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Abellaneda-Pérez K, Delgado-Martínez I, Salgado P, Ginés JM, Guardiola R, Vaqué-Alcázar L, Roca-Ventura A, Molist-Puigdomènech R, Manero RM, Viles-Garcia M, Medrano-Martorell S, Bartrés-Faz D, Pascual-Leone A, Pérez-Solà V, Villalba-Martínez G. Structural connectivity modifications following deep brain stimulation of the subcallosal cingulate and nucleus accumbens in severe anorexia nervosa. Acta Neurochir (Wien) 2024; 166:364. [PMID: 39261306 DOI: 10.1007/s00701-024-06258-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/24/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE Anorexia nervosa (AN) is a mental health disorder characterized by significant weight loss and associated medical and psychological comorbidities. Conventional treatments for severe AN have shown limited effectiveness, leading to the exploration of novel interventional strategies, including deep brain stimulation (DBS). However, the neural mechanisms driving DBS interventions, particularly in psychiatric conditions, remain uncertain. This study aims to address this knowledge gap by examining changes in structural connectivity in patients with severe AN before and after DBS. METHODS Sixteen participants, including eight patients with AN and eight controls, underwent baseline T1-weigthed and diffusion tensor imaging (DTI) acquisitions. Patients received DBS targeting either the subcallosal cingulate (DBS-SCC, N = 4) or the nucleus accumbens (DBS-NAcc, N = 4) based on psychiatric comorbidities and AN subtype. Post-DBS neuroimaging evaluation was conducted in four patients. Data analyses were performed to compare structural connectivity between patients and controls and to assess connectivity changes after DBS intervention. RESULTS Baseline findings revealed that structural connectivity is significantly reduced in patients with AN compared to controls, mainly regarding callosal and subcallosal white matter (WM) tracts. Furthermore, pre- vs. post-DBS analyses in AN identified a specific increase after the intervention in two WM tracts: the anterior thalamic radiation and the superior longitudinal fasciculus-parietal bundle. CONCLUSIONS This study supports that structural connectivity is highly compromised in severe AN. Moreover, this investigation preliminarily reveals that after DBS of the SCC and NAcc in severe AN, there are WM modifications. These microstructural plasticity adaptations may signify a mechanistic underpinning of DBS in this psychiatric disorder.
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Affiliation(s)
- Kilian Abellaneda-Pérez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ignacio Delgado-Martínez
- Human Anatomy and Embryology Unit, Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Purificación Salgado
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
| | - José María Ginés
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
| | - Rocío Guardiola
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
| | - Lídia Vaqué-Alcázar
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau-Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Roca-Ventura
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | | | | | | | | | - David Bartrés-Faz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Víctor Pérez-Solà
- Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
- Grupo de Investigación en Salud Mental del Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Gloria Villalba-Martínez
- Department of Neurosurgery, Hospital del Mar, Barcelona, Spain.
- Systems Neurologic and Neurotherapeutic Group at Research Institute Hospital del Mar, Barcelona, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
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Carrillo-Ruiz JD, Carrillo-Márquez JR, Beltrán JQ, Jiménez-Ponce F, García-Muñoz L, Navarro-Olvera JL, Márquez-Franco R, Velasco F. Innovative perspectives in limbic surgery using deep brain stimulation. Front Neurosci 2023; 17:1167244. [PMID: 37274213 PMCID: PMC10233042 DOI: 10.3389/fnins.2023.1167244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
Limbic surgery is one of the most attractive and retaken fields of functional neurosurgery in the last two decades. Psychiatric surgery emerged from the incipient work of Moniz and Lima lesioning the prefrontal cortex in agitated patients. Since the onset of stereotactic and functional neurosurgery with Spiegel and Wycis, the treatment of mental diseases gave attention to refractory illnesses mainly with the use of thalamotomies. Neurosis and some psychotic symptoms were treated by them. Several indications when lesioning the brain were included: obsessive-compulsive disorder, depression, and aggressiveness among others with a diversity of targets. The indiscriminately use of anatomical sites without enough scientific evidence, and uncertainly defined criteria for selecting patients merged with a deficiency in ethical aspects, brought a lack of procedures for a long time: only select clinics allowed this surgery around the world from 1950 to the 1990s. In 1999, Nuttin et al. began a new chapter in limbic surgery with the use of Deep Brain Stimulation, based on the experience of pain, Parkinson's disease, and epilepsy. The efforts were focused on different targets to treat depression and obsessive-compulsive disorders. Nevertheless, other diseases were added to use neuromodulation. The goal of this article is to show the new opportunities to treat neuropsychiatric diseases.
