Summary: Responsive deep brain stimulation targeting the nucleus accumbens reduced binge episodes and supported weight loss in two patients with loss-of-control binge eating disorder.
Source: University of Pennsylvania
Researchers at the Perelman School of Medicine at the University of Pennsylvania report encouraging results from a small clinical pilot in which an implanted device detected craving-related brain activity and interrupted it with electrical stimulation. The trial focused on two patients with severe, loss-of-control binge eating disorder (BED), monitored over six months.
The study, published in Nature Medicine, used a commercially available neurostimulation system—typically employed for medically intractable epilepsy—to monitor electrophysiological signals in the nucleus accumbens, a brain region central to reward, pleasure, and addictive behaviors. Prior work by the team identified a distinctive low-frequency oscillation in this region that consistently appeared seconds before binge-eating episodes. In this trial, when the implanted device detected those low-frequency signals that predict food cravings, it automatically delivered high-frequency stimulation to disrupt them.
Over the six-month treatment period, both patients reported substantial reductions in the frequency of binge episodes and in their subjective sense of losing control over eating. Each patient lost more than 11 pounds, and one participant improved to the point of no longer meeting formal diagnostic criteria for binge-eating disorder. The investigators reported no significant adverse effects related to the stimulation during the trial.
“This was an early feasibility study primarily designed to assess safety, but the clinical responses we observed were striking and encouraging,” said study senior author Casey Halpern, MD, associate professor of Neurosurgery and chief of Stereotactic and Functional Neurosurgery at Penn Medicine and the Corporal Michael J. Crescenz Veterans Affairs Medical Center.
Binge eating disorder is the most common eating disorder in the United States, affecting millions of people. It is characterized by recurrent episodes of eating large amounts of food with a sense of being unable to stop, and unlike bulimia, it does not involve compensatory behaviors such as purging. BED is frequently associated with obesity and considerable distress and functional impairment.
Earlier laboratory work by Halpern and colleagues, involving both animal models and human subjects, identified a reliable low-frequency electrical pattern in the nucleus accumbens that precedes intense food cravings linked to loss-of-control eating but does not occur before normal, controlled meals. In rodent experiments, disrupting that signal with targeted stimulation reduced consumption of palatable, high-calorie foods that the animals would otherwise overeat.
For the human pilot, the research team implanted the responsive device beneath the scalp, with leads extending to the nucleus accumbens on both sides of the brain. The system continuously recorded neural activity and could be programmed to deliver stimulation when a craving-predictive pattern emerged. The two study participants—both severely obese and diagnosed with BED—were observed in laboratory sessions that included exposure to buffets of preferred foods, and were also monitored during their normal daily routines at home.
In both laboratory and home settings, the team observed the same low-frequency nucleus accumbens signature appearing in the seconds before the first bite of a binge meal. Once the responsive stimulation algorithm was activated, the device delivered high-frequency pulses each time that signature occurred. The result was a sharp decline in binge frequency and a marked improvement in participants’ reported control over eating.
Camarin Rolle, PhD, a postdoctoral researcher and co-lead author, described the study as a clear example of translational neuroscience: findings from basic animal and human electrophysiology guided a targeted neuromodulation strategy that produced measurable clinical benefit in people.
The investigators have continued to follow the two patients for an additional six months beyond the initial study period and have begun enrolling more participants in a larger trial to better evaluate efficacy and safety across a broader population. They note that this responsive neuromodulation approach could, in principle, be adapted to other disorders where loss of control is central, including bulimia nervosa and possibly other impulse-control conditions.
Funding: This research was supported by the National Institutes of Health (grant 5UH3NS103446-02).
About this eating disorder and neurotech research news
Author: Kelsey Odorczyk
Source: University of Pennsylvania
Contact: Kelsey Odorczyk – University of Pennsylvania
Image: The image is in the public domain
Original Research: Open access.
“Pilot study of responsive nucleus accumbens deep brain stimulation for loss-of-control eating” by Casey Halpern et al., Nature Medicine (trial registration no. NCT03868670)
Abstract
Pilot study of responsive nucleus accumbens deep brain stimulation for loss-of-control eating
Cravings that precede loss of control over food intake offer a window for intervention in patients with binge eating disorder (BED). In this pilot trial, responsive deep brain stimulation (DBS) recorded nucleus accumbens electrophysiology during craving episodes that led to loss-of-control eating in two patients with BED and severe obesity (trial registration no. NCT03868670).
Low-frequency oscillations in the nucleus accumbens that are prominent during these cravings were used to trigger DBS delivery. Across six months of treatment, participants showed improved control over food intake and experienced weight loss.
These preliminary results support the concept that electrophysiologically guided nucleus accumbens DBS can help restore inhibitory control over binge eating. Larger studies are required to confirm scalability, long-term safety, and effectiveness across diverse patient populations.