Deep Brain Stimulation as a Treatment Approach for Anorexia Nervosa: a Systematic Literature Review

Abstract

Anorexia nervosa is a psychiatric disorder characterized by distortions of body size, weight, and shape perception, as well as by food restriction and/or binge and purging behaviors. It mostly affects young women and causes severe negative impacts on their physical, psychological, and social health. Recent studies have analyzed deep brain stimulation (DBS), a neurosurgical procedure that involves electrode implantation in strategical brain areas, to obtain remission of the symptoms of anorexia nervosa. The results showed that the stimulation of areas associated to the neurocircuitry of anorexia nervosa, such as nucleus accumbens, anterior cingulate cortex, ventral striatum, and bed nucleus of the stria terminalis, provokes beneficial responses in terms of body mass index, quality of life, social functioning, and psychiatric comorbidities. Nevertheless, broader investigations are needed to endorse the clinical usage of DBS in the management of anorexia nervosa.

Psychological Treatments for People With Severe and Enduring Anorexia Nervosa: A Mini Review

“…Given the challenging nature of SEAN treatment, researchers and clinicians are now exploring novel biological treatments based on a neuroscientific understanding of the disorder (19). These include brain-directed treatments such as neuromodulation with non-invasive (20) and deep brain stimulation (21,22). Novel medications such as dronabinol, a synthetic cannabinoid (23) have also begun to be investigated.…”

Neurostimulation Approaches in the Treatment of Severe Anorexia Nervosa

“…Similarly, DBS demonstrates promising evidence of beneficial effects in mood-related circuits leading to an increased interest in using it for alleviating AN. The procedure is used in multiple targets of the neurocircuitry of AN, such as the nucleus accumbens (NAc), SCC, subgenual cingulate, and BNST [86] to directly intervene in illness driving circuits while addressing particularly high rates of comorbid mood disorders and/or anxiety [92]. Nevertheless, understanding its efficacy, consequences, side effects, and health and safety implications are in very early stages.…”

“…As mentioned above, DBS is an invasive form of neurostimulation at an early stage in severe AN (for a systematic review of experimental studies see [86]). In brief, DBS is a reversible, non-lesion neurosurgical procedure delivering electrical pulses to specific neural targets via electrodes connected to an implantable device in the chest.…”

Deep brain stimulation (DBS) in resistant mental disorders

“…It therefore seems reasonable to develop specific patient inclusion and exclusion criteria that will help guide researchers through the ethical implications of treating this disease. Steps such as assessing individual needs, possible risks and benefits, considering mental performance, informed consent and future care after participation in the study [16].…”

“…Zasadne więc zdaje się być opracowanie szczegółowych kryteriów włączenia i wyłączenia pacjentów, które pomogą poprowadzić badaczy przez etyczne implikacje związane z leczeniem tej choroby. Etapy takie, jak ocena indywidualnych potrzeb oraz możliwych zagrożeń i korzyści, rozważenie kwestii sprawności umysłowej i świadomej zgody oraz rozważenie przyszłej opieki po udziale w badaniu [16].…”