Deep Brain Stimulation in the Subgenual Cingulate Cortex for an Intractable Eating Disorder

Israël, Mimi; Steiger, Howard; Kolivakis, Theodore; McGregor, Leslie; Sadikot, Abbas F.

doi:10.1016/j.biopsych.2009.11.016

Cited by 99 publications

(73 citation statements)

References 9 publications

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“…Four studies observed clinical improvements and weight gain in patients with anorexia nervosa (AN) treated with DBS (in the Cg25, Nac, or ventral capsule/striatum – VC/VS) (Israel et al, 2010; Lipsman et al, 2013; McLaughlin et al, 2013; Wu et al, 2013); a single case report showed a significant weight loss in a DBS-treated patient suffering from obsessive–compulsive disorders (Mantione et al, 2010); and eleven studies reported either over-eating and/or increases in cravings, weight gain and BMI following DBS of the STN and/or globus pallidus — GP (Macia et al, 2004; Tuite et al, 2005; Montaurier et al, 2007; Novakova et al, 2007; Bannier et al, 2009; Sauleau et al, 2009b; Walker et al, 2009; Strowd et al, 2010; Locke et al, 2011; Novakova et al, 2011; Zahodne et al, 2011). In patients treated for PD, we can assume that the decrease in motor activity, and thus in energy expenditure, might explain part of the increased weight gain, even though Amami et al (2014) recently suggested that compulsive eating may be specifically related to STN stimulation.…”

Section: Invasive Neuromodulation Strategies: Recent Developments Andmentioning

confidence: 99%

Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity

Val‐Laillet¹,

Aarts

Weber

et al. 2015

NeuroImage: Clinical

391

321

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Functional, molecular and genetic neuroimaging has highlighted the existence of brain anomalies and neural vulnerability factors related to obesity and eating disorders such as binge eating or anorexia nervosa. In particular, decreased basal metabolism in the prefrontal cortex and striatum as well as dopaminergic alterations have been described in obese subjects, in parallel with increased activation of reward brain areas in response to palatable food cues. Elevated reward region responsivity may trigger food craving and predict future weight gain. This opens the way to prevention studies using functional and molecular neuroimaging to perform early diagnostics and to phenotype subjects at risk by exploring different neurobehavioral dimensions of the food choices and motivation processes. In the first part of this review, advantages and limitations of neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), pharmacogenetic fMRI and functional near-infrared spectroscopy (fNIRS) will be discussed in the context of recent work dealing with eating behavior, with a particular focus on obesity. In the second part of the review, non-invasive strategies to modulate food-related brain processes and functions will be presented. At the leading edge of non-invasive brain-based technologies is real-time fMRI (rtfMRI) neurofeedback, which is a powerful tool to better understand the complexity of human brain–behavior relationships. rtfMRI, alone or when combined with other techniques and tools such as EEG and cognitive therapy, could be used to alter neural plasticity and learned behavior to optimize and/or restore healthy cognition and eating behavior. Other promising non-invasive neuromodulation approaches being explored are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS). Converging evidence points at the value of these non-invasive neuromodulation strategies to study basic mechanisms underlying eating behavior and to treat its disorders. Both of these approaches will be compared in light of recent work in this field, while addressing technical and practical questions. The third part of this review will be dedicated to invasive neuromodulation strategies, such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS). In combination with neuroimaging approaches, these techniques are promising experimental tools to unravel the intricate relationships between homeostatic and hedonic brain circuits. Their potential as additional therapeutic tools to combat pharmacorefractory morbid obesity or acute eating disorders will be discussed, in terms of technical challenges, applicability and ethics. In a general discussion, we will put the brain at the core of fundamental research, prevention and therapy in the context of obesity and eating disorders. First, we will discuss the possibility to identify new biological markers of brain functions. Second, we will highli...

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Section: Invasive Neuromodulation Strategies: Recent Developments Andmentioning

confidence: 99%

Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity

Val‐Laillet¹,

Aarts

Weber

et al. 2015

NeuroImage: Clinical

391

321

View full text Add to dashboard Cite

show abstract

“…In a case report on DBS in the SCC, a patient with AN had a clear correlation between her depressive episodes and eating disorder relapses. 114 The patient presented with a BMI of 19.7, and in the 2 years after electrode implantation in the SCC she had no reliable improvement in BMI, but did have a significant improvement in approach toward food, as measured with the Eating Attitudes Test (EAT_26). 80 A second, larger study on AN and DBS involved bilateral SCC electrode implantation in 6 patients with long-standing, treatment-refractory AN.…”

mentioning

confidence: 96%

Deep brain stimulation for psychiatric disorders: where we are now

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Raslan

et al. 2015

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Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

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“…en 2010, en un paciente con depresión mayor y AN comórbida (42). La diana seleccionada fue el cíngulo subgeniculado (SCC), dada la evidencia de su eficacia en los ensayos de ECP efectuados para el tratamiento de la depresión (Mayberg y cols.)…”

Section: Estimulación Cerebral Profundaunclassified

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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Deep Brain Stimulation in the Subgenual Cingulate Cortex for an Intractable Eating Disorder

Cited by 99 publications

References 9 publications

Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity

Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity

Deep brain stimulation for psychiatric disorders: where we are now

Tratamiento quirúrgico de la anorexia nerviosa resistente al tratamiento médico

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