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Affiliation(s)
- José Damián Carrillo-Ruiz
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
- Research Direction, Mexico General Hospital, Mexico City, Mexico
- Neuroscience Coordination, Psychology Faculty, Anahuac University, Mexico City, Mexico
| | - José Rodrigo Carrillo-Márquez
- Faculty of Health Sciences, Anahuac University, Mexico City, Mexico
- Alpha Health Sciences Leadership Program, Anahuac University, Mexico City, Mexico
| | - Jesús Quetzalcóatl Beltrán
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
| | - Fiacro Jiménez-Ponce
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
| | - Luis García-Muñoz
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
| | - José Luis Navarro-Olvera
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
| | - René Márquez-Franco
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
| | - Francisco Velasco
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
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Lara-Almunia M, Aguirre-Orue I, Roset-Ferrer C, Bermudez-Andion C, Alvarez AS, Mas-Bonet A, Miguel-Pueyo J, Hernandez-Vicente J. Refractory anorexia nervosa in adulthood and nucleus accumbens deep brain stimulation. Surg Neurol Int 2023; 14:14. [PMID: 36751454 PMCID: PMC9899471 DOI: 10.25259/sni_1112_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/01/2023] [Indexed: 01/22/2023] Open
Abstract
Background Anorexia Nervosa is a life-threatening mental illness with numerous consequences. Some cases are chronic and refractory to multiple treatments. Consequently, there is great interest in therapeutic alternatives that may improve severe patients. We present an adult patient with anorexia nervosa that underwent to bilateral nucleus accumbens deep brain stimulation (NAc-DBS). Case description The patient was a healthy 46-year-old woman with higher education and an adequate premorbid socio-labour situation. Her disease had a late onset (25 years). The patient never presented clinical remission or weight stability. In recent years, the patient's body mass index (BMI) was 13.16 (32kg). The case was evaluated with multiple neuropsychological tests as well as the BMI before and after surgery. The clinical follow-up was 50 months. After bilateral NAc-DBS the patient experienced an important clinical benefit and significant improvement in neuropsychological tests and weight (BMI 17.28, 42 kg; 50th month) Programming: 4,5V, 130Hz, 210 µs. Conclusion Despite the patient´s age and the long duration of the disease, our results suggest that bilateral nucleus accumbens stimulation may be a useful and effective therapeutic strategy for cases such as the one presented. Additionally, this case presents a surgical midlife patient with both the latest disease onset and the longest follow-up after treatment in the literature.
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Affiliation(s)
- Monica Lara-Almunia
- Department of Neurosurgery, Jimenez Diaz Foundation University Hospital, Madrid, Spain,Corresponding author: Monica Lara-Almunia, Department of Neurosurgery, Jimenez Diaz Foundation University Hospital, Madrid, Spain.
| | - Iratxe Aguirre-Orue
- Department of Psychiatry and Psychology, Son Espases University Hospital, Palma, Spain
| | - Carolina Roset-Ferrer
- Department of Psychiatry and Psychology, Son Espases University Hospital, Palma, Spain
| | | | - Ana Sofia Alvarez
- Department of Neurosurgery, Jimenez Diaz Foundation University Hospital, Madrid, Spain
| | - Antonio Mas-Bonet
- Department of Radiology, Son Espases University Hospital, Palma, Spain
| | - Jose Miguel-Pueyo
- Department of Psychiatry and Psychology, Son Espases University Hospital, Palma, Spain
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Zhao ZP, Nie C, Jiang CT, Cao SH, Tian KX, Yu S, Gu JW. Modulating Brain Activity with Invasive Brain-Computer Interface: A Narrative Review. Brain Sci 2023; 13:brainsci13010134. [PMID: 36672115 PMCID: PMC9856340 DOI: 10.3390/brainsci13010134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
Brain-computer interface (BCI) can be used as a real-time bidirectional information gateway between the brain and machines. In particular, rapid progress in invasive BCI, propelled by recent developments in electrode materials, miniature and power-efficient electronics, and neural signal decoding technologies has attracted wide attention. In this review, we first introduce the concepts of neuronal signal decoding and encoding that are fundamental for information exchanges in BCI. Then, we review the history and recent advances in invasive BCI, particularly through studies using neural signals for controlling external devices on one hand, and modulating brain activity on the other hand. Specifically, regarding modulating brain activity, we focus on two types of techniques, applying electrical stimulation to cortical and deep brain tissues, respectively. Finally, we discuss the related ethical issues concerning the clinical application of this emerging technology.
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Affiliation(s)
- Zhi-Ping Zhao
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Chuang Nie
- Strategic Support Force Medical Center, Beijing 100101, China
| | - Cheng-Teng Jiang
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Sheng-Hao Cao
- Brainnetome Center and National Laboratory of Pattern Recognition, Chinese Academy of Sciences, Beijing 100190, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Kai-Xi Tian
- Brainnetome Center and National Laboratory of Pattern Recognition, Chinese Academy of Sciences, Beijing 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shan Yu
- Brainnetome Center and National Laboratory of Pattern Recognition, Chinese Academy of Sciences, Beijing 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
- Correspondence: (S.Y.); (J.-W.G.); Tel.: +86-010-8254-4786 (S.Y.); +86-010-6635-6729 (J.-W.G.)
| | - Jian-Wen Gu
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
- Strategic Support Force Medical Center, Beijing 100101, China
- Correspondence: (S.Y.); (J.-W.G.); Tel.: +86-010-8254-4786 (S.Y.); +86-010-6635-6729 (J.-W.G.)
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Efficiency of Transcranial Direct Current Stimulation (tDCS) in Anorexia Nervosa Treatment- Case Report. CURRENT PROBLEMS OF PSYCHIATRY 2022. [DOI: 10.2478/cpp-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation with considerable potential as a treatment for many CNS disorders. Individuals suffering from eating disorders have elevated rates of lifetime depression, anxiety and obsessive-compulsive disorder, also affecting specific brain regions. More studies assess the effect of brain modulation in anorexia nervosa (AN). This study aimed to evaluate the effect, tolerability and safety of tDCS stimulation in the patient with an AN diagnosis.
Material and method: The therapy was implemented in an 18-year-old female hospitalized at the I Department of Psychiatry, Psychotherapy and Early Intervention Medical University of Lublin. The simulation was performed twice daily for 25 minutes for two weeks, 20 sessions. To assess a. anthropometric measures, bioelectrical impedance analysis was conducted; b. biological factors fasting venous blood was drawn; c. psychological aspects: Eating Attitudes Test, Rosenberg self-esteem scale, Beck Depression Inventory, Eating Disorder Examination Questionnaire, Body Esteem Scale, Perceived Stress Scale were used.
