Is deep brain stimulation a treatment option for anorexia nervosa?

Abstract

Anorexia nervosa (AN) is a severe psychiatric disorder with high rates of morbidity, comorbidity and mortality, which in a subset of patients (21%) takes on a chronic course. Since an evidence based treatment for AN is scarce, it is crucial to investigate new treatment options, preferably focused on influencing the underlying neurobiological mechanisms of AN. The objective of the present paper was to review the evidence for possible neurobiological correlates of AN, and to hypothesize about potential targets for Deep brain stimulation (DBS) as a treatment for chronic, therapy-refractory AN. One avenue for exploring new treatment options based on the neurobiological correlates of AN, is the search for symptomatologic and neurobiologic parallels between AN and other compulsivity- or reward-related disorders. As in other compulsive disorders, the fronto-striatal circuitry, in particular the insula, the ventral striatum (VS) and the prefrontal, orbitofrontal, temporal, parietal and anterior cingulate cortices, are likely to be implicated in the neuropathogenesis of AN. In this paper we will review the few available cases in which DBS has been performed in patients with AN (either as primary diagnosis or as comorbid condition). Given the overlap in symptomatology and neurocircuitry between reward-related disorders such as obsessive compulsive disorder (OCD) and AN, and the established efficacy of accumbal DBS in OCD, we hypothesize that DBS of the nucleus accumbens (NAc) and other areas associated with reward, e.g. the anterior cingulated cortex (ACC), might be an effective treatment for patients with chronic, treatment refractory AN, providing not only weight restoration, but also significant and sustained improvement in AN core symptoms and associated comorbidities and complications. Possible targets for DBS in AN are the ACC, the ventral anterior limb of the capsula interna (vALIC) and the VS. We suggest conducting larger efficacy studies that also explore the functional effects of DBS in AN.

The application of deep brain stimulation in the treatment of psychiatric disorders

“…The NAc and vALIC have proven to be valid DBS targets for OCD, and many parallels can be drawn between OCD and AN, for instance in terms of compulsive behaviours and underlying neurocircuitry (Oudijn, Storosum, Nelis, & Denys, 2013). One study examined the effects of stimulation of the NAc in four AN patients (Wu et al, 2013).…”

Emerging Treatments in Eating Disorders

“…DBS is an established therapy for the treatment of refractory cases of movement disorders and obsessivecompulsive disorder (OCD). Given the shared neural circuitry of AN and OCD, some have hypothesized that DBS may be effective for the treatment of AN as well [46,47]. Several studies have provided support for this hypothesis by reporting a potential role for DBS in the treatment of severe, enduring cases of AN.…”

Relevanz von Bildgebungsbefunden für die Diagnostik und Therapie der adoleszenten Anorexia nervosa

“…Bei den in der Literatur bisher publizierten Einzelfälle handelt es sich deshalb größtenteils um komorbide Patienten, bei denen der Stimulationsort meistens auf der Basis der komorbiden Erkrankung gewählt wurde, und die als zusätzlichen positiven Effekt der neuromodulatorischen Behandlung einen BMI-Anstieg und eine geringere Angst, zu viel zu essen berichteten [25]. Bislang stellt die Tiefenhirnstimulation zur Behandlung der therapierefraktären AN einen rein experimentellen Ansatz dar, der aufgrund fehlender klinischer Studien noch nicht bewertet werden kann [26]. Der Einsatz von Neuromodulationstechniken sollte prinzipiell nur nach bestmöglicher Abwägung des NutzenRisikoProfils und unter Berücksichtigung des Alters und der Hirnreife des Patienten und der Chronizität der Erkrankung getroffen werden.…”