Efficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysis

Karaszewska, Dominika; Cleintuar, Patrick; Oudijn, Marloes; Lok, Anja; Elburg, Annemarie van; Denys, Damiaan; Mocking, Roel J. T.

doi:10.1038/s41398-022-02102-w

Cited by 9 publications

(7 citation statements)

References 47 publications

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“…Despite the application of psychotherapy, the treatment of psychiatric comorbidities, and nutritional rehabilitation [ 9 , 10 , 11 ], it is estimated that up to a fifth of AN patients [ 13 ] and a quarter of BN patients [ 12 ] do not respond to the current standard of care. Various neuromodulation techniques have been proposed to bridge the existing treatment gap, with the aim of reducing such serious morbidities and mortalities.…”

Section: Discussionmentioning

confidence: 99%

“…Various neuromodulation techniques have been proposed to bridge the existing treatment gap, with the aim of reducing such serious morbidities and mortalities. DBS in particular has shown promise in preclinical studies in reducing certain illness behaviors and enabling weight gain (an average of a 14% increase in AN, based on a meta-analysis by Karaszewskaet et al [ 13 ], and up to a 50% increase in BMI in some DBS studies [ 105 , 113 ]), and several groups—particularly those utilizing DBS, rTMS, and tDCS—have demonstrated such benefits in early-phase clinical trials [ 59 , 60 , 103 , 110 , 115 , 138 ].…”

Section: Discussionmentioning

confidence: 99%

“…And, in the case of AN, antipsychotics are occasionally prescribed [ 10 ]. Despite such efforts, a substantial portion of patients are not responsive to standard treatment: 20% of AN patients and 20–26% in BN patients [ 12 , 13 ]. Due to the severity of malnutrition, related adverse events can lead to mortality, most commonly for AN patients at approximately 5% within the first four years [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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

Wu,

Lo,

Cavaleri

et al. 2024

Brain Sciences

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Eating disorders are a group of psychiatric conditions that involve pathological relationships between patients and food. The most prolific of these disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. The current standard of care involves psychotherapy, pharmacotherapy, and the management of comorbid conditions, with nutritional rehabilitation reserved for severe cases of anorexia nervosa. Unfortunately, many patients often fail to respond, leaving a concerning treatment gap between the current and requisite treatments for eating disorders. To better understand the neurobiology underlying these eating disorders, investigations have been undertaken to characterize the activity of various neural networks, primarily those activated during tasks of executive inhibition, reward processing, and self-reference. Various neuromodulatory techniques have been proposed to stimulate these networks with the goal of improving patients’ BMI and mental health. The aim of this review is to compile a comprehensive summarization of the current literature regarding the underlying neural connectivity of anorexia nervosa, bulimia nervosa, and binge eating disorder as well as the numerous neuromodulatory modalities that have been investigated. Importantly, we aimed to summarize the most significant clinical trials to date as well as to provide an updated assessment of the role of deep brain stimulation, summarizing numerous recently published clinical studies that have greatly contributed to the literature. In this review, we found therapeutic evidence for transcranial magnetic stimulation and transcranial direct current stimulation in treating individuals suffering from anorexia nervosa, bulimia nervosa, and binge eating disorder. We also found significant evidence for the role of deep brain stimulation, particularly as an escalatory therapy option for the those who failed standard therapy. Finally, we hope to provide promising directions for future clinical investigations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Wu,

Lo,

Cavaleri

et al. 2024

Brain Sciences

View full text Add to dashboard Cite

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“…The 80/20 rule does appear to approximately apply for AN. About 20% are refractory to treatment [80]. P(ASD|AN) is about 25% [13].…”

Section: A Worked Examplementioning

confidence: 99%

Female Teens and Young Adults with Mental Illness Who Are Autistic: How Common Is It and Why Is It Important?

McCrossin

2024

Preprint

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New information suggests female autistic spectrum disorder (ASD) is much more common than previously thought, with a likely prevalence of 6% and with 80% undiagnosed at the age of 18. ASD then becomes a common comorbidity of female mental illness with nearly one in five women who develop a mental illness being autistic. ASD has heretofore been regarded as a pediatric condition and though now thought to be life long it is still not well recognized by adult health services. Most mental illness first presents in the teens and early twenties. Comorbid ASD is more difficult to diagnose due to diagnostic overshadowing, and ASD comorbidity maks the mental illness more severe and mor difficult to treat. Recognized ASD is readily treatable with an approach sympathetic to neurodiversity. Improving the pathway from adolescence to adulthood by increasing knowledge of autism in adult health services would dramatically improve female mental health at surprisingly little extra cost. It is low hanging fruit in a very fraught area of healthcare. This paper will examine the extent of the problem. It will explore solutions and quantify the gains of appropriate therapy.

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“…Deep brain stimulation (DBS) has been proposed as a promising last-resort treatment option for severe therapy refractory AN-patients [ 1 ]. A recent meta-analysis showed overall beneficial effects of DBS on weight, eating disorder, depression and anxiety symptoms, as well as quality of life [ 2 ]. A better understanding of the working mechanisms of DBS in AN would improve our understanding of the pathophysiology AN and enhance DBS therapy by optimizing patient and target selection.…”

Section: Introductionmentioning

confidence: 99%

Neural effects of deep brain stimulation on reward and loss anticipation and food viewing in anorexia nervosa: a pilot study

Oudijn,

Linders,

Lok

et al. 2023

J Eat Disord

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Background Anorexia nervosa (AN) is a severe and life-threatening psychiatric disorder. Initial studies on deep brain stimulation (DBS) in severe, treatment-refractory AN have shown clinical effects. However, the working mechanisms of DBS in AN remain largely unknown. Here, we used a task-based functional MRI approach to understand the pathophysiology of AN. Methods We performed functional MRI on four AN patients that participated in a pilot study on the efficacy, safety, and functional effects of DBS targeted at the ventral limb of the capsula interna (vALIC). The patients and six gender-matched healthy controls (HC) were investigated at three different time points. We used an adapted version of the monetary incentive delay task to probe generic reward processing in patients and controls, and a food-specific task in patients only. Results At baseline, no significant differences for reward anticipation were found between AN and HC. Significant group (AN and HC) by time (pre- and post-DBS) interactions were found in the right precuneus, right putamen, right ventral and medial orbitofrontal cortex (mOFC). No significant interactions were found in the food viewing task, neither between the conditions high-calorie and low-calorie food images nor between the different time points. This could possibly be due to the small sample size and the lack of a control group. Conclusion The results showed a difference in the response of reward-related brain areas post-DBS. This supports the hypotheses that the reward circuitry is involved in the pathogenesis of AN and that DBS affects responsivity of reward-related brain areas. Trial registration Registered in the Netherlands Trial Register (https://www.trialregister.nl/trial/3322): NL3322 (NTR3469).

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Efficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysis

Cited by 9 publications

References 47 publications

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

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

Female Teens and Young Adults with Mental Illness Who Are Autistic: How Common Is It and Why Is It Important?

Neural effects of deep brain stimulation on reward and loss anticipation and food viewing in anorexia nervosa: a pilot study

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