Results: The patient responded well to stimulation - apart from a mild headache. After tDCS sessions, improvement in anthropometric measurements, mood, and body self-esteem was observed. No severe changes in blood parameters were observed after the intervention.
Conclusions: Described study case offer preliminary support for achieving meaningful clinical outcomes using transcranial stimulation. However, future clinical studies compared to the placebo group are necessary for proposing a new type of AN therapy.
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Messina G, Vetrano IG, Bonomo G, Broggi G. Role of deep brain stimulation in management of psychiatric disorders. PROGRESS IN BRAIN RESEARCH 2022; 270:61-96. [PMID: 35396031 DOI: 10.1016/bs.pbr.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Nowadays, most of patients affected by psychiatric disorders are successfully treated with conservative therapies. Still, a variable percentage of them demonstrate resistance to conventional treatments, and alternative methods can then be considered. During the last 20 years, there is a progressive interest in use of deep brain stimulation (DBS) in mental illnesses. It has become clear nowadays, that this modality may be effectively applied under specific indications in some patients with major depressive disorder, obsessive-compulsive disorder, anorexia nervosa and other eating disorders, Tourette syndrome, schizophrenia, substance use disorder, and even pathologically aggressive behavior. Despite the fact that the efficacy of neuromodulation with DBS, as well as of various lesional interventions, in cases of mental illnesses is still not fully established, there are several premises for wider applications of such "unclassical" psychiatric treatments in the future. Novel technologies of DBS, developments in non-invasive lesioning using stereotactic radiosurgery and transcranial magnetic resonance-guided focused ultrasound, and advances of neurophysiological and neuroimaging modalities may bolster further clinical applications of psychiatric neurosurgery, improve its results, and allow for individually selected treatment strategies tailored to specific needs of the patient.
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Affiliation(s)
- Giuseppe Messina
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giulio Bonomo
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Broggi
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Neurosurgery, M Cecilia Hospital-GVM, Ravenna, Italy
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7
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De Salles A, Lucena L, Paranhos T, Ferragut MA, de Oliveira-Souza R, Gorgulho A. Modern neurosurgical techniques for psychiatric disorders. PROGRESS IN BRAIN RESEARCH 2022; 270:33-59. [PMID: 35396030 DOI: 10.1016/bs.pbr.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Psychosurgery refers to an ensemble of more or less invasive techniques designed to reduce the burden caused by psychiatric diseases in patients who have failed to respond to conventional therapy. While most surgeries are designed to correct apparent anatomical abnormalities, no discrete cerebral anatomical lesion is evident in most psychiatric diseases amenable to invasive interventions. Finding the optimal surgical targets in mental illness is troublesome. In general, contemporary psychosurgical procedures can be classified into one of two primary modalities: lesioning and stimulation procedures. The first group is divided into (a) thermocoagulation and (b) stereotactic radiosurgery or recently introduced transcranial magnetic resonance-guided focused ultrasound, whereas stimulation techniques mainly include deep brain stimulation (DBS), cortical stimulation, and the vagus nerve stimulation. The most studied psychiatric diseases amenable to psychosurgical interventions are severe treatment-resistant major depressive disorder, obsessive-compulsive disorder, Tourette syndrome, anorexia nervosa, schizophrenia, and substance use disorder. Furthermore, modern neuroimaging techniques spurred the interest of clinicians to identify cerebral regions amenable to be manipulated to control psychiatric symptoms. On this way, the concept of a multi-nodal network need to be embraced, enticing the collaboration of psychiatrists, psychologists, neurologists and neurosurgeons participating in multidisciplinary groups, conducting well-designed clinical trials.
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Affiliation(s)
- Antonio De Salles
- University of California Los Angeles (UCLA), Los Angeles, CA, United States; NeuroSapiens®, Brazil; Hospital Rede D'Or, São Luiz, SP, Brazil.
| | - Luan Lucena
- NeuroSapiens®, Brazil; Hospital Rede D'Or, São Luiz, SP, Brazil
| | - Thiago Paranhos
- Hospital Rede D'Or, São Luiz, SP, Brazil; Federal University of Rio De Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Ricardo de Oliveira-Souza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Federal University of the State of Rio De Janeiro (UNIRIO), Rio de Janeiro, Brazil
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Pérez V, Villalba-Martínez G, Elices M, Manero RM, Salgado P, Ginés JM, Guardiola R, Cedrón C, Polo M, Delgado-Martínez I, Conesa G, Medrano S, Portella MJ. Cognitive and quality-of-life related factors of body mass index (BMI) improvement after deep brain stimulation in the subcallosal cingulate and nucleus accumbens in treatment-refractory chronic anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:353-363. [PMID: 35322504 DOI: 10.1002/erv.2895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 02/03/2022] [Accepted: 02/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Up to 20% of the cases of anorexia nervosa (AN) are chronic and treatment-resistant. Recently, the efficacy of deep brain stimulation (DBS) for severe cases of AN has been explored, with studies showing an improvement in body mass index and other psychiatric outcomes. While the effects of DBS on cognitive domains have been studied in patients with other neurological and psychiatric conditions so far, no evidence has been gathered in AN. METHODS Eight patients with severe, chronic, treatment-resistant AN received DBS either to the nucleus accumbens (NAcc) or subcallosal cingulate (SCC; four subjects on each target). A comprehensive battery of neuropsychological and clinical outcomes was used before and 6-month after surgery. FINDINGS Although Body Mass Index (BMI) did not normalise, statistically significant improvements in BMI, quality of life, and performance on cognitive flexibility were observed after 6 months of DBS. Changes in BMI were related to a decrease in depressive symptoms and an improvement in memory functioning. INTERPRETATION These findings, although preliminary, support the use of DBS in AN, pointing to its safety, even for cognitive functioning; improvements of cognitive flexibility are reported. DBS seems to exert changes on cognition and mood that accompany BMI increments. Further studies are needed better to determine the impact of DBS on cognitive functions.
