous System Controlling Gastrointestinal Function?

“…This helps to explain weight loss resistance and why any weight loss induced by calorie restriction recovers very quickly [9,27]. This obesity onset model also presupposes an imbalance between the reward circuits and the prefrontal cortical areas that wield cognitive control over food by inhibiting excessive behavior (the anterior cingulate cortex (ACC), the lateral prefrontal cortex (LPFC), and the left dorsolateral prefrontal cortex (DLPFC)) [38]. In obese patients, cortical inhibitory control is weaker [39].…”

“…The left dorsolateral prefrontal cortex (DLPFC), which is part of the dorsal cognitive fronto-striatal circuit, exerts cognitive control over food intake [38]. Obesity is associated with a reduced activation of this brain region [61].…”

Longer Cortical Silent Period Length Is Associated to Binge Eating Disorder: An Exploratory Study

“…Neuromodulatory techniques, such as TMS, have been utilized not only as a diagnostic tool to access cortical excitability of a target brain region, being an indirect measure of the activity of GABA receptors, but also as treatment strategies [repetitive TMS (rTMS)] for a variety of neurologic and psychiatric disorders. Administration of single or multiple sessions of rTMS over right and/or left dorsolateral prefrontal cortex (DLPFC) showed reduction in craving, weight, and eating disorder (ED) symptoms ( 6 , 14 , 15 ).…”