Subscribe to RSS
DOI: 10.1055/s-0039-1685486
Deep Brain Stimulation as a Treatment Approach for Anorexia Nervosa: a Systematic Literature Review
Estimulação cerebral profunda como uma abordagem de tratamento para anorexia nervosa: Uma revisão sistemática de literaturaPublication History
01 November 2018
19 February 2019
Publication Date:
31 May 2019 (online)
Abstract
Anorexia nervosa is a psychiatric disorder characterized by distortions of body size, weight, and shape perception, as well as by food restriction and/or binge and purging behaviors. It mostly affects young women and causes severe negative impacts on their physical, psychological, and social health. Recent studies have analyzed deep brain stimulation (DBS), a neurosurgical procedure that involves electrode implantation in strategical brain areas, to obtain remission of the symptoms of anorexia nervosa. The results showed that the stimulation of areas associated to the neurocircuitry of anorexia nervosa, such as nucleus accumbens, anterior cingulate cortex, ventral striatum, and bed nucleus of the stria terminalis, provokes beneficial responses in terms of body mass index, quality of life, social functioning, and psychiatric comorbidities. Nevertheless, broader investigations are needed to endorse the clinical usage of DBS in the management of anorexia nervosa.
Resumo
A anorexia nervosa é uma desordem psiquiátrica caracterizada pela distorção da percepção de tamanho, peso e formas corporais, bem como por restrição alimentar e/ou comportamentos excessivos e purgativos. Afeta principalmente mulheres jovens e causa grande impacto negativo sobre a sua saúde física, psicológica e social. Estudos recentes analisaram a estimulação cerebral profunda (ECP), um procedimento neurocirúrgico que envolve a implantação de eletrodos em áreas cerebrais estratégicas, como forma de obter remissão dos sintomas da anorexia nervosa. Os resultados demonstraram que a estimulação de regiões que participam da neurocircuitaria da anorexia nervosa, como núcleo accumbens, córtex do cíngulo anterior, estriato e núcleo da estria terminal, provocou respostas benéficas em termos de índice de massa corporal, qualidade de vida, funcionamento social e comorbidades psiquiátricas. No entanto, investigações mais amplas são necessárias para se recomendar a aplicação clínica da ECP no manejo da anorexia nervosa.
-
References
- 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: APA; 2013
- 2 Lipsman N, Lam E, Volpini M. , et al. Deep brain stimulation of the subcallosal cingulate for treatment-refractory anorexia nervosa: 1 year follow-up of an open-label trial. Lancet Psychiatry 2017; 4 (04) 285-294 . Doi: 10.1016/S2215-0366(17)30076-7
- 3 Lipsman N, Woodside DB, Giacobbe P. , et al. Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial. Lancet 2013; 381 (9875): 1361-1370 . Doi: 10.1016/S0140-6736(12)62188-6
- 4 Wood L, Al-Khairulla H, Lask B. Group cognitive remediation therapy for adolescents with anorexia nervosa. Clin Child Psychol Psychiatry 2011; 16 (02) 225-231 . Doi: 10.1177/1359104511404750
- 5 Bartsch C, Kuhn J. Tiefe Hirnstimulation bei Sucht, Anorexie und Zwang. Rationale, klinische Ergebnisse und ethische Implikationen. Nervenarzt 2014; 85 (02) 162-168
- 6 Prinz P, Stengel A. Deep brain stimulation—possible treatment strategy for pathologically altered body weight?. Brain Sci 2018; 8 (01) 1-15 . Doi: 10.3390/brainsci8010019
- 7 Norrington A, Stanley R, Tremlett M, Birrell G. Medical management of acute severe anorexia nervosa. Arch Dis Child Educ Pract Ed 2012; 97 (02) 48-54 . Doi: 10.1136/adc.2010.199885
- 8 Oudijn MS, Storosum JG, Nelis E, Denys D. Is deep brain stimulation a treatment option for anorexia nervosa?. BMC Psychiatry 2013; 13: 277 . Doi: 10.1186/1471-244X-13-277
- 9 Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 2011; 68 (07) 724-731 . Doi: 10.1001/archgenpsychiatry.2011.74
- 10 Redgrave GW, Bakker A, Bello NT. , et al. Differential brain activation in anorexia nervosa to Fat and Thin words during a Stroop task. Neuroreport 2008; 19 (12) 1181-1185 . Doi: 10.1097/WNR.0b013e32830a70f2
- 11 Sun B, Li D, Liu W, Zhan S, Pan Y, Zhang X. Surgical treatments for anorexia nervosa. In: Sun B, Salles A. , editors. Neurosurgical Treatments for Psychiatric Disorders. Dordrecht: Springer; 2015: 175-187
- 12 Pietrini F, Castellini G, Ricca V, Polito C, Pupi A, Faravelli C. Functional neuroimaging in anorexia nervosa: a clinical approach. Eur Psychiatry 2011; 26 (03) 176-182
- 13 Liberati A, Altman DG, Tetzlaff J. , et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700 . Doi: 10.1136/bmj.b2700
- 14 Wu H, Van Dyck-Lippens PJ, Santegoeds R. , et al. Deep-brain stimulation for anorexia nervosa. World Neurosurg 2013; 80 (3-4): 29.e1-29.e10
- 15 Wang J, Chang C, Geng N, Wang X, Gao G. Treatment of intractable anorexia nervosa with inactivation of the nucleus accumbens using stereotactic surgery. Stereotact Funct Neurosurg 2013; 91 (06) 364-372 . Doi: 10.1159/000348278
- 16 Zhang HW, Li DY, Zhao J, Guan YH, Sun BM, Zuo CT. Metabolic imaging of deep brain stimulation in anorexia nervosa: a 18F-FDG PET/CT study. Clin Nucl Med 2013; 38 (12) 943-948 . Doi: 10.1097/RLU.0000000000000261
- 17 Israël M, Steiger H, Kolivakis T, McGregor L, Sadikot AF. Deep brain stimulation in the subgenual cingulate cortex for an intractable eating disorder. Biol Psychiatry 2010; 67 (09) e53-e54 . Doi: 10.1016/j.biopsych.2009.11.016
- 18 McLaughlin NCR, Didie ER, Machado AG, Haber SN, Eskandar EN, Greenberg BD. Improvements in anorexia symptoms after deep brain stimulation for intractable obsessive-compulsive disorder. Biol Psychiatry 2013; 73 (09) e29-e31 . Doi: 10.1016/j.biopsych.2012.09.015
- 19 Blomstedt P, Naesström M, Bodlund O. Deep brain stimulation in the bed nucleus of the stria terminalis and medial forebrain bundle in a patient with major depressive disorder and anorexia nervosa. Clin Case Rep 2017; 5 (05) 679-684 . Doi: 10.1002/ccr3.856
- 20 Martínez GV. Deep brain stimulation for patients with chronic, severe and resistant anorexia nervosa. Barcelona, Spain, 2017. (ongoing clinical trial). Available at: https://clinicaltrials.gov/ct2/show/NCT03168893 . Access in: July 8, 2018
- 21 Guodong G. Deep brain stimulation of nucleus accumbens to treat severe anorexia nervosa. Tangdu Hospital, Shaanxi, China, 2015. (ongoing clinical trial). Available at: https://clinicaltrials.gov/ct2/show/NCT02593695 . Access in: July 8, 2018
- 22 Park RJ, Singh I, Pike AC, Tan JOA. Deep brain stimulation in anorexia nervosa: hope for the hopeless or exploitation of the vulnerable? The Oxford Neuroethics Gold Standard Framework. Front Psychiatry 2017; 8: 44 . Doi: 10.3389/fpsyt.2017.00044
- 23 Lozano AM, Lipsman N. Probing and regulating dysfunctional circuits using deep brain stimulation. Neuron 2013; 77 (03) 406-424 . Doi: 10.1016/j.neuron.2013.01.020
- 24 Luyten L, Casteels C, Vansteenwegen D. , et al. Micro-positron emission tomography imaging of rat brain metabolism during expression of contextual conditioning. J Neurosci 2012; 32 (01) 254-263 . Doi: 10.1523/JNEUROSCI.3701-11.2012
- 25 Kaye WH, Wagner A, Fudge JL, Paulus M. Neurocircuity of eating disorders. Curr Top Behav Neurosci 2011; 6: 37-57 . Doi: 10.1007/7854_2010_85
- 26 Kaye WH, Fudge JL, Paulus M. New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci 2009; 10 (08) 573-584 . Doi: 10.1038/nrn2682
- 27 Winston AP. The clinical biochemistry of anorexia nervosa. Ann Clin Biochem 2012; 49 (Pt 2): 132-143 . Doi: 10.1258/acb.2011.011185
- 28 van Kuyck K, Gérard N, Van Laere K. , et al. Towards a neurocircuitry in anorexia nervosa: evidence from functional neuroimaging studies. J Psychiatr Res 2009; 43 (14) 1133-1145 . Doi: 10.1016/j.jpsychires.2009.04.005
- 29 Brockmeyer T, Friederich HC, Schmidt U. Advances in the treatment of anorexia nervosa: a review of established and emerging interventions. Psychol Med 2018; 48 (08) 1228-1256 . Doi: 10.1017/S0033291717002604
- 30 Friederich HC, Wu M, Simon JJ, Herzog W. Neurocircuit function in eating disorders. Int J Eat Disord 2013; 46 (05) 425-432 . Doi: 10.1002/eat.22099