Does local cerebellar volume predict treatment success in anorexia nervosa?

Gabriella Milos,Lisa-Katrin Kaufmann,Lutz Jäncke,Marco Piccirelli,Maria Blatow,Chantal Martin-Soelch,Roland Von Känel,Jürgen Hänggi,Volker Baur

doi:10.1016/j.pscychresns.2021.111355

Gabriella Milos, Lisa-Katrin Kaufmann + Show 7 more

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https://doi.org/10.1016/j.pscychresns.2021.111355

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Abstract

Anorexia nervosa (AN) is difficult to treat with up to half of patients failing to gain weight during treatment. Neurobiological factors predicting treatment response in AN are poorly understood. In this longitudinal study, we aimed to identify morphological characteristics in the grey matter which predict treatment success in patients with AN. Fifty patients with severe AN participated in an eating disorder-specific inpatient treatment. On admission, T1-weighted magnetic resonance images were acquired from all patients. Half of the patients successfully gained weight, reaching a body-mass index ≥ 17.5 kg/m2. Using voxel-based morphometry, local grey matter volumes were compared between the two groups of patients who gained weight and those who did not. This approach allowed us to identify anatomical characteristics which predict treatment success in terms of post-treatment weight status. Patients who did not reach the weight threshold at discharge had a smaller volume in the right cerebellar crus I at the time of admission. In this group, smaller volume was associated with a greater alexithymia score. The findings suggest that a trophic state within the cerebellum before treatment might be prognostic for treatment success. Consistent with previous reports, this result further substantiates the possible role of the cerebellum in the psychopathology of AN.

Highlights

Treatment of anorexia nervosa (AN) often proves to be difficult, with less than half of the patients reaching full remission (Fichter et al, 2017; Steinhausen, 2002)
voxel-based morphometry (VBM) yielded a cluster with smaller grey matter (GM) volume in assigned to the “non-weight-restored” (ANnr) compared to assigned to the “weight–restored” (ANwr)
There were no clusters with increased GM volume in ANnr compared to ANwr

Summary

Introduction

Treatment of anorexia nervosa (AN) often proves to be difficult, with less than half of the patients reaching full remission (Fichter et al, 2017; Steinhausen, 2002). Magnetic resonance imaging (MRI) studies on AN focusing on the subgroup of patients with a positive treatment outcome, which is primarily measured by normalization of body weight, report the reversibility of global and local grey matter (GM) reduction (Bernardoni et al., 2016; Bomba et al, 2015; Kaufmann et al, 2020; Mainz et al, 2012) as a correlate of treatment success. Studies investigating predictors of treatment success report that lower GM volume of the cerebellum at admission is associated with lower body mass index (BMI) at 1–year follow–up in adolescent patients with AN (Seitz et al, 2015). A region–of–interest analysis of the anterior cingulate cortex revealed that higher GM volume is associated with more stable remission at 1–year follow-up in AN (McCormick et al, 2008)

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