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Affiliation(s)
- Víctor Pérez
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parce de Salut Mar, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | - Matilde Elices
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parce de Salut Mar, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Rosa María Manero
- Department of Neurology, Hospital del Mar, Barcelona, Catalonia, Spain
| | - Purificación Salgado
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - José María Ginés
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Rocío Guardiola
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Carlos Cedrón
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - María Polo
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Gerardo Conesa
- Department of Neurosurgery, Hospital del Mar, Barcelona, Spain
| | - Santiago Medrano
- Department of Radiology, Hospital del Mar, Barcelona, Catalonia, Spain
| | - Maria J Portella
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Institut de d'Investigació Biomèdica Sant Pau. Hospital de la Santa Creu i Sant Pau. UAB, Barcelona, Catalonia, Spain
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Devos JVP, Temel Y, Ackermans L, Visser-Vandewalle V, Onur OA, Schruers K, Smit J, Janssen MLF. Methodological Considerations for Setting Up Deep Brain Stimulation Studies for New Indications. J Clin Med 2022; 11:jcm11030696. [PMID: 35160153 PMCID: PMC8836606 DOI: 10.3390/jcm11030696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022] Open
Abstract
Deep brain stimulation (DBS) is a neurosurgical treatment with a growing range of indications. The number of clinical studies is expanding because of DBS for new indications and efforts to improve DBS for existing indications. To date, various methods have been used to perform DBS studies. Designing a clinical intervention study with active implantable medical devices has specific challenges while expanding patient treatment. This paper provides an overview of the key aspects that are essential for setting up a DBS study.
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Affiliation(s)
- Jana V. P. Devos
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.); (J.S.); (M.L.F.J.)
- Department of Ear, Nose, Throat, Head and Neck Surgery, Maastricht University Medical Center, Maastricht University, 6229 HX Maastricht, The Netherlands
- Correspondence: (J.V.P.D.); (Y.T.)
| | - Yasin Temel
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.); (J.S.); (M.L.F.J.)
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht University, 6229 HX Maastricht, The Netherlands
- Correspondence: (J.V.P.D.); (Y.T.)
| | - Linda Ackermans
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.); (J.S.); (M.L.F.J.)
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany;
| | - Oezguer A. Onur
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany;
| | - Koen Schruers
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht University, 6229 HX Maastricht, The Netherlands;
| | - Jasper Smit
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.); (J.S.); (M.L.F.J.)
- Department of Ear, Nose, Throat, Head and Neck Surgery, Zuyderland Medical Center, 6419 PC Heerlen, The Netherlands
| | - Marcus L. F. Janssen
- School for Mental Health and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands; (L.A.); (J.S.); (M.L.F.J.)
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht University, 6229 HX Maastricht, The Netherlands
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He W, Shao L, Wang H, Huang H, Zhang S, Li C, Zhang C, Yi W. Bilateral Anterior Capsulotomy for the Treatment of Refractory Somatic Symptom Disorder: A Case Report. Front Integr Neurosci 2022; 15:721833. [PMID: 35115912 PMCID: PMC8805728 DOI: 10.3389/fnint.2021.721833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Somatic symptom disorder (SSD) is a form of mental illness that causes one or more distressing somatic symptoms leading to a significant disruption to everyday life, characterized by excessive thoughts, feelings, or behaviors related to these symptoms. While SSD is characterized by significant discomfort in some parts of the body, these symptoms are not related to any known medical condition and therefore it cannot be diagnosed using any medical instrument examination. Currently available treatments for SSD, including drug therapy and psychotherapy (such as cognitive behavioral therapy), usually improve psychiatric symptoms, but the results are often disappointing. Furthermore, SSD is often comorbid with anxiety and depression (75.1 and 65.7%, respectively). Importantly, interventions targeting the anterior limb of the internal capsule (ALIC; e.g., deep brain stimulation and thermal ablation) can effectively treat various mental disorders, such as refractory obsessive-compulsive disorder, depression, and eating disorders, suggesting that it may also be effective for treating the depressive symptoms associated with SSD comorbidity. In this report, a 65-year-old woman diagnosed with SSD accompanied with depression and anxiety underwent bilateral anterior capsulotomy. The patient complained of nausea and vomiting, swelling of the hilum of the liver for 14 years, weakness of the limbs for 13 years, and burning pain in the esophagus for 1 year. Psychiatric and neuropsychological assessments were conducted to record the severity of the patients' symptoms and the progression of postoperative symptoms. The patient's somatization, depression, and anxiety symptoms as well as quality of life improved significantly and steadily; thus, anti-depressive and anti-anxiety medication were stopped. However, the patient developed new somatization symptoms, including dizziness, headache, and sternal pain, 10 months after the operation. Therefore, the patient resumed taking flupentixol and melitracen in order to control the new symptoms. This study shows that bilateral anterior capsulotomy appears to be a complementary treatment for refractory SSD with depressive and anxiety symptoms. Furthermore, postoperative use of anxiolytic and antidepressant medications may be useful for controlling future somatization symptoms.
