scholarly journals 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

2020 ◽  
Vol 9 (6) ◽  
pp. 1946 ◽  
Author(s):  
Gloria Villalba Martínez ◽  
Azucena Justicia ◽  
Purificación Salgado ◽  
José María Ginés ◽  
Rocío Guardiola ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Deep Brain Stimulation ◽  
Nucleus Accumbens ◽  
Brain Stimulation ◽  
Inpatient Care ◽  
Reference Value ◽  
Primary Outcome Measure ◽  
Significant Difference ◽  
The Mean ◽  
Deep Brain

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.

Impressive weight gain after deep brain stimulation of nucleus accumbens in treatment-resistant bulimic anorexia nervosa

2020 ◽  
Vol 13 (11) ◽  
pp. e239316
Author(s):  
Isabel Fernandes Arroteia ◽  
Andreas Husch ◽  
Mehri Baniasadi ◽  
Frank Hertel
Keyword(s):  
Quality Of Life ◽  
Anorexia Nervosa ◽  
Weight Gain ◽  
Deep Brain Stimulation ◽  
Nucleus Accumbens ◽  
Brain Stimulation ◽  
Treatment Modalities ◽  
Durable Response ◽  
Deep Brain

Anorexia nervosa (AN) severely impacts individual’s mental and physical health as well as quality of life. In 21% of cases no durable response to conservative treatment can be obtained. The serious course of the disease in the most severely affected patients justifies invasive treatment options. One of the treatment methods increasingly used in recent years is deep brain stimulation (DBS). A 42-year-old woman suffering from chronic AN of the bulimic subtype shows a 46.9% weight gain and a subjective increase in quality of life, 12 months after bilateral nucleus accumbens (NAcc) DBS implantation. No improvement in comorbid depression could be achieved. DBS of the NAcc is a treatment option to be considered in severe AN when conventional treatment modalities recommended by evidence-based guidelines have not been able to bring lasting relief to the patient’s suffering.

scholarly journals Deep brain stimulation for appetite disorders: a review

2018 ◽  
Vol 45 (2) ◽  
pp. E9 ◽  
Author(s):  
Alexander C. Whiting ◽  
Michael Y. Oh ◽  
Donald M. Whiting
Keyword(s):  
Anorexia Nervosa ◽  
Deep Brain Stimulation ◽  
Nucleus Accumbens ◽  
Brain Stimulation ◽  
Lateral Hypothalamus ◽  
Ventromedial Hypothalamus ◽  
Stria Terminalis ◽  
The Central Nervous System ◽  
Deep Brain

The mechanisms of appetite disorders, such as refractory obesity and anorexia nervosa, have been vigorously studied over the last century, and these studies have shown that the central nervous system has significant involvement with, and responsibility for, the pathology associated with these diseases. Because deep brain stimulation has been shown to be a safe, efficacious, and adjustable treatment modality for a variety of other neurological disorders, it has also been studied as a possible treatment for appetite disorders. In studies of refractory obesity in animal models, the ventromedial hypothalamus, the lateral hypothalamus, and the nucleus accumbens have all demonstrated elements of success as deep brain stimulation targets. Multiple targets for deep brain stimulation have been proposed for anorexia nervosa, with research predominantly focusing on the subcallosal cingulate, the nucleus accumbens, and the stria terminalis and medial forebrain bundle. Human deep brain stimulation studies that focus specifically on refractory obesity and anorexia nervosa have been performed but with limited numbers of patients. In these studies, the target for refractory obesity has been the lateral hypothalamus, ventromedial hypothalamus, and nucleus accumbens, and the target for anorexia nervosa has been the subcallosal cingulate. These studies have shown promising findings, but further research is needed to elucidate the long-term efficacy of deep brain stimulation for the treatment of appetite disorders.

Rescue Anterior Capsulotomy after Failure of Nucleus Accumbens Deep Brain Stimulation in Anorexia Nervosa: A Case Report

2021 ◽  
pp. 1-5
Author(s):  
Zhengyu Lin ◽  
Lulin Dai ◽  
Chencheng Zhang ◽  
Dianyou Li ◽  
Bomin Sun
Keyword(s):  
Anorexia Nervosa ◽  
Deep Brain Stimulation ◽  
Nucleus Accumbens ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Sustained Remission ◽  
Treatment Resistant ◽  
Rescue Treatment ◽  
Anterior Capsulotomy ◽  
Deep Brain

Anorexia nervosa (AN) is a highly disabling mental disorder with high rates of morbidity and mortality. Few psychological treatments and pharmacotherapy are proven to be effective for adult AN. Two invasive stereotactic neurosurgical interventions, deep brain stimulation (DBS) and anterior capsulotomy, are now commonly used as investigational approaches for the treatment of AN. Here, we report the long-term safety and efficacy of rescue bilateral anterior capsulotomy after the failure of bilateral nucleus accumbens (NAcc)-DBS in an 18-year-old female patient with life-threatening and treatment-resistant restricting subtype AN. Improvements in the neuropsychiatric assessment were not documented 6 months after the NAcc-DBS. Rescue bilateral anterior capsulotomy was proposed and performed, resulting in a long-lasting restoration of body weight and a significant and sustained remission in AN core symptoms. The DBS pulse generator was exhausted 2 years after capsulotomy and removed 3 years postoperatively. No relapse was reported at the last follow-up (7 years after the first intervention). From this case, we suggest that capsulotomy could be a rescue treatment for patients with treatment-resistant AN after NAcc-DBS failure. Further well-controlled studies are warranted to validate our findings.

Multitract Orthogonal Microelectrode Localization of the Subthalamic Nucleus: Description of a Novel Technique

2014 ◽  
Vol 10 (2) ◽  
pp. 240-245 ◽  
Author(s):  
Jennifer A. Sweet ◽  
Benjamin L. Walter ◽  
Charles Munyon ◽  
Jonathan P. Miller
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Internal Capsule ◽  
Primary Outcome Measure ◽  
New Technique ◽  
Electrode Position ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Deep Brain

Abstract BACKGROUND: Microelectrode recording helps surgeons accurately localize boundaries of the subthalamic nucleus (STN) and surrounding structures in deep brain stimulation. OBJECTIVE: To describe a novel adaptation of the Ben gun device to optimize efficient mapping. METHODS: Patients who underwent STN deep brain stimulation over a 3-year period were reviewed. For the final year, the Ben gun was rotated 45° and the target was offset 1.4 mm lateral and anterior in the plane orthogonal to the intended trajectory to allow for simultaneous parallel tracks at target, 2.8 mm anterior (localizing the front of STN), and 2.8 mm lateral (identifying the internal capsule). Before this step, the initial pass consisted of 1 to 2 tracks with the frame center targeted to STN. The primary outcome measure was the number of passes required for accurate localization of the nucleus and boundaries. RESULTS: Eighty-three electrodes were implanted in 45 patients (mean age, 62; range, 37-78 years), of which 29 electrodes were placed by the use of the new technique. One electrode (4%) required more than 1 pass using the new technique compared with 36 (67%) using the older technique (P < .01). The distance from original target to final electrode position increased from 0.67 ± 0.13 mm to 1.06 ± 0.15 mm (P < .05) with a greater tendency to move the final electrode position posteriorly. There was no statistically significant difference in benefit from neurostimulation. CONCLUSION: This technique facilitates reliable localization of the STN with fewer passes, possibly decreasing the risks associated with more passes and longer duration of surgery.

Acute and Reproducible Mood Improvement Due to Nucleus Accumbens Deep Brain Stimulation

2015 ◽  
Vol 8 (4) ◽  
pp. 842-843 ◽  
Author(s):  
Bruno Giordana ◽  
Michel Benoit ◽  
Nelly Darmon ◽  
Jerome Yelnik ◽  
Bruno Millet ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Nucleus Accumbens ◽  
Brain Stimulation ◽  
Deep Brain

Accuracy of Magnetic Resonance Imaging–Directed Frame-Based Stereotaxis

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons114-ons124 ◽  
Author(s):  
Nova B. Thani ◽  
Arul Bala ◽  
Christopher R. P. Lind
Keyword(s):  
Deep Brain Stimulation ◽  
Magnetic Resonance ◽  
Brain Stimulation ◽  
Entry Point ◽  
Mean Deviation ◽  
Guide Tube ◽  
3 Dimensional ◽  
The Mean ◽  
The Brain ◽  
Deep Brain

Abstract BACKGROUND: Accurate placement of a probe to the deep regions of the brain is an important part of neurosurgery. In the modern era, magnetic resonance image (MRI)-based target planning with frame-based stereotaxis is the most common technique. OBJECTIVE: To quantify the inaccuracy in MRI-guided frame-based stereotaxis and to assess the relative contributions of frame movements and MRI distortion. METHODS: The MRI-directed implantable guide-tube technique was used to place carbothane stylettes before implantation of the deep brain stimulation electrodes. The coordinates of target, dural entry point, and other brain landmarks were compared between preoperative and intraoperative MRIs to determine the inaccuracy. RESULTS: The mean 3-dimensional inaccuracy of the stylette at the target was 1.8 mm (95% confidence interval [CI], 1.5-2.1. In deep brain stimulation surgery, the accuracy in the x and y (axial) planes is important; the mean axial inaccuracy was 1.4 mm (95% CI, 1.1-1.8). The maximal mean deviation of the head frame compared with brain over 24.1 ± 1.8 hours was 0.9 mm (95% CI, 0.5-1.1). The mean 3-dimensional inaccuracy of the dural entry point of the stylette was 1.8 mm (95% CI, 1.5-2.1), which is identical to that of the target. CONCLUSION: Stylette positions did deviate from the plan, albeit by 1.4 mm in the axial plane and 1.8 mm in 3-dimensional space. There was no difference between the accuracies at the dura and the target approximately 70 mm deep in the brain, suggesting potential feasibility for accurate planning along the whole trajectory.

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