This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Bulimia nervosa is a serious psychiatric disease that occurs almost exclusively in women with a reported lifetime prevalence ranging from 1%-4%. The most common form of the illness is characterized by binge-eating followed by purging, usually in the form of self-induced vomiting with an accompanying loss of control over the behaviors. Treament usually consists of cognitive, behavioral therapy or antidepressent use. Because these treatments are only somewhat effective, especially for severely ill patients, there is a need for alternative treatments. The decision to try the vagal nerve stimulation in patients with bulimia nervosa is based on our belief that the activity in the gastric vagus nerves might be altered in bulimia nervosa. We have tested this hypothesis by using a drug, ondansetron, which stabilized the activity in the vagus nerve. In women receiving ondansetron under controlled experimental conditions, a rapid and significant reduction in binge eating and vomitng was found. While these results supported our basic hypothesis of vagal involvement in driving binge/vomit episodes, individual responses seemed related to the severity of the illness. That is, the women in this study who had severe intractable bulmina experienced a reduction in the frequency of bulimia episodes; however, they did not uniformly achieve complete abstinence. Since ondansetron only acts on a subset of vagal nerves, the above results suggests that a complete response may be achieved in severely ill patients if a greater proportion of the vagal nerves are modulated. Electrical stimulation of the vagus nerve by implantation of the NeuroCybernetic Prosthesis (NCP) System represents one way of affecting a larger number of nerves that can be accomplished through drug treatment.
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