Cognitive and quality‐of‐life related factors of body mass index (BMI) improvement after deep brain stimulation in the subcallosal cingulate and nucleus accumbens in treatment‐refractory chronic anorexia nervosa

Abstract

Background Up to 20% of the cases of anorexia nervosa (AN) are chronic and treatment‐resistant. Recently, the efficacy of deep brain stimulation (DBS) for severe cases of AN has been explored, with studies showing an improvement in body mass index and other psychiatric outcomes. While the effects of DBS on cognitive domains have been studied in patients with other neurological and psychiatric conditions so far, no evidence has been gathered in AN. Methods Eight patients with severe, chronic, treatment‐resistant AN received DBS either to the nucleus accumbens (NAcc) or subcallosal cingulate (SCC; four subjects on each target). A comprehensive battery of neuropsychological and clinical outcomes was used before and 6‐month after surgery. Findings Although Body Mass Index (BMI) did not normalise, statistically significant improvements in BMI, quality of life, and performance on cognitive flexibility were observed after 6 months of DBS. Changes in BMI were related to a decrease in depressive symptoms and an improvement in memory functioning. Interpretation These findings, although preliminary, support the use of DBS in AN, pointing to its safety, even for cognitive functioning; improvements of cognitive flexibility are reported. DBS seems to exert changes on cognition and mood that accompany BMI increments. Further studies are needed better to determine the impact of DBS on cognitive functions.

Neuromodulation of Eating Disorders: A Review of Underlying Neural Network Activity and Neuromodulatory Treatments

“…Martínez et al examined both targets by implanting DBS electrodes in either the SCC or Nacc, depending upon comorbidities (affective or anxiety disorder, respectively), in eight patients with refractory AN [ 114 , 117 ]. For those without a predominant comorbidity, the binge–purge subtype of AN received DBS to the Nacc, and the restrictive subtype of AN received DBS to the SCC.…”

“…Additionally, it should be noted that while most studies reported significant weight restoration and improvement in ratings of comorbid symptoms (i.e., depression, OCD, and anxiety), QoL improvement is less certain. Most studies did not provide strict metrics for QoL, although it is worth noting that among those that did [ 103 , 106 , 116 , 117 ], all but De Vloo et al found improvements in such measures [ 115 ]. In reference to their findings, De Vloo et al suggested that an early post-operative placebo effect and expectation bias could contribute to more positive short-term results which diminish in the long term [ 115 ].…”

Eating Disorders: Causes, Symptoms, Diagnosis and Management

“…After 25 years of study and evidence-based knowledge, the ICD-11 reorganized the chapter of food and eating disorders to be more clinically useful and relevant throughout the globe. Other health issues, developmental factors, or cultural background do not explain the diseases discussed in this chapter (Matherne et al, 2022;Meneguzzo et al, 2022;Pérez et al, 2022). Furthermore, two previously distinct conditions were combined into a single block known as feeding and eating disorders, which combines abnormal eating patterns associated with fear of gaining weight, body image.…”