Deep-brain stimulation for anorexia nervosa

Abstract

Objective: Anorexia nervosa (AN) is a complex and severe, sometimes life-threatening, psychiatric disorder with high relapse rates under standard treatment. After decades of brain-lesioning procedures offered as a last resort, deep-brain stimulation (DBS) has come under investigation in the last few years as a treatment option for severe and refractory AN.

Methods and results: In this jointly written article, Sun et al. (the Shanghai group) report an average of 65% increase in body weight in four severe and refractory patients with AN after they underwent the DBS procedure (average follow-up: 38 months). All patients weighed greater than 85% of expected body weight and thus no longer met the diagnostic criteria of AN at last follow-up. Nuttin et al. (the Leuven group) describe other clinical studies that provide evidence for the use of DBS for AN and further discuss patient selection criteria, target selection, and adverse event of this evolving therapy.

Conclusion: Preliminary results from the Shanghai group and other clinical centers showed that the use of DBS to treat AN may be a valuable option for weight restoration in otherwise-refractory and life-threatening cases. The nature of this procedure, however, remains investigational and should not be viewed as a standard clinical treatment option. Further scientific investigation is essential to warrant the long-term efficacy and safety of DBS for AN.

Keywords: 5-HT; AN; AVP; Anorexia nervosa; Arginine-vasopressin; BMI; BNST; Bed nucleus of stria terminalis; Bed nucleus of the stria terminalis; Body mass index; CRH; CT; Computed tomography; Corticotropin-releasing hormone; DBS; Deep-brain stimulation; HAM-A; Hamilton Anxiety Rating Scale; MRI; Magnetic resonance imaging; NuAcc; Nucleus accumbens; OCD; Obsessive-compulsive disorder; PET; Positron emission topography; Serotonin; Y-BOCS; Yale-Brown Obsessive-Compulsive Scale.