Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial

Lipsman, Nir; Woodside, D. Blake; Giacobbe, Peter; Hamani, Clement; Carter, Jacqueline C.; Norwood, Sarah Jane; Sutandar, Kalam; Staab, Randy; Elias, Gavin J B; Lyman, Christopher; Smith, Gwenn S.; Lozano, Andrés M.

doi:10.1016/s0140-6736(12)62188-6

Cited by 229 publications

(181 citation statements)

References 60 publications

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“…This study is a continuation of a pilot study in which 6 patients underwent SCC stimulation for 9 months. 121 Initial results after 9 months included 3 of 6 patients increasing and maintaining their body mass index, and improvement in mood, anxiety, obsessions, and compulsions in 4 of 6 patients. Another trial is currently recruiting similar patients for implantation and stimulation of the nucleus accumbens.…”

Section: Obesity and Anorexiamentioning

confidence: 99%

“…Up to 70% of patients suffering from anorexia have a chronic refractory course, and it is one of the deadliest psychiatric disorders, with a mortality rate of 10%. 147 Initial trials of DBS 121 showed promising clinical results, as well as changes in metabolic activity in cortical and limbic regions associated with the subcallosal cingulate. Regions of the brain believed to be abnormal in anorexia nervosa include the parietal cortex, anterior and subgenual cingulate, and superior frontal, dorsolateral prefrontal, and orbitofrontal cortex.…”

Section: Obesity and Anorexiamentioning

confidence: 99%

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Deep brain stimulation: a mechanistic and clinical update

Karas

Mikell

Christian

et al. 2013

FOC

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Deep brain stimulation (DBS), the practice of placing electrodes deep into the brain to stimulate subcortical structures with electrical current, has been increasing as a neurosurgical procedure over the past 15 years. Originally a treatment for essential tremor, DBS is now used and under investigation across a wide spectrum of neurological and psychiatric disorders. In addition to applying electrical stimulation for clinical symptomatic relief, the electrodes implanted can also be used to record local electrical activity in the brain, making DBS a useful research tool. Human single-neuron recordings and local field potentials are now often recorded intraoperatively as electrodes are implanted. Thus, the increasing scope of DBS clinical applications is being matched by an increase in investigational use, leading to a rapidly evolving understanding of cortical and subcortical neurocircuitry. In this review, the authors discuss recent innovations in the clinical use of DBS, both in approved indications as well as in indications under investigation. Deep brain stimulation as an investigational tool is also reviewed, paying special attention to evolving models of basal ganglia and cortical function in health and disease. Finally, the authors look to the future across several indications, highlighting gaps in knowledge and possible future directions of DBS treatment.

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Section: Obesity and Anorexiamentioning

confidence: 99%

Section: Obesity and Anorexiamentioning

confidence: 99%

Deep brain stimulation: a mechanistic and clinical update

Karas

Mikell

Christian

et al. 2013

FOC

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“…The rarity of these cases makes the extrapolation to national estimates more subject to sampling error, as a few centers performing these procedures but not captured in the NIS data set could change the estimates significantly. Notable reported indications not captured in the data set include anorexia, 34 substance addiction, 42 and dementia or cognitive decline. 19,33 …”

Section: Rapid Growth Of Hde and Emerging Indicationsmentioning

confidence: 99%

A decade of emerging indications: deep brain stimulation in the United States

Youngerman

Chan

Mikell

et al. 2016

JNS

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OBJECTIVE Deep brain stimulation (DBS) is an emerging treatment option for an expanding set of neurological and psychiatric diseases. Despite growing enthusiasm, the patterns and implications of this rapid adoption are largely unknown. National trends in DBS surgery performed for all indications between 2002 and 2011 are reported. METHODS Using a national database of hospital discharges, admissions for DBS for 14 indications were identified and categorized as either FDA approved, humanitarian device exempt (HDE), or emerging. Trends over time were examined, differences were analyzed by univariate analyses, and outcomes were analyzed by hierarchical regression analyses. RESULTS Between 2002 and 2011, there were an estimated 30,490 discharges following DBS for approved indications, 1647 for HDE indications, and 2014 for emerging indications. The volume for HDE and emerging indications grew at 36.1% annually in comparison with 7.0% for approved indications. DBS for emerging indications occurred at hospitals with more neurosurgeons and neurologists locally, but not necessarily at those with the highest DBS caseloads. Patients treated for HDE and emerging indications were younger with lower comorbidity scores. HDE and emerging indications were associated with greater rates of reported complications, longer lengths of stay, and greater total costs. CONCLUSIONS DBS for HDE and emerging indications underwent rapid growth in the last decade, and it is not exclusively the most experienced DBS practitioners leading the charge to treat the newest indications. Surgeons may be selecting younger and healthier patients for their early experiences. Differences in reported complication rates warrant further attention and additional costs should be anticipated as surgeons gain experience with new patient populations and targets.

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“…Se han propuesto varios tipos de tratamiento farmacológico y psicoterapéutico, a pesar de los cuales, aproximadamente un 20% de los pacientes adquiere un curso crónico, con serias consecuencias para la salud del paciente e importantes repercusiones familiares y sociales en su entorno (3,4). La mortalidad en este grupo de sujetos es aproximadamente de cuatro a seis veces mayor que la población general de la misma edad, y se trata de uno de los trastornos psiquiátricos más difíciles en su manejo (3).…”

Section: Introductionunclassified

Tratamiento quirúrgico de la anorexia nerviosa resistente al tratamiento médico

et al. 2016

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Palabras clave:Anorexia nerviosa. Estimulación cerebral profunda. Psicocirugía. Neuroestimulación. Key words:Anorexia nervosa. Deep brain stimulation. Psychosurgery. Neurostimulation. AbstractGiven the advances experienced in neurosurgical techniques, and because the diagnosis and classifi cation of psychiatric diseases has evolved over the past decades, new experimental treatments are arising to treat a greater number of medication-resistant psychiatric patients. Among psychiatric diseases, anorexia nervosa has the highest mortality rate, and approximately 20% of patients experience torpid outcomes. For these patients who do not respond to conservative management, deep brain stimulation has arisen as an alternative option, although studies are still scarce. We review the pathophysiology of anorexia nervosa, as well as the various neurosurgical treatments that have been performed throughout history. The prospect of current surgical treatments is detailed, as well as the ethical aspects to consider regarding the emergence of these new therapies. ResumenGracias a los avances en técnicas neuroquirúrgicas, y debido a que el diagnóstico y la clasifi cación de las enfermedades psiquiátricas han evolucionado signifi cativamente a lo largo de las últimas décadas, se están desarrollando tratamientos a nivel experimental para aquellos pacientes resistentes al manejo conservador. La anorexia nerviosa es una enfermedad de prevalencia creciente, con la tasa de mortalidad más elevada dentro de los trastornos psiquiátricos, y con aproximadamente un 20% de pacientes que presentan una evolución tórpida. Para estos pacientes que no responden a manejo conservador, la estimulación cerebral profunda ha surgido como una alternativa terapéutica, si bien la literatura especializada al respecto es escasa. A continuación presentamos una revisión de la fi siopatología de la anorexia nerviosa, así como de los distintos tratamientos neuroquirúrgicos realizados a lo largo de la historia. Se detalla la perspectiva de tratamiento quirúrgico actual, así como los aspectos éticos que se han de considerar en relación con el surgimiento de estas nuevas terapias.

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Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial

Cited by 229 publications

References 60 publications

Deep brain stimulation: a mechanistic and clinical update

Deep brain stimulation: a mechanistic and clinical update

A decade of emerging indications: deep brain stimulation in the United States

Tratamiento quirúrgico de la anorexia nerviosa resistente al tratamiento médico

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