Neuromodulatory techniques in eating disorders: From electroconvulsive therapy to transcranial magnetic stimulation and beyond: A mixed method systematic meta-review

Background: Psychosocial and pharmacological interventions can effectively treat eating disorders (EDs), but improvements are often short-term and modest. Neuromodulation, altering nerve activity through targeted neurological stimulation, is an emerging intervention in neuropsychiatric disorders. This meta-review synthesizes evidence on neuromodulatory techniques in ED patients, identifying research gaps and future directions. Data sources: PubMed/Medline, EMBASE, and PsycINFO were searched using relevant terms. Study selection, data extraction, and synthesis: Only systematic reviews or meta-analyses reporting on neuromodulatory techniques in ED patients were included. Three evaluators extracted data, resolving discrepancies with two experienced researchers. Study quality was assessed using AMSTAR-2. Defined outcomes and effect sizes were reported for systematic reviews, and pooled effect sizes and heterogeneity information for meta-analyses. Results: Eighteen systematic reviews (five meta-analyses) were included, with minimal primary study overlap (<5%). Most focused on anorexia nervosa (AN), some on treatment-resistant cases, and others on bulimia nervosa (BN) and binge eating disorder (BED). The quality of most systematic reviews was critically low, and they often combined observational studies with randomized-controlled trials (RCTs). Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) showed promising results in RCTs, managing binge eating and craving levels more effectively than body mass index in AN. Side effects included headaches, nausea, and drowsiness for rTMS and tDCS, and rare instances of seizures and infection with deep brain stimulation. Conclusion: Neuromodulation holds promise for treating EDs. Future studies should prioritize RCTs, objective outcome measures, longer follow-up for stability assessment, and comprehensive adverse event monitoring.