Deep-Brain Stimulation for Anorexia Nervosa

Laboratory of Experimental Neurosurgery and Neuroanatomy, Katholieke Universiteit Leuven, Leuven, Belgium.
World Neurosurgery (Impact Factor: 2.42). 06/2012; 80(3-4). DOI: 10.1016/j.wneu.2012.06.039
Source: PubMed

ABSTRACT OBJECTIVE: Anorexia nervosa (AN) is a complex and severe, sometimes life-threatening, psychiatric disorder with high relapse rates under standard treatment. After decades of brain-lesioning procedures offered as a last resort, deep-brain stimulation (DBS) has come under investigation in the last few years as a treatment option for severe and refractory AN. METHODS AND RESULTS: In this jointly written article, Sun et al. (the Shanghai group) report an average of 65% increase in body weight in four severe and refractory patients with AN after they underwent the DBS procedure in (average follow-up, 38 months). All patients weighed greater than 85% of expected body weight and thus no longer met the diagnostic criteria of AN at last follow-up. Nuttin et al. (the Leuven group) describe other clinical studies that provide evidence for the use of DBS for AN and further discuss patient selection criteria, target selection, and adverse event of this evolving therapy. CONCLUSION: Preliminary results from the Shanghai group and other clinical centers showed that the use of DBS to treat AN may be a valuable option for weight restoration in otherwise-refractory and life-threatening cases. The nature of this procedure, however, remains investigational and should not be viewed as a standard clinical treatment option. Further scientific investigation is essential to warrant the long-term efficacy and safety of DBS for AN.

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    • "It has been suggested that this approach may be a viable treatment option for patients in the severe and enduring stage of illness as a method to target the neurobiological mechanisms that underlie symptoms [119] [120]. A preliminary study from China with DBS of the nucleus accumbens in the early stage of AN reported benefits [170]. DBS in the subcallosal cingulate (an area implicated in treatment resistant depression) has also been used. "
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    • "), and DBS is currently being explored as a treatment for depression (Anderson et al. 2012; Mayberg et al. 2005), Tourette's syndrome (Kuhn et al. 2009), Alzheimer's disease (AD) (Laxton et al. 2010), anorexia (Wu et al. 2012), and alcoholism (Heldmann et al. 2012). TMS (specifically repetitive TMS, or rTMS) was given FDA approval in 2008 as a treatment for medication refractory depression. 1 There is also ongoing research into its potential therapeutic benefits for a variety of other neurologic and psychiatric conditions, including but not limited to motor dysfunction (Groppa et al. 2012), obsessive compulsive disorder (OCD) (Wu et al. 2010), Alzheimer's disease (Haffen et al. 2012), hallucinations in schizophrenia (Guller et al. 2012), and pain disorders (Sampson et al. 2011). "
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