This pilot study involves using new equipment for brain stimulation. Users wear a helmet with a figure-eight coil that’s located in a specific spot to target the insula -- an area of the brain that has been shown to play a significant role in perception, mood, anxiety and feeding behaviour.
The design of the helmet and coil is what is enabling CAMH researchers to try rTMS for the first time on people with anorexia nervosa.
Yuliya Knyahnytska with the brain stimulation device her team is using to help clients with treatment-resistant anorexia nervosa
Dr. Yuliya Knyahnytska is a clinical fellow and physician working in general psychiatry. She’s one of the researchers involved in the study, along with Dr. Jeff Daskalakis and Dr. Daniel Blumberger. They’re working under the supervision of principal investigator Dr. Allan Kaplan, one of the leading experts in eating disorders.
Dr. Kaplan says his group is conducting the study for “the possibility of identifying a safe, new, innovative treatment for a subgroup of patients with treatment resistant anorexia nervosa, for whom there are no evidence-based effective treatments currently available.”
“We couldn’t do this pilot before because no brain stimulation technology could get so deep inside," says Dr. Knyahnytska. "Basically you’re getting magnetic pulses with specific intensity targeting the insula repeatedly, two seconds on and 20 seconds off."
“Because rTMS is safe and well-tolerated without side effects, pain, or other discomfort, people are more likely to stay in the trial and complete the treatment. They are also more open to try brain stimulation compared to medication.”
The study involves a small sample of clients that go through six weeks of active treatment and six weeks of maintenance. Dr. Knyahnytska has been working closely with all the clients and has noticed some promising changes.
“From my preliminary observations I noticed positive changes in how participants relate to food. They’re able to handle changes in their diet and eating behaviour. These changes may seem to be insignificant, but for somebody diagnosed with anorexia, this is a huge step forward and requires an ability to handle their anxiety.”
If the pilot is successful, Dr. Kaplan has plans to expand the group’s research.
“If we can show efficacy and safety in this small pilot study, we hope to proceed with a proper placebo randomized controlled trial in a larger number of patients to definitively demonstrate safety and efficacy of this new treatment.”