Responsive Neurostimulation for Binge Eating Disorder

(DBSLOC Trial)

Recruiting at 1 trial location

Overseen By Casey Halpern, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Casey H. Halpern

Must be taking: GLP-1 agonists

Must not be taking: Appetite suppressants

Disqualifiers: Neurological disorders, Severe depression, Drug abuse, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

6 Participants Needed

Trial Summary

What is the purpose of this trial?

The primary objective of this trial is to assess device function and safety, with secondary objectives including the feasibility.

Will I have to stop taking my current medications?

The trial requires that any medical conditions and related therapies or medications be stable for the past 6 months and remain stable during the study. This means you should not change your current medications if they are related to a stable medical condition.

What data supports the effectiveness of the treatment Responsive Neurostimulation for Binge Eating Disorder?

A pilot study using responsive deep brain stimulation (DBS) in two patients with binge eating disorder showed improved self-control of food intake and weight loss over 6 months, suggesting early support for this approach. However, more research with larger sample sizes is needed to confirm these findings. ^{1 2 3 4 5}

Is responsive neurostimulation safe for humans?

Responsive neurostimulation, including deep brain stimulation (DBS), has been used in small studies for conditions like binge eating disorder and has shown some promise in improving self-control and reducing cravings. However, more research with larger groups is needed to fully understand its safety and effectiveness. ^{1 4 5 6 7}

How does responsive neurostimulation differ from other treatments for binge eating disorder?

Responsive neurostimulation is unique because it uses deep brain stimulation (DBS) to target specific brain activity patterns associated with food cravings, helping to improve self-control over eating. Unlike other treatments, it delivers stimulation only when abnormal brain activity is detected, potentially offering a more precise and effective approach to managing binge eating disorder. ^{1 4 7 8 9}

Eligibility Criteria

This trial is for adults with severe obesity (BMI 40-60) who've tried at least one weight loss medication without success. They must be able to attend clinic visits, follow study rules, and premenopausal women should use birth control. It's not for those with brain implants or pacemakers, or who can't fit in a CT scanner.

Inclusion Criteria

Proficiency with the English language.

I understand the study and agree to participate.

Subject is able to comply w/ all testing and follow-up requirements defined by the study protocol.

Exclusion Criteria

You have a medical device in your brain that uses electrical energy.

You have a device in your body like a pacemaker, defibrillator, or neurostimulator.

Subject is likely to require repeat MR imaging after implant of the RNS Neurostimulator and Leads.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Surgical Treatment

Participants undergo surgery to receive the NeuroPace RNS® System for nucleus accumbens responsive neurostimulation

1-2 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

5 years

Treatment Details

Interventions

• Responsive Neurostimulation

Trial Overview The trial is testing responsive neurostimulation, a device that may help control binge eating by sending electrical impulses to the brain. The focus is on how well the device works and its safety.

Participant Groups

Group I: Responsive Neurostimulation Experimental Treatment 1 Intervention

Surgical arm. Patients expected to receive treatment.

Who Is Running the Clinical Trial?

Casey H. Halpern

Lead Sponsor

Trials

2

Recruited

10+

Casey Halpern

Lead Sponsor

Trials

1

Recruited

6+

University of Pennsylvania

Lead Sponsor

Trials

2,118

Recruited

45,270,000+

NeuroPace

Industry Sponsor

Trials

11

Recruited

1,500+

Findings from Research

This pilot study involved two patients with binge eating disorder (BED) and severe obesity, using responsive deep brain stimulation (DBS) to monitor brain activity during food cravings.

Over a 6-month period, the patients showed improved self-control over food intake and experienced weight loss, suggesting that targeting the nucleus accumbens (NAc) with DBS may help restore control over eating behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pilot study of responsive nucleus accumbens deep brain stimulation for loss-of-control eating. Shivacharan, RS., Rolle, CE., Barbosa, DAN., et al.[2022]

In a study of 28 subjects with anorexia nervosa or bulimia nervosa, 16 participants showed a significant response to repetitive transcranial magnetic stimulation (rTMS) targeting the dorsomedial prefrontal cortex, indicating its potential efficacy for treating binge/purge behaviors.

Resting-state functional MRI (rs-fMRI) revealed that treatment responders had distinct neural connectivity patterns at baseline, which changed positively during treatment, while nonresponders exhibited high baseline connectivity that worsened with rTMS, suggesting that rs-fMRI could help tailor future treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increases in frontostriatal connectivity are associated with response to dorsomedial repetitive transcranial magnetic stimulation in refractory binge/purge behaviors. Dunlop, K., Woodside, B., Lam, E., et al.[2019]

Non-invasive brain stimulation (NIBS) techniques like rTMS and tDCS may offer promising treatment options for eating disorders (ED) by targeting specific neural substrates related to behaviors such as reward processing and cognitive control.

The review emphasizes the importance of selecting appropriate brain targets for NIBS based on the Research Domain Criteria (RDoC) framework, which could enhance treatment efficacy by focusing on the underlying neurobiological and behavioral dimensions of ED rather than just traditional diagnostic criteria.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Targeting Neural Endophenotypes of Eating Disorders with Non-invasive Brain Stimulation. Dunlop, KA., Woodside, B., Downar, J.[2020]

This study will investigate the efficacy of transcranial magnetic stimulation (TMS) in reducing binge eating episodes among 60 obese females with binge eating disorder, comparing results from 20 sessions of TMS to a sham treatment.

The research aims to provide insights into the neural mechanisms of binge eating disorder and assess whether TMS can lead to a significant reduction in binge eating episodes, with follow-up assessments planned 8 weeks after treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of repetitive transcranial magnetic stimulation in obese females with binge eating disorder: a protocol for a double-blinded, randomized, sham-controlled trial. Maranhão, MF., Estella, NM., Cury, ME., et al.[2019]

Recent evidence suggests that neuromodulation techniques, particularly rTMS and DBS, show therapeutic potential and safety in treating severe cases of anorexia nervosa, although most studies are limited to small trials and case reports.

There is a need for high-quality clinical trials to explore various neuromodulation methods and their mechanisms of action across different eating disorder populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuromodulation and Eating Disorders. Gallop, L., Flynn, M., Campbell, IC., et al.[2023]

A woman with severe bulimia nervosa experienced a rapid and complete remission of binge-purge episodes after undergoing repetitive transcranial magnetic stimulation (rTMS) targeting the dorsomedial prefrontal cortex (DMPFC), with no episodes occurring after the 10th session.

The treatment also led to significant improvements in her depression, suggesting that DMPFC-rTMS may enhance impulse control, which is crucial for managing bulimia nervosa. Further research with larger trials is recommended to explore this treatment's efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Unanticipated Rapid Remission of Refractory Bulimia Nervosa, during High-Dose Repetitive Transcranial Magnetic Stimulation of the Dorsomedial Prefrontal Cortex: A Case Report. Downar, J., Sankar, A., Giacobbe, P., et al.[2021]

Transcranial direct current stimulation (tDCS) significantly reduced cravings for various foods and decreased overall food intake by 11% and preferred food intake by 17.5% in individuals with binge eating disorder (BED), based on a study of 30 adults.

The study suggests that tDCS may enhance cognitive control and reduce the desire for food rewards, indicating its potential as a safe and noninvasive treatment option for BED.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of transcranial direct current stimulation (tDCS) on binge eating disorder. Burgess, EE., Sylvester, MD., Morse, KE., et al.[2022]

Non-invasive brain stimulation (NIBS), especially repetitive transcranial magnetic stimulation (rTMS), has been shown to effectively reduce food cravings in both single-session and multi-session formats, with more consistent results compared to transcranial direct current stimulation (tDCS).

While preliminary findings suggest potential benefits of NIBS for treating obesity and eating disorders, more research is needed to confirm these effects, particularly for conditions like bulimia and binge eating disorder, and caution is advised when considering NIBS for anorexia due to possible adverse effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Non-invasive brain stimulation for food cravings, consumption, and disorders of eating: A review of methods, findings and controversies. Hall, PA., Vincent, CM., Burhan, AM.[2018]

Responsive deep brain stimulation (DBS) effectively reduces impulsive overeating by triggering sustained activity in D1 medium spiny neurons in the nucleus accumbens, leading to a long-term decrease in high-fat food intake.

In contrast, continuous DBS resulted in a decay of this neuronal activity and a return to high-fat intake, highlighting the importance of stimulation strategy in managing overeating behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Local accumbens in vivo imaging during deep brain stimulation reveals a strategy-dependent amelioration of hedonic feeding. Wu, H., Kakusa, B., Neuner, S., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Pilot study of responsive nucleus accumbens deep brain stimulation for loss-of-control eating. [2022]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Increases in frontostriatal connectivity are associated with response to dorsomedial repetitive transcranial magnetic stimulation in refractory binge/purge behaviors. [2019]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Targeting Neural Endophenotypes of Eating Disorders with Non-invasive Brain Stimulation. [2020]

4. England pubmed.ncbi.nlm.nih.gov

The effects of repetitive transcranial magnetic stimulation in obese females with binge eating disorder: a protocol for a double-blinded, randomized, sham-controlled trial. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Neuromodulation and Eating Disorders. [2023]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Unanticipated Rapid Remission of Refractory Bulimia Nervosa, during High-Dose Repetitive Transcranial Magnetic Stimulation of the Dorsomedial Prefrontal Cortex: A Case Report. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Effects of transcranial direct current stimulation (tDCS) on binge eating disorder. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Non-invasive brain stimulation for food cravings, consumption, and disorders of eating: A review of methods, findings and controversies. [2018]

9. United States pubmed.ncbi.nlm.nih.gov

Local accumbens in vivo imaging during deep brain stimulation reveals a strategy-dependent amelioration of hedonic feeding. [2022]