Impressive weight gain after deep brain stimulation of nucleus accumbens in treatment-resistant bulimic anorexia nervosa

Abstract

Anorexia nervosa (AN) severely impacts individual's mental and physical health as well as quality of life. In 21% of cases no durable response to conservative treatment can be obtained. The serious course of the disease in the most severely affected patients justifies invasive treatment options. One of the treatment methods increasingly used in recent years is deep brain stimulation (DBS). A 42-year-old woman suffering from chronic AN of the bulimic subtype shows a 46.9% weight gain and a subjective increase in quality of life, 12 months after bilateral nucleus accumbens (NAcc) DBS implantation. No improvement in comorbid depression could be achieved. DBS of the NAcc is a treatment option to be considered in severe AN when conventional treatment modalities recommended by evidence-based guidelines have not been able to bring lasting relief to the patient's suffering.

Keywords: eating disorders; neurosurgery; psychiatry.

Figure 1

DBS location, electric fields and estimated VTA. The positioning of the electrodes and selected contacts led to a satisfying overlap-volume between VTA and NAcc, as shown in table 1. DBS, deep brain stimulation; NAcc, nucleus accumbens; VTA, volumes of tissue activated; GPe, globus pallidus externus; GPi, globus pallidus internus.

Figure 2

Illustration of the initial stimulation parameters applied after electrode implantation. As a good clinical response was obtained in terms of weight gain, the initially selected contacts have been maintained throughout the whole process. ACC; Nucleus Accumbens.

Figure 3

Increase in weight over time.

Figure 4

A 1×1 cm large skin ulceration over the left DBS-electrode fixation cap. Even though the material is exposed there is no sign of infection; no inflammation of the wound edges and no pus formation. This complication may be common in AN patients as the disease causes severe skin atrophy which can lead to wound healing disorders and ulcerations over the implanted material. AN, anorexia nervosa; DBS, deep brain stimulation.