Reg Little meets a doctor whose deep brain stimulation treatment is used worldwide

When Prof Tipu Aziz implanted electrodes inside the brain of a young woman, the potential of his life’s work became known to millions.

For this experimental operation was carried out on a British woman suffering from anorexia. Suddenly, the Oxford-based professor of neurosurgery was being hailed as the man who held out hope to thousands of patients with anorexia and other eating disorders.

Prof Aziz has, however, been at the vanguard of developing deep brain stimulation over many years. Treating a girl with anorexia may have made headlines around the world but the technique has already helped transform the lives of hundreds of patients suffering from Parkinson’s disease, tremors and other conditions such as chronic pain and depression.

He believes we are now seeing the fruits of research that involved animal experiments in Oxford. His readiness almost a decade ago to defend vivisection and even speak for the vivisection protest group made him one of the few researchers prepared to go public and risk becoming a hate figure amongst anti-vivisectionists.

His remarks back then about England having “probably the most violent and absurd animal rights movement in the world” and being a country “with a humanoid perception of animals that’s almost comic” were not designed to endear him to extremists or the nation’s more sentimental animal lovers.

Today, he can point to the fact that deep brain stimulation is the main type of surgery used in the treatment for Parkinson’s patients, and may well remain the main surgical therapy for Parkinson’s over the next two or three decades. While not offering a cure, it can offer patients better control of their symptoms, removing symptoms of Parkinson’s, such as slowness of movement, stiffness and tremor.

Every week, he undertakes two or three deep brain stimulation operations at Oxford’s John Radcliffe Hospital, most involving Parkinson’s patients.

The surgery involves drilling a small hole into the skull. Fine wires are implanted with the electrode having to be positioned in an exact location.

The electrode is connected to a pacemaker device implanted under the skin of the chest, below the collarbone. Once activated, the device sends continuous electrical pulses to the target areas in the brain, modifying the brain circuits that are responsible for motor symptoms of Parkinson’s disease.

Prof Aziz said: “It is very similar to cardiac pacemakers by delivering electrical impulses.”

Changing the frequency can be used to control over- or under-active areas of the brain. Now the idea of carrying electricity to parts of the brain that register feelings of reward for eating is seen as having huge potential in treating anorexia.

Prof Aziz said that “food becomes a very painful object” for anorexics and the part of the brain that makes people enjoy eating does not work in the same way. It is thought the signals can trigger a change in the way the patient feels about food, helping them to eat more and overcome their condition.

He said: “Anorexics have a 40 times higher mortality rate compared to the normal population and people forget that. Otherwise healthy people, mostly girls, die of this disease.

“This is a very preliminary study to show that if you put electrodes in the right place you can alter people’s reaction to food.

“It is quite a departure in how we think about treating this condition. In the past, people were force-fed and had all sorts of stuff done to them because otherwise a lot of people will die.”

All the patients considered for the Oxford experiment had been under psychiatric care, and had already undertaken cognitive behavioural therapy and feeding programmes.

“They only came to us, if there was nothing else to offer,” said Prof Aziz.

The operation costs an estimated £40,000 and the trial is expected to take two years to complete.

About 1.6 million people in the UK are affected by an eating disorder and 89 per cent of them are female, according to the National Institute for Health and Care Excellence.

A significant number of those struggling with anorexia reach such a dangerously low weight they end up in hospital.

Prof Aziz said: “A lot of these people are high-functioning young women. We have to help these folks. This research could open a whole new door into how we think about treating people with anorexia.

“The cost of anorexia medically is about £100,000 per patient, and how many of them get better? It is a very stubborn illness, intractable. Terrible.”

Asked how the woman is doing now, he said: “All I can say is it looks promising.”

The pioneering research follows similar operations in China and Canada.

It has been mainly funded by charitable trusts and the Oxford team are hoping to carry out operations on another five patients.

The treatment has also been used in treating obsessive compulsive disorders and depression.

But funding remains a key factor. With typical honesty, he recognises that helping all the Parkinson’s patients who could benefit from deep brain stimulation would bankrupt the NHS. Securing funding to treat epilepsy patients and for chronic pain is now a real concern.

But he reveals that his dream is to create a deep brain stimulation centre in Oxford.

“My vision is to have one floor dedicated to research and two floors for patients. It is something I have been trying to put together for the last two years. I want it based in Oxford, which has been my home since 1973.

Born in Bangladesh into a medical family, Prof Aziz’s earliest childhood memories are of being taken by his father to his laboratory and clinics in Minnesota, when he was working towards his PhD in the functions of the liver.

“I learned that science was intrinsically part of medical developments,” he would recall.

After completing a degree in physiology at University College London and becoming fascinated with the idea that neurosurgical procedures could restore normality in some Parkinson’s disease sufferers, he decided to study medicine at King’s College London, reading for his doctorate at Manchester University.

It was still early days in the story of deep brain stimulation. When I mention an experiment by Jose Delgado in the 1960s, within seconds Prof Aziz has the film on his laptop. It shows the effect on a bull of an electrode implanted in its brain. At the press of a small radio transmitter the bull brakes to a halt, becoming a picture of calm.

Half a century later, it remains impressive. Yet implanting electrodes in the brains of patients must still be viewed as a new and last resort treatment, involving a degree of risk from stroke and infection, with possible side effects such as slurred speech and poor balance.

Whether Prof Aziz realises his dream of creating a global centre of research and treatment with private and public money remains to be seen. But while he remains at the John Radcliffe, however, Oxford is certain to be a leader in using brain implants to treat an ever-widening number of disorders and diseases