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Affiliation(s)
- Weibin He
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lingmin Shao
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huan Huang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shudi Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chenhui Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chencheng Zhang
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
- *Correspondence: Wei Yi
| | - Wei Yi
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
- Chencheng Zhang
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11
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Murray SB, Strober M, Tadayonnejad R, Bari AA, Feusner JD. Neurosurgery and neuromodulation for anorexia nervosa in the 21st century: a systematic review of treatment outcomes. Eat Disord 2022; 30:26-53. [PMID: 32991247 PMCID: PMC8386186 DOI: 10.1080/10640266.2020.1790270] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As current psychosocial and pharmacological interventions show limited efficacy in the treatment of anorexia nervosa (AN), interest in the potential value of neurosurgical intervention and neuromodulation in managing severe and enduring illness has grown. We conducted a systematic review of 20 trials of neurosurgical and neuromodulatory treatments for AN, including neurosurgical ablation, deep brain stimulation (DBS), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS). Overall, there is evidence to support the role of stereotactic ablation and DBS in the treatment of AN. In contrast, results for rTMS and tDCS have been modest and generally more mixed. Neurosurgical treatment may offer important new avenues for the treatment of AN. Additional randomized clinical trials with comparable patient populations will be needed, in which change in affective, cognitive, and perceptual symptom phenomena, and interrogation of targeted circuits, pre- and post-intervention, are carefully documented.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Reza Tadayonnejad
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Ausaf A Bari
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
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12
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Keuken MC, Alkemade A, Stevenson N, Innes RJ, Forstmann BU. Structure-function similarities in deep brain stimulation targets cross-species. Neurosci Biobehav Rev 2021; 131:1127-1135. [PMID: 34715147 DOI: 10.1016/j.neubiorev.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 11/24/2022]
Abstract
Deep Brain Stimulation (DBS) is an effective neurosurgical treatment to alleviate motor symptoms of advanced Parkinson's disease. Due to its potential, DBS usage is rapidly expanding to target a large number of brain regions to treat a wide range of diseases and neuropsychiatric disorders. The identification and validation of new target regions heavily rely on the insights gained from rodent and primate models. Here we present a large-scale automatic meta-analysis in which the structure-function associations within and between species are compared for 21 DBS targets in humans. The results indicate that the structure-function association for the majority of the 21 included subcortical areas were conserved cross-species. A subset of structures showed overlapping functional association. This can potentially be attributed to shared brain networks and might explain why multiple brain areas are targeted for the same disease or neuropsychiatric disorder.
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Affiliation(s)
- Max C Keuken
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Nieuwe Achtergracht 129B, Postbus 15926, 1001 NK, Amsterdam, The Netherlands.
| | - Anneke Alkemade
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Nieuwe Achtergracht 129B, Postbus 15926, 1001 NK, Amsterdam, The Netherlands
| | - Niek Stevenson
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Nieuwe Achtergracht 129B, Postbus 15926, 1001 NK, Amsterdam, The Netherlands
| | - Reilly J Innes
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Nieuwe Achtergracht 129B, Postbus 15926, 1001 NK, Amsterdam, The Netherlands; Newcastle Cognition Lab, University of Newcastle, Callaghan, NSW, Australia
| | - Birte U Forstmann
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Nieuwe Achtergracht 129B, Postbus 15926, 1001 NK, Amsterdam, The Netherlands
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13
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Georgiev D, Akram H, Jahanshahi M. Deep brain stimulation for psychiatric disorders: role of imaging in identifying/confirming DBS targets, predicting, and optimizing outcome and unravelling mechanisms of action. PSYCHORADIOLOGY 2021; 1:118-151. [PMID: 38665808 PMCID: PMC10917192 DOI: 10.1093/psyrad/kkab012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 04/28/2024]
Abstract
Following the established application of deep brain stimulation (DBS) in the treatment of movement disorders, new non-neurological indications have emerged, such as for obsessive-compulsive disorders, major depressive disorder, dementia, Gilles de la Tourette Syndrome, anorexia nervosa, and addictions. As DBS is a network modulation surgical treatment, the development of DBS for both neurological and psychiatric disorders has been partly driven by advances in neuroimaging, which has helped explain the brain networks implicated. Advances in magnetic resonance imaging connectivity and electrophysiology have led to the development of the concept of modulating widely distributed, complex brain networks. Moreover, the increasing number of targets for treating psychiatric disorders have indicated that there may be a convergence of the effect of stimulating different targets for the same disorder, and the effect of stimulating the same target for different disorders. The aim of this paper is to review the imaging studies of DBS for psychiatric disorders. Imaging, and particularly connectivity analysis, offers exceptional opportunities to better understand and even predict the clinical outcomes of DBS, especially where there is a lack of objective biomarkers that are essential to properly guide DBS pre- and post-operatively. In future, imaging might also prove useful to individualize DBS treatment. Finally, one of the most important aspects of imaging in DBS is that it allows us to better understand the brain through observing the changes of the functional connectome under neuromodulation, which may in turn help explain the mechanisms of action of DBS that remain elusive.
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Affiliation(s)
- Dejan Georgiev
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
- Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Večna pot 113, 1000 Ljubljana, Slovenia
| | - Harith Akram
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Marjan Jahanshahi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, 611731, China
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14
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Lin Z, Dai L, Zhang C, Li D, Sun B. Rescue Anterior Capsulotomy after Failure of Nucleus Accumbens Deep Brain Stimulation in Anorexia Nervosa: A Case Report. Stereotact Funct Neurosurg 2021; 99:491-495. [PMID: 34218229 DOI: 10.1159/000517105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, .,Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,
| | - Lulin Dai
- Department of Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Potes MI, Joaquin C, Wiecks N, Phan S, Hassan O. The utility of deep brain stimulation surgery for treating eating disorders: A systematic review. Surg Neurol Int 2021; 12:169. [PMID: 34084597 PMCID: PMC8168795 DOI: 10.25259/sni_730_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/16/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Deep brain stimulation (DBS) has demonstrated preliminary success as a treatment for neuropsychological disorders including obsessive-compulsive disorder and substance use disorder. This systematic review aims to assess the use of DBS in treating eating disorders (EDs) to determine its utility and the extent of adverse effects. Methods: A PubMed search following PRISMA guidelines was executed to find studies encompassing DBS as a treatment of ED. Outcomes were extracted from the literature and summarized while a review of quality was also performed. Results: From a search yielding 299 publications, 11 studies published between 2010 and 2020 were found to fit the inclusion criteria. Out of 53 patients who began with an abnormal BMI before treatment, 22 patients (41.5%) achieved normal BMI on follow-up. Significant neuropsychological improvement was seen in most patients as measured by neuropsychiatric testing and questionnaires. Conclusion: DBS as a treatment for ED may result in significant objective and psychological benefits. Further studies should aim to increase the sample size, standardize follow-up protocol, and standardize the neuropsychiatric tests used to determine psychological and physiological benefits.
