A Randomized Trial of Deep Brain Stimulation to the Subcallosal Cingulate and Nucleus Accumbens in Patients with Treatment-Refractory, Chronic, and Severe Anorexia Nervosa: Initial Results at 6 Months of Follow Up

Gloria Villalba Martínez,Antoni Grau,José María Ginés,Rosa María Manero,Víctor Pérez,Purificación Salgado,Ignacio Delgado-Martínez,Carlos Cedrón,Matilde Elices,Rocío Guardiola,Gerardo Conesa,María Polo,Gustavo Faus,Santiago Medrano,Azucena Justicia

doi:10.3390/jcm9061946

Abstract

Background: The main objective of this study was to assess the safety and efficacy of deep brain stimulation (DBS) in patients with severe anorexia nervosa (AN). Methods: Eight participants received active DBS to the subcallosal cingulate (SCC) or nucleus accumbens (NAcc) depending on comorbidities (affective or anxiety disorders, respectively) and type of AN. The primary outcome measure was body mass index (BMI). Results: Overall, we found no significant difference (p = 0.84) between mean preoperative and postoperative (month 6) BMI. A BMI reference value (BMI-RV) was calculated. In patients that received preoperative inpatient care to raise the BMI, the BMI-RV was defined as the mean BMI value in the 12 months prior to surgery. In patients that did not require inpatient care, the BMI-RV was defined as the mean BMI in the 3-month period before surgery. This value was compared to the postoperative BMI (month 6), revealing a significant increase (p = 0.02). After 6 months of DBS, five participants showed an increase of ≥10% in the BMI-RV. Quality of life was improved (p = 0.03). Three cases presented cutaneous complications. Conclusion: DBS may be effective for some patients with severe AN. Cutaneous complications were observed. Longer term data are needed.

Highlights

Anorexia nervosa (AN) is a psychiatric disorder with an estimated prevalence of 0.7–3%
We compared preoperative body mass index (BMI) to postoperative BMI values obtained at the monthly assessments, finding no significant increase in body mass in the overall sample
When we calculated a preoperative reference BMI value (BMI-RV) for each patient, we found a significant increase in BMI at month 6, the mean BMI at this follow-up assessment was still quite low (M = 13.98)

Summary

Introduction

Anorexia nervosa (AN) is a psychiatric disorder with an estimated prevalence of 0.7–3%. It primarily affects females and is usually diagnosed in adolescence and young adulthood [1,2]. In patients that received preoperative inpatient care to raise the BMI, the BMI-RV was defined as the mean BMI value in the 12 months prior to surgery. In patients that did not require inpatient care, the BMI-RV was defined as the mean BMI in the 3-month period before surgery. This value was compared to the postoperative BMI (month 6), revealing a significant increase (p = 0.02).

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Discussion

Conclusion