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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(04): e386-e390
DOI: 10.1055/s-0042-1748846
Case Report

Thermocoagulation for the Treatment of Anorexia Nervosa Associated with Obsessive-Compulsive Disorder: Case Report

Termocoagulação para tratamento de anorexia nervosa associada a transtorno obsessivo compulsivo: Relato de caso
Cristiano Mendonça Sarkis 
1   School of Medicine, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
,
Jordana Gonçalves de Miranda Amaral 
1   School of Medicine, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
,
Ledismar José da Silva 
1   School of Medicine, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
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Abstract

Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are two psychiatric disorders that often overlap or are diagnosed as distinct disorders in the same individual. Although neurosurgical treatment is currently reserved for patients with refractory chronic OCD, it has been evidenced that it is also effective for the treatment of AN, since these two disorders share some pathophysiological neurocircuits. The present study aimed to report the case of a patient with AN, OCD, schizophrenia, and comorbid depression who underwent thermocoagulation of the nucleus accumbens associated with anterior cingulotomy and anterior capsulotomy, all of them bilaterally. Follow-up, performed 16 months after the procedure, showed substantial improvement in AN, OCD, and schizophrenia symptoms, demonstrating the effectiveness of this type of intervention in patients refractory to conservative treatment.

Resumo

A anorexia nervosa (AN) e o transtorno obsessivo-compulsivo (TOC) são dois transtornos psiquiátricos que, muitas vezes, se sobrepõem ou são diagnosticados como transtornos distintos no mesmo indivíduo. Embora o tratamento neurocirúrgico seja atualmente reservado para pacientes com TOC crônico refratário, foi evidenciado que também é eficaz para o tratamento de AN, uma vez que estes dois distúrbios compartilham alguns neurocircuitos fisiopatológicos. O presente estudo teve como objetivo relatar o caso de uma paciente com AN, TOC, esquizofrenia e depressão comórbida submetida a termocoagulação de nucleus accumbens em associação com cingulotomia anterior e capsulotomia anterior, todos bilateralmente. O seguimento, realizado 16 meses após o procedimento, mostrou melhora substancial de AN, TOC e sintomas de esquizofrenia, demonstrando a eficácia deste tipo de intervenção em pacientes refratários ao tratamento conservador.

Keywords

stereotaxic technique - radiofrequency - anorexia nervosa - obsessive-compulsive disorder - schizophrenia

Palavras-chave

técnica estereotáxica - radiofrequência - anorexia nervosa - transtorno obsessivo-compulsivo - esquizofrenia


Publication History

Received: 24 May 2021

Accepted: 06 April 2022

Article published online:
01 August 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Schmidt E, Mata GF. Anorexia nervosa: uma revisão. Fractal Rev Psicol 2008; 20 (02) 387-400
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 3 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
    CrossrefPubMedGoogle Scholar
  • 4 Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. Am J Clin Nutr 2019; 109 (05) 1402-1413
    CrossrefPubMedGoogle Scholar
  • 5 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
    Google Scholar
  • 6 American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5™. 5th ed.. Washington, DC:: American Psychiatric Publishing;; 2013
    CrossrefGoogle Scholar
  • 7 Brock H, Hany M. Obsessive-compulsive disorder (OCD). In: StatPearls [Internet]. Treasure Island: StatPearls Publishing 2021 Accessed on: 17 May 2021 at: https://www.ncbi.nlm.nih.gov/books/NBK553162/
    PubMedGoogle Scholar
  • 8 LaSalle VH, Cromer KR, Nelson KN, Kazuba D, Justement L, Murphy DL. Diagnostic interview assessed neuropsychiatric disorder comorbidity in 334 individuals with obsessive-compulsive disorder. Depress Anxiety 2004; 19 (03) 163-173
    CrossrefPubMedGoogle Scholar
  • 9 Pinto A, Mancebo MC, Eisen JL, Pagano ME, Rasmussen SA. The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. J Clin Psychiatry 2006; 67 (05) 703-711
    CrossrefPubMedGoogle Scholar
  • 10 Haynos AF, Hall LMJ, Lavender JM. et al. Resting state functional connectivity of networks associated with reward and habit in anorexia nervosa. Hum Brain Mapp 2019; 40 (02) 652-662
    CrossrefPubMedGoogle Scholar
  • 11 Uniacke B, Wang Y, Biezonski D. et al. Resting-state connectivity within and across neural circuits in anorexia nervosa. Brain Behav 2019; 9 (01) e01205
    CrossrefPubMedGoogle Scholar
  • 12 Cha J, Ide JS, Bowman FD, Simpson HB, Posner J, Steinglass JE. Abnormal reward circuitry in anorexia nervosa: A longitudinal, multimodal MRI study. Hum Brain Mapp 2016; 37 (11) 3835-3846
    CrossrefPubMedGoogle Scholar
  • 13 Ehrlich S, Lord AR, Geisler D. et al. Reduced functional connectivity in the thalamo-insular subnetwork in patients with acute anorexia nervosa. Hum Brain Mapp 2015; 36 (05) 1772-1781
    CrossrefPubMedGoogle Scholar
  • 14 Silva LJ, Naciff TH, Oliveira MFV. Deep brain stimulation as a treatment approach for anorexia nervosa: a systematic literature review. Arq Bras Neurosurg 2019; 38 (03) 175-182
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 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
    CrossrefPubMedGoogle Scholar
  • 16 Doshi PK. Surgical treatment of obsessive compulsive disorders: Current status. Indian J Psychiatry 2009; 51 (03) 216-221
    CrossrefPubMedGoogle Scholar
  • 17 Mueller J, Skogseid IM, Benecke R. et al; Deep-Brain Stimulation for Dystonia Study Group. Pallidal deep brain stimulation improves quality of life in segmental and generalized dystonia: results from a prospective, randomized sham-controlled trial. Mov Disord 2008; 23 (01) 131-134
    CrossrefPubMedGoogle Scholar
  • 18 O'Sullivan D, Pell M. Long-term follow-up of DBS of thalamus for tremor and STN for Parkinson's disease. Brain Res Bull 2009; 78 (2-3): 119-121
    CrossrefPubMedGoogle Scholar
  • 19 Goodman WK, Alterman RL. Deep brain stimulation for intractable psychiatric disorders. Annu Rev Med 2012; 63: 511-524
    CrossrefPubMedGoogle Scholar
  • 20 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
    CrossrefPubMedGoogle Scholar
  • 21 World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310 (20) 2191-2194
    Google Scholar
  • 22 Conselho Federal de Medicina. Resolução CFM n° 2.165, de 23.06. 2017 Altera a alínea “b” do parágrafo 4° do artigo 20 da Resolução CFM n° 2.057/2013, publicada no D.O.U. de 12 de novembro de 2013, Seção I, p. 165–171, em seu capítulo VIII, da Neuropsicocirurgia. Diário Oficial União 2017;Seção 1:64, Aug. 15
    PubMedGoogle Scholar
  • 23 Clausen L, Rosenvinge JH, Friborg O, Rokkedal K. Validating the Eating Disorder Inventory-3 (EDI-3): a comparison between 561 female eating disorders patients and 878 females from the general population. J Psychopathol Behav Assess 2011; 33 (01) 101-110
    CrossrefPubMedGoogle Scholar
  • 24 Aardoom JJ, Dingemans AE, Slof Op't Landt MC, Van Furth EF. Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q). Eat Behav 2012; 13 (04) 305-309
    CrossrefPubMedGoogle Scholar
  • 25 Goodman WK, Price LH, Rasmussen SA. et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989; 46 (11) 1006-1011
    CrossrefPubMedGoogle Scholar
  • 26 Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23 (01) 56-62
    Google Scholar
  • 27 Borges TJB, D'Assunção APA, Silva LJ. Oliveira LAG, Araújo PH. A importância de múltiplos alvos no tratamento cirúrgico da agressividade refratária. Rev Med Saúde Brasília 2017; 6 (02) 193-202
    PubMedGoogle Scholar
  • 28 Stein DJ, Costa DLC, Lochner C. et al. Obsessive-compulsive disorder. Nat Rev Dis Primers 2019; 5 (01) 52
    CrossrefPubMedGoogle Scholar
  • 29 Agarwal P, Sarris CE, Herschman Y, Agarwal N, Mammis A. Schizophrenia and neurosurgery: A dark past with hope of a brighter future. J Clin Neurosci 2016; 34: 53-58
    CrossrefPubMedGoogle Scholar