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Affiliation(s)
- Mark Immanuel Potes
- Department of Medical Education, School of Medicine, California University of Science and Medicine, Colton, California, United States
| | - Christian Joaquin
- Department of Clinical Education, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, United States
| | - Nicole Wiecks
- Department of Basic Sciences, Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada, United States
| | - Sheshanna Phan
- Department of Basic Sciences, Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada, United States
| | - Omron Hassan
- Department of Basic Sciences, Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada, United States
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16
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Kahn L, Sutton B, Winston HR, Abosch A, Thompson JA, Davis RA. Deep Brain Stimulation for Obsessive-Compulsive Disorder: Real World Experience Post-FDA-Humanitarian Use Device Approval. Front Psychiatry 2021; 12:568932. [PMID: 33868034 PMCID: PMC8044872 DOI: 10.3389/fpsyt.2021.568932] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: While case series have established the efficacy of deep brain stimulation (DBS) in treating obsessive-compulsive disorder (OCD), it has been our experience that few OCD patients present without comorbidities that affect outcomes associated with DBS treatment. Here we present our experience with DBS therapy for OCD in patients who all have comorbid disease, together with the results of our programming strategies. Methods: For this case series, we assessed five patients who underwent ventral capsule/ventral striatum (VC/VS) DBS for OCD between 2015 and 2019 at the University of Colorado Hospital. Every patient in this cohort exhibited comorbidities, including substance use disorders, eating disorder, tic disorder, and autism spectrum disorder. We conducted an IRB-approved, retrospective study of programming modifications and treatment response over the course of DBS therapy. Results: In addition to patients' subjective reports of improvement, we observed significant improvement in the Yale-Brown Obsessive-Compulsive Scale (44%), the Montgomery-Asberg Depression Rating Scale (53%), the Quality of Life Enjoyment and Satisfaction Questionnaire (27%), and the Hamilton Anxiety Rating scales (34.9%) following DBS. With respect to co-morbid disease, there was a significant improvement in a patient with tic disorder's Total Tic Severity Score (TTSS) (p = 0.005). Conclusions: DBS remains an efficacious tool for the treatment of OCD, even in patients with significant comorbidities in whom DBS has not previously been investigated. Efficacious treatment results not only from the accurate placement of the electrodes by the surgeon but also from programming by the psychiatrist.
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Affiliation(s)
- Lora Kahn
- Department of Neurosurgery, Ochsner Health, Tulane University-Ochsner Health Neurosurgery Program, New Orleans, LA, United States
| | - Brianne Sutton
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Helena R. Winston
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - John A. Thompson
- Department of Neurosurgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
- Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Rachel A. Davis
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
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17
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Alternatives to Pharmacological and Psychotherapeutic Treatments in Psychiatric Disorders. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Nowadays, most of the patients affected by psychiatric disorders are successfully treated with psychotherapy and pharmacotherapy. Nevertheless, according to the disease, a variable percentage of patients results resistant to such modalities, and alternative methods can then be considered. The purpose of this review is to summarize the techniques and results of invasive modalities for several treatment-resistant psychiatric diseases. A literature search was performed to provide an up-to-date review of advantages, disadvantages, efficacy, and complications of Deep-Brain Stimulation, Magnetic Resonance-guided Focused-Ultrasound, radiofrequency, and radiotherapy lesioning for depression, obsessive-compulsive disorder, schizophrenia, addiction, anorexia nervosa, and Tourette’s syndrome. The literature search did not strictly follow the criteria for a systematic review: due to the large differences in methodologies and patients’ cohort, we tried to identify the highest quality of available evidence for each technique. We present the data as a comprehensive, narrative review about the role, indication, safety, and results of the contemporary instrumental techniques that opened new therapeutic fields for selected patients unresponsive to psychotherapy and pharmacotherapy.
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18
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Muratore AF, Attia E. Current Therapeutic Approaches to Anorexia Nervosa: State of the Art. Clin Ther 2020; 43:85-94. [PMID: 33293054 DOI: 10.1016/j.clinthera.2020.11.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022]
Abstract
Anorexia nervosa (AN) is a devastating psychiatric disorder characterized by extreme restriction of food intake and low body weight, both associated with significant medical and psychological morbidity. The clinical severity of AN has prompted the consideration and study of behavioral and pharmacological treatments in efforts to establish empirically based methods to reduce the burden of the disorder. Among adolescents, family-based treatment is considered a first-line behavioral treatment. Research continues to explore the efficacy of family-based treatment and predictors of treatment response to further improve outcomes. Several behavioral treatments for adults also exist, including cognitive-behavioral therapy, exposure and response prevention, third-wave acceptance-based treatments, and supportive psychotherapy, all of which help to improve symptoms and promote modest weight gain. Despite this, no one treatment is considered superior, and all existing behavioral approaches leave a proportion of adults symptomatic or at a high risk of relapse. As such, among adults, there is continued need for development of novel, mechanism-based approaches to better target the core symptoms of AN. Although antidepressants impart little benefit on weight or symptoms, the second-generation antipsychotic olanzapine has shown ability to promote modest weight gain in outpatients with AN. Most recently, the field's evolving conceptualization of AN as a biologically based disorder coupled with technological advancements has led to consideration of varying neuromodulation strategies as a potential therapeutic approach that remains under investigation.
