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. 2024 Sep 12;166(1):364.
doi: 10.1007/s00701-024-06258-w.

Structural connectivity modifications following deep brain stimulation of the subcallosal cingulate and nucleus accumbens in severe anorexia nervosa

Kilian Abellaneda-Pérez #  1   2   3 , Ignacio Delgado-Martínez #  4 , Purificación Salgado  5 , José María Ginés  5 , Rocío Guardiola  5 , Lídia Vaqué-Alcázar  6   7 , Alba Roca-Ventura  1   3   6 , Roger Molist-Puigdomènech  8 , Rosa María Manero  9 , Marc Viles-Garcia  10 , Santiago Medrano-Martorell  11 , David Bartrés-Faz  1   6   12 , Alvaro Pascual-Leone  13   14 , Víctor Pérez-Solà  5   15   16 , Gloria Villalba-Martínez  17   18   19
Affiliations

Structural connectivity modifications following deep brain stimulation of the subcallosal cingulate and nucleus accumbens in severe anorexia nervosa

Kilian Abellaneda-Pérez et al. Acta Neurochir (Wien). .

Abstract

Purpose: Anorexia nervosa (AN) is a mental health disorder characterized by significant weight loss and associated medical and psychological comorbidities. Conventional treatments for severe AN have shown limited effectiveness, leading to the exploration of novel interventional strategies, including deep brain stimulation (DBS). However, the neural mechanisms driving DBS interventions, particularly in psychiatric conditions, remain uncertain. This study aims to address this knowledge gap by examining changes in structural connectivity in patients with severe AN before and after DBS.

Methods: Sixteen participants, including eight patients with AN and eight controls, underwent baseline T1-weigthed and diffusion tensor imaging (DTI) acquisitions. Patients received DBS targeting either the subcallosal cingulate (DBS-SCC, N = 4) or the nucleus accumbens (DBS-NAcc, N = 4) based on psychiatric comorbidities and AN subtype. Post-DBS neuroimaging evaluation was conducted in four patients. Data analyses were performed to compare structural connectivity between patients and controls and to assess connectivity changes after DBS intervention.

Results: Baseline findings revealed that structural connectivity is significantly reduced in patients with AN compared to controls, mainly regarding callosal and subcallosal white matter (WM) tracts. Furthermore, pre- vs. post-DBS analyses in AN identified a specific increase after the intervention in two WM tracts: the anterior thalamic radiation and the superior longitudinal fasciculus-parietal bundle.

Conclusions: This study supports that structural connectivity is highly compromised in severe AN. Moreover, this investigation preliminarily reveals that after DBS of the SCC and NAcc in severe AN, there are WM modifications. These microstructural plasticity adaptations may signify a mechanistic underpinning of DBS in this psychiatric disorder.

Keywords: Anorexia nervosa; Deep brain stimulation; Nucleus accumbens; Psychosurgery; Structural connectivity; Subcallosal cingulate.

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