. 2022 Feb 18;24(1):61–69. doi: 10.1007/s11920-022-01321-8

Table 1.

Overview of each neuromodulation technique for EDs

Non-invasive neuromodulation	Strengths	Weaknesses
Repetitive transcranial magnetic stimulation (rTMS) Electromagnetic coil is used to modulate cortical excitability in a target brain region, e.g. DLPFC	• Minimal adverse effects • Safe and well-tolerated in EDs • Evidence for benefits in BMI, ED and mood symptoms in SE-AN • Evidence for cognitive benefits across EDs	• Time-intensive, 20–30 sessions for optimal effects • Heterogeneity in response • Optimal parameters yet to be determined • Small evidence base in BED and BN • Cost-effectiveness yet to be determined
Transcranial direct current stimulation (tDCS) Applies weak direct current to the scalp to modulate existing neuronal activity	• Ease of use and minimal adverse effects • Safe and well-tolerated in EDs • Can be used “online” and applied at-home • Evidence for short-term benefits in cognition and ED symptoms • Low-cost treatment	• Few studies have applied tDCS therapeutically (i.e. > 5 sessions) • Lack of RCTs across EDs
Transcutaneous auricular vagus nerve stimulation (taVNS) Attached to the auricular concha and delivers electrical stimulation at the subcutaneous course of the vagus nerve	• Non-invasive alternative to surgical VNS • Can be delivered at-home • Low-cost treatment	• Small evidence base in psychiatric disorders, with only one case series in EDs
Electroconvulsive therapy (ECT) Performed under general anaesthesia using electrical stimulation to the scalp to induce a generalised tonic–clonic seizure	• May have positive effects on comorbid mood symptoms •Effect on weight unclear “last resort” treatment option	• Adverse effects, e.g. cognition and memory • Not a long-term treatment option • No RCTs to show clinical efficacy in AN • Not associated with improvement in ED symptoms
Invasive neuromodulation
Deep brain stimulation (DBS) Electrical impulses are delivered to illness-relevant brain regions via implanted electrodes	• Preliminary success for improving BMI, ED and affective symptoms in SE-AN • Relatively safe in the short- and long-term • Focal stimulation • Targets subcortical regions that are inaccessible with other neuromodulation techniques	• Adverse side effects (e.g. infection) may be over-represented in SE-AN • Requires neurosurgery • Close monitoring or follow-up is essential which patients may find burdensome • Switching the device off could lead to deterioration of symptoms (i.e. not reversible) • Expensive treatment

Non-invasive neuromodulation

Strengths

Weaknesses

Repetitive transcranial magnetic stimulation (rTMS)

Electromagnetic coil is used to modulate cortical excitability in a target brain region, e.g. DLPFC

• Minimal adverse effects

• Safe and well-tolerated in EDs

• Evidence for benefits in BMI, ED and mood symptoms in SE-AN

• Evidence for cognitive benefits across EDs

• Time-intensive, 20–30 sessions for optimal effects

• Heterogeneity in response

• Optimal parameters yet to be determined

• Small evidence base in BED and BN

• Cost-effectiveness yet to be determined

Transcranial direct current stimulation (tDCS)

Applies weak direct current to the scalp to modulate existing neuronal activity

• Ease of use and minimal adverse effects

• Safe and well-tolerated in EDs

• Can be used “online” and applied at-home

• Evidence for short-term benefits in cognition and ED symptoms

• Low-cost treatment

• Few studies have applied tDCS therapeutically (i.e. > 5 sessions)

• Lack of RCTs across EDs

Transcutaneous auricular vagus nerve stimulation (taVNS)

Attached to the auricular concha and delivers electrical stimulation at the subcutaneous course of the vagus nerve

• Non-invasive alternative to surgical VNS

• Can be delivered at-home

• Low-cost treatment

• Small evidence base in psychiatric disorders, with only one case series in EDs

Electroconvulsive therapy (ECT)

Performed under general anaesthesia using electrical stimulation to the scalp to induce a generalised tonic–clonic seizure

• May have positive effects on comorbid mood symptoms

•Effect on weight unclear “last resort” treatment option

• Adverse effects, e.g. cognition and memory

• Not a long-term treatment option

• No RCTs to show clinical efficacy in AN

• Not associated with improvement in ED symptoms

Invasive neuromodulation

Deep brain stimulation (DBS)

Electrical impulses are delivered to illness-relevant brain regions via implanted electrodes

• Preliminary success for improving BMI, ED and affective symptoms in SE-AN

• Relatively safe in the short- and long-term

• Focal stimulation

• Targets subcortical regions that are inaccessible with other neuromodulation techniques

• Adverse side effects (e.g. infection) may be over-represented in SE-AN

• Requires neurosurgery

• Close monitoring or follow-up is essential which patients may find burdensome

• Switching the device off could lead to deterioration of symptoms (i.e. not reversible)

• Expensive treatment