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Affiliation(s)
- Alexandra F Muratore
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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19
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Fernandes Arroteia I, Husch A, Baniasadi M, Hertel F. Impressive weight gain after deep brain stimulation of nucleus accumbens in treatment-resistant bulimic anorexia nervosa. BMJ Case Rep 2020; 13:e239316. [PMID: 33257397 PMCID: PMC7705521 DOI: 10.1136/bcr-2020-239316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
| | - Andreas Husch
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Mehri Baniasadi
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Frank Hertel
- Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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20
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Deep brain stimulation (DBS) in resistant mental disorders. CURRENT PROBLEMS OF PSYCHIATRY 2020. [DOI: 10.2478/cpp-2020-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Deep Brain Stimulation can directly alter brain activity in a controlled manner and the effect is reversible. The mechanism is that the electrode acts locally on neural activity, which is transferred to monosynchronous and multisynaptic network connections.
Methods: We present studies conducted on a group of patients that show an improvement in mental state after Deep Brain Stimulation.
Material: The diseases we included in our work are: Obsessive-Compulsive Disorder, Eating Disorder, Depression and Bipolar Affective Disorder.
Discussion: The use of deep brain stimulation can inhibit development of acute state of patients and improve both psychiatric features and the time of remission. The results indicate the greatest effectiveness of Deep Brain Stimulation in Obsessive-Compulsive Disorders.
Conclusions: Brain stimulation may be a promising therapeutic target in mental illness. In a properly selected location, it can contribute to a significant clinical improvement however further research in this direction is necessary.
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21
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Changes in eating behavior after deep brain stimulation for anorexia nervosa. A case study. Eat Weight Disord 2020; 25:1481-1486. [PMID: 31290029 DOI: 10.1007/s40519-019-00742-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/24/2019] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate changes in the nutritional status, body image concerns, and eating behaviors occurring in a patient who underwent deep brain stimulation (DBS) of the bed nucleus of the stria terminalis for treatment-refractory anorexia nervosa (AN). METHODS Bilateral DBS of the bed nucleus of the stria terminalis was performed in a 37-year-old woman affected by refractory AN. Pre- and post-surgical evaluations were conducted via an array of validated testing instruments, which took into account the weight variations, body image concerns, eating behavior, quality of life, and nutritional status. RESULTS Overall, eating behavior-, body image concern-, and nutritional status-related testing instruments demonstrated improvements starting from the first post-operative month. Normal body weight was restored after 4 months of stimulation. DISCUSSION Only a few cases of DBS for AN have been conducted to determine the efficacy of surgery based upon weight variation and psychometric scales for anxiety and affective disorders. In contrast, we have designed a comprehensive approach taking into account the most important aspects of this disease. This approach should be considered in future studies dealing with the neurosurgical treatment of AN.
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22
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Duriez P, Bou Khalil R, Chamoun Y, Maatoug R, Strumila R, Seneque M, Gorwood P, Courtet P, Guillaume S. Brain Stimulation in Eating Disorders: State of the Art and Future Perspectives. J Clin Med 2020; 9:E2358. [PMID: 32717984 PMCID: PMC7465000 DOI: 10.3390/jcm9082358] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
The management of eating disorders (EDs) is still difficult and few treatments are effective. Recently, several studies have described the important contribution of non-invasive brain stimulation (repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and electroconvulsive therapy) and invasive brain stimulation (deep brain stimulation and vagal nerve stimulation) for ED management. This review summarizes the available evidence supporting the use of brain stimulation in ED. All published studies on brain stimulation in ED as well as ongoing trials registered at clinicaltrials.gov were examined. Articles on neuromodulation research and perspective articles were also included. This analysis indicates that brain stimulation in EDs is still in its infancy. Literature data consist mainly of case reports, cases series, open studies, and only a few randomized controlled trials. Consequently, the evidence supporting the use of brain stimulation in EDs remains weak. Finally, this review discusses future directions in this research domain (e.g., sites of modulation, how to enhance neuromodulation efficacy, personalized protocols).
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Affiliation(s)
- Philibert Duriez
- GHU Paris Psychiatry and Neuroscience, Clinique des Maladies Mentales et de l’Encéphale (CMME), Sainte-Anne Hospital, 75014 Paris, France; (P.D.); (P.G.)
- Institute of Psychiatry and Neurosciences of Paris (IPNP), UMR_S1266, INSERM, Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - Rami Bou Khalil
- Department of Psychiatry, Hotel Dieu de France- Saint Joseph University, 166830 Beirut, Lebanon; (R.B.K.); (Y.C.)
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
| | - Yara Chamoun
- Department of Psychiatry, Hotel Dieu de France- Saint Joseph University, 166830 Beirut, Lebanon; (R.B.K.); (Y.C.)
| | - Redwan Maatoug
- Sorbonne Université, AP-HP, Service de Psychiatrie Adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, 75013 Paris, France;
| | - Robertas Strumila
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, 03101 Vilnius, Lithuania;
| | - Maude Seneque
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
| | - Philip Gorwood
- GHU Paris Psychiatry and Neuroscience, Clinique des Maladies Mentales et de l’Encéphale (CMME), Sainte-Anne Hospital, 75014 Paris, France; (P.D.); (P.G.)
- Institute of Psychiatry and Neurosciences of Paris (IPNP), UMR_S1266, INSERM, Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - Philippe Courtet
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
| | - Sébastien Guillaume
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
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23
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Villalba Martínez G, Justicia A, Salgado P, Ginés JM, Guardiola R, Cedrón C, Polo M, Delgado-Martínez I, Medrano S, Manero RM, Conesa G, Faus G, Grau A, Elices M, Pérez V. 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. J Clin Med 2020; 9:jcm9061946. [PMID: 32580399 PMCID: PMC7357090 DOI: 10.3390/jcm9061946] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 01/28/2023] Open
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.
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Affiliation(s)
- Gloria Villalba Martínez
- Department of Neurosurgery, Hospital del Mar, 08003 Barcelona, Spain; (G.V.M.); (I.D.-M.); (G.C.)
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain;
| | - Azucena Justicia
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain;
- Institut de Neuropsiquiatria i Adiccions (INAD), Hospital del Mar, 08003 Barcelona, Spain; (P.S.); (J.M.G.); (R.G.); (C.C.); (M.P.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Purificación Salgado
- Institut de Neuropsiquiatria i Adiccions (INAD), Hospital del Mar, 08003 Barcelona, Spain; (P.S.); (J.M.G.); (R.G.); (C.C.); (M.P.)
| | - José María Ginés
- Institut de Neuropsiquiatria i Adiccions (INAD), Hospital del Mar, 08003 Barcelona, Spain; (P.S.); (J.M.G.); (R.G.); (C.C.); (M.P.)
| | - Rocío Guardiola
- Institut de Neuropsiquiatria i Adiccions (INAD), Hospital del Mar, 08003 Barcelona, Spain; (P.S.); (J.M.G.); (R.G.); (C.C.); (M.P.)
| | - Carlos Cedrón
- Institut de Neuropsiquiatria i Adiccions (INAD), Hospital del Mar, 08003 Barcelona, Spain; (P.S.); (J.M.G.); (R.G.); (C.C.); (M.P.)
| | - María Polo
- Institut de Neuropsiquiatria i Adiccions (INAD), Hospital del Mar, 08003 Barcelona, Spain; (P.S.); (J.M.G.); (R.G.); (C.C.); (M.P.)
| | - Ignacio Delgado-Martínez
- Department of Neurosurgery, Hospital del Mar, 08003 Barcelona, Spain; (G.V.M.); (I.D.-M.); (G.C.)
| | - Santiago Medrano
- Department of Radiology, Hospital del Mar, 08003 Barcelona, Spain;
| | | | - Gerardo Conesa
- Department of Neurosurgery, Hospital del Mar, 08003 Barcelona, Spain; (G.V.M.); (I.D.-M.); (G.C.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain;
- Department of Surgery, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain
| | - Gustavo Faus
- ITA, Mental Health Specialists, 08036 Barcelona, Spain; (G.F.); (A.G.)
| | - Antoni Grau
- ITA, Mental Health Specialists, 08036 Barcelona, Spain; (G.F.); (A.G.)
| | - Matilde Elices
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-933160
| | - Víctor Pérez
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain;
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain;
- Institut de Neuropsiquiatria i Adiccions (INAD), Hospital del Mar, 08003 Barcelona, Spain; (P.S.); (J.M.G.); (R.G.); (C.C.); (M.P.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
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24
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Liu W, Zhan S, Li D, Lin Z, Zhang C, Wang T, Pan S, Zhang J, Cao C, Jin H, Li Y, Sun B. Deep brain stimulation of the nucleus accumbens for treatment-refractory anorexia nervosa: A long-term follow-up study. Brain Stimul 2020; 13:643-649. [PMID: 32289691 DOI: 10.1016/j.brs.2020.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 01/20/2020] [Accepted: 02/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Given that anorexia nervosa (AN) is a life-threatening mental disorder and has poor clinical outcomes, novel effective treatments are warranted, especially for severe and persistent cases. OBJECTIVE To investigate the safety, feasibility, and clinical outcomes of using deep brain stimulation (DBS) of the nucleus accumbens (NAcc) in treatment-refractory AN patients. METHODS A total of 28 women with refractory AN underwent NAcc-DBS and completed this 2-year follow-up study. The clinical outcomes, including body mass index (BMI) and mood, anxiety, and obsessive symptoms, were assessed using a series of psychiatric scales at 6 and 24 months post operation. RESULTS While no fatalities were reported during this study, 1 patient showed device rejection. The most common short-term side effect observed was varying degrees of pain at the incision sites (n = 22), which usually disappeared 3-4 days following the operation. No severe surgical adverse events were observed. Compared to presurgical levels, significant increases in BMI and improvement in psychiatric scale scores were noted during the 6-month follow-up and were maintained at the 2-year review. Finally, a post-hoc analysis revealed that the NAcc-DBS was less effective for weight restoration in patients with the binge-eating/purge subtype of AN than in those with the restricting subtype (R-AN). CONCLUSION Our long-term follow-up study suggests that NAcc-DBS is safe and effective for improving the BMI and psychiatric symptoms of patients with refractory AN. Although NAcc-DBS appears to be more suitable for patients with R-AN, strict inclusion criteria must be applied considering surgery-related complications.
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Affiliation(s)
- Wei Liu
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shikun Zhan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengyu Lin
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sijian Pan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunyan Cao
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongchao Li
- Department of Psychiatry, Shanghai YangPu District Mental Health Center, Shanghai, China
| | - Bomin Sun
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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25
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Abstract
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.
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Affiliation(s)
- Alexander C Whiting
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Michael Y Oh
- 2Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Donald M Whiting
- 2Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania
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26
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Weight Change after