Targeting Emotion Circuits with Deep Brain Stimulation in Refractory Anorexia Nervosa

Lipsman, Nir; Lozano, Andrés M.

doi:10.1038/npp.2013.244

Cited by 14 publications

(12 citation statements)

References 9 publications

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“…AN is a disorder marked by compulsivity and impaired emotional processing, and functional imaging studies have revealed a strong involvement of corticolimbic networks (Lipsman & Lozano, 2014) that could serve as targets for DBS. Furthermore, DBS has previously been shown to improve symptoms of depression and anxiety Greenberg et al, 2010) that are also prevalent in AN.…”

Section: Anorexia Nervosamentioning

confidence: 99%

“…Her score on the Eating Attitude Test (EAT-26) decreased from 41 to 18 following 2 months of treatment, which occurred partially independent of her improvement in depressive symptoms. In the first pilot trial of SCC DBS for AN, DBS was associated with a mean BMI increase of 12% along with a 40% reduction of depression scores (HDRS) in six treatment-refractory AN patients at 6 months follow-up (Lipsman & Lozano, 2014). At 9 months post-DBS, three of the six patients had substantially improved core symptoms of AN accompanied by weight gain and an increase in QoL.…”

Section: Anorexia Nervosamentioning

confidence: 99%

“…Four patients experienced improvements in mood, anxiety, affect regulation, and anorexia nervosa-related obsessions and compulsions. PET scans showed that DBS of the SCC led to increased activity in parietal regions, which are hypometabolic in AN patients, and decreased activity in the SCC and insula (Lipsman & Lozano, 2014).…”

Section: Anorexia Nervosamentioning

confidence: 99%

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The application of deep brain stimulation in the treatment of psychiatric disorders

Graat

Figee

Denys

2017

International Review of Psychiatry

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Deep brain stimulation (DBS) is a last-resort treatment for neurological and psychiatric disorders that are refractory to standard treatment. Over the last decades, the progress of DBS in psychiatry has been slower than in neurology, in part owing to the heterogenic symptomatology and complex neuroanatomy of psychiatric disorders. However, for obsessive-compulsive disorder (OCD) DBS is now an accepted treatment. This study first reviews clinical outcomes and mechanisms of DBS for OCD, and then discusses these results in an overview of current and future psychiatric applications, including DBS for mood disorders, Tourette's syndrome, addiction, anorexia nervosa, autism, schizophrenia, and anxiety disorders. In addition, it will focus on novel techniques that may enhance the application of DBS in psychiatry.ARTICLE HISTORY

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Section: Anorexia Nervosamentioning

confidence: 99%

Section: Anorexia Nervosamentioning

confidence: 99%

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The application of deep brain stimulation in the treatment of psychiatric disorders

Graat

Figee

Denys

2017

International Review of Psychiatry

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“…With sufficient sample sizes, the imaging-genetics approach may improve how we classify eating disorders and prognosticate disorder risk and trajectory. Furthermore, coupling imaging and genetic research approaches may gain critical knowledge that improves the efficacy and safety for neuromodulation treatments for AN such as repetitive transcranial magnetic stimulation (Bartholdy et al, 2015) and deep brain stimulation (Lipsman and Lozano, 2014). Due to a lack of consensus on effective pharmacological treatment strategy (Treasure et al, 2015; Watson and Bulik, 2013), pharmacogenetic studies have yet to yield significant insights in changing treatments in the clinical setting (Adan and Vink, 2001; Gorwood, 2004; Monteleone and Maj, 2008).…”

Section: Imaging Genetic and Pharmacologenetic Studiesmentioning

confidence: 99%

Contemporary views on the genetics of anorexia nervosa

Shih

Woodside

2016

European Neuropsychopharmacology

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Anorexia nervosa (AN) is a serious mental illness characterized by severe dietary restriction that leads to high rates of morbidity, chronicity, and mortality. Unfortunately, effective treatment is lacking and few options are available. High rates of familial aggregation and significant heritability suggested that the complex etiology of AN is affected by both genetic and environmental factors. In this paper, we review studies that reported common and rare genetic variation that influence susceptibility of AN through candidate gene studies, genome-wide association studies, and sequencing-based studies. We also discuss gene expression, methylation, imaging genetics, and pharmacogenetics to demonstrate that these studies have collectively advanced our knowledge of how genetic variation contributes to AN susceptibility and clinical course. Lastly, we highlight the importance of gene by environment interactions (G x E) and share our enthusiasm for the use of nutritional genomic approaches to elucidate the interaction among nutrients, metabolic intermediates, and genetic variation in AN. A deeper understanding of how nutrition alters genome stability, how genetic variation influences uptake and metabolism of nutrients, and how response to food components affects disordered eating, will lead to personalized dietary interventions and effective nutraceutical and pharmacological treatments for AN.

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“…Actualmente el foco de la investigación se encuentra en las áreas del cerebro involucradas en la modulación de la recompensa de los alimentos y la motivación para comer, en la corteza mesolímbica y el núcleo estriado (13). Parece que una disfunción de los circuitos talamocorticoestriatales pudiera conducir, al igual que en el trastorno obsesivo compulsivo, a una perpetuación de los comportamientos patológicos (14). Por otra parte, parece que las áreas del cerebro involucradas en el control cognitivo de la alimentación y el apetito, situadas en el área prefrontal y en la corteza parietal dorsolateral, pueden ser importantes en la fisiopatología de la AN (15).…”

Section: Neurobiologíaunclassified

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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Targeting Emotion Circuits with Deep Brain Stimulation in Refractory Anorexia Nervosa

Cited by 14 publications

References 9 publications

The application of deep brain stimulation in the treatment of psychiatric disorders

The application of deep brain stimulation in the treatment of psychiatric disorders

Contemporary views on the genetics of anorexia nervosa

Tratamiento quirúrgico de la anorexia nerviosa resistente al tratamiento médico

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