Deep brain stimulation for the treatment of severe intractable anorexia nervosa

Sobstyl, Michał; Sokół-Szawłowska, Marlena; Kupryjaniuk, Anna

doi:10.1080/02688697.2019.1667484

Cited by 16 publications

(18 citation statements)

References 24 publications

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“…DBS involves the surgical implantation of electrodes in targeted brain structures so as to allow for controlled, local electrical stimulation. The procedure has been studied as a treatment option for severe and refractory AN by several different groups, using different stimulation targets, including the bed nucleus of the stria terminalis, the subcallosal cingulate, the nucleus accumbens, or the ventral/capsule/ ventral striatum (Sobstyl, Stapinska-Syniec, Sokol-Szawlowska, & Kupryjaniuk, 2019). The largest series to date included 16 patients with chronic and treatment-refractory AN (Lipsman et al, 2017).…”

Section: Brain Stimulation Interventionsmentioning

confidence: 99%

Severe and enduring anorexia nervosa: Update and observations about the current clinical reality

Wonderlich

Bulik

Schmidt

et al. 2020

Intl J Eating Disorders

100

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Several objectives underlie the current article. First, to review historical diagnostic issues and clinical strategies for treating SE-AN. Second, to provide an overview of recent evidence informed strategies and clinical innovations for the treatment of SE-AN. Third, based on the authors' collective clinical and research experience, we offer eight observations that we believe capture the current clinical experience of patients with SE-AN. Some of these observations represent empirically testable hypotheses, but all are designed to generate a meaningful discussion about the treatment of this group of individuals with eating disorders. Finally, we hope to call clinicians, scientists, professional organizations, advocates, and policy makers to action to attend to critical issues related to the care of individuals with SE-AN. We believe that an international discussion could clarify areas of need for these patients and identify opportunities for clinical innovation that would enhance the lives of individuals with SE-AN and their families. K E Y W O R D S anorexia nervosa, disordered eating, eating disorders, severe and enduring anorexia nervosa Anorexia nervosa (AN) is most common in girls and young women with a lifetime prevalence in women of up to 2-4% (Galmiche, Dechelotte,

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Section: Brain Stimulation Interventionsmentioning

confidence: 99%

Severe and enduring anorexia nervosa: Update and observations about the current clinical reality

Wonderlich

Bulik

Schmidt

et al. 2020

Intl J Eating Disorders

100

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“…In addition to brain-wide analyses that consider all regions, we focused on brain regions and circuits previously associated with anorexia nervosa and feeding behaviour. We examined expression profiles of sites from deep brain stimulation studies: the nucleus accumbens and the subgenual region of the anterior cingulate cortex (Brodmann area 25) [31][32][33][34] . Specifically, the related studies and regions are detailed www.nature.com/scientificreports/ in Table 1 of Sobstyl et al 33 .…”

Section: Regions Of Interestmentioning

confidence: 99%

“…We examined expression profiles of sites from deep brain stimulation studies: the nucleus accumbens and the subgenual region of the anterior cingulate cortex (Brodmann area 25) [31][32][33][34] . Specifically, the related studies and regions are detailed www.nature.com/scientificreports/ in Table 1 of Sobstyl et al 33 . The hypothalamus and ventral tegmental area provide two additional regions that have been named as potential sites 34 .…”

Section: Regions Of Interestmentioning

confidence: 99%

Molecular neuroanatomy of anorexia nervosa

Howard

Negraes

Voineskos

et al. 2020

Sci Rep

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Anorexia nervosa is a complex eating disorder with genetic, metabolic, and psychosocial underpinnings. Using genome-wide methods, recent studies have associated many genes with the disorder. We characterized these genes by projecting them into reference transcriptomic atlases of the prenatal and adult human brain to determine where these genes are expressed in fine detail. We found that genes from an induced stem cell study of anorexia nervosa cases are expressed at higher levels in the lateral parabrachial nucleus. Although weaker, expression enrichment of the adult lateral parabrachial is also found with genes from independent genetic studies. Candidate causal genes from the largest genetic study of anorexia nervosa to date were enriched for expression in the arcuate nucleus of the hypothalamus. We also found an enrichment of anorexia nervosa associated genes in the adult and fetal raphe and ventral tegmental areas. Motivated by enrichment of these feeding circuits, we tested if these genes respond to fasting in mice hypothalami, which highlighted the differential expression of Rps26 and Dalrd3. This work improves our understanding of the neurobiology of anorexia nervosa by suggesting disturbances in subcortical appetitive circuits. Anorexia nervosa is a complex eating disorder that primarily occurs in women with onset often occurring during adolescence. While a portion of anorexia nervosa patients sustain a full recovery, a substantial fraction suffer from protracted partial recovery or are afflicted with a chronic disease course 1. Currently, there are few effective treatments, and the standard-of-care is broadly aimed at psychological and nutritional recovery 2,3. Specifically, for youth, family-based treatment has been shown to be beneficial 4. Due to self-starvation and suicide, anorexia nervosa is consistently reported to be among psychiatric disorders with the highest all-cause mortality ratios 5,6. Our understanding of the neuroanatomical circuits involved in anorexia nervosa is limited. MRI studies of people affected with the illness are only able to examine large structures, and such studies find broad volume reductions and white matter alterations 7-9. Diffusion tensor imaging studies have found changes in several white matter tracts 10. Due to the coarse resolution of MR images, these studies cannot detect structural or functional changes at the microcircuit level. In addition, it is difficult to identify structural alterations that may underlie the disorder due to a lack of studies initiated prior to the onset of symptoms. While subjects with anorexia nervosa are noted to have widespread cortical thinning and decreased volume, recent studies report that measured alterations in brain structure reflect changes in nutritional status and that weight restoration can rapidly reverse these changes in younger patients 11-13. Regional analyses have found stronger differences in reward and somatosensory regions. The identification of the reward areas was hypothesized to mark aberrant reward responses to food...

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“…The NAc is also a stereotactic target in other diseases, including OCD, depression, TS, AN, and alcoholism. 23,28 The NAc was a stereotactic target in the treatment of six cases, despite many studies on animal models. In more than half of all cases, DBS lead implantations caused weight reduction and decrease in BMI.…”

Section: Methodsmentioning

confidence: 99%

Deep Brain Stimulation for Morbid Obesity: An Underutilized Neuromodulatory Treatment for Severely Obese Patients?

Stapińska-Syniec

Kupryjaniuk

Sobstyl

2022

J Neurol Surg A Cent Eur Neurosurg

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Background Morbid obesity (MO) has been steadily increasing in the last few years. Pharmacotherapy and bariatric surgeries remain the main treatment modalities for MO, although in the long-term they may lose their effectiveness. Other treatment approaches are urgently needed and deep brain stimulation (DBS) is a promising therapy. Disturbed energy homeostasis caused by intake of highly palatable and caloric foods may induce hedonic eating. The brain nuclei responsible for energy homeostasis and hedonia are the hypothalamic nuclei and nucleus accumbens. These brain structures constitute the stereotactic targets approached with DBS to treat MO. Material and Methods We have performed a literature search of all available clinical applications of DBS for MO in humans. We were able to identify three case series reports and additional six case reports involving 16 patients. The selected stereotactic targets included lateral hypothalamus in eight patients, ventromedial hypothalamus in two patients, and nucleus accumbens in six patients. Results In general, the safety profile of DBS in refractory MO patients was good. Clinical improvement regarding the mean body mass index could be observed in obese patients. Conclusions MO is a demanding condition. Since in some cases standardized treatment is ineffective, new therapies should be implemented. DBS is a promising therapy that might be used in patients suffering from MO, however, more studies incorporating more individuals and with a longer follow-up are needed to obtain more reliable results concerning its effectiveness and safety profile.

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Deep brain stimulation for the treatment of severe intractable anorexia nervosa

Cited by 16 publications

References 24 publications

Severe and enduring anorexia nervosa: Update and observations about the current clinical reality

Severe and enduring anorexia nervosa: Update and observations about the current clinical reality

Molecular neuroanatomy of anorexia nervosa

Deep Brain Stimulation for Morbid Obesity: An Underutilized Neuromodulatory Treatment for Severely Obese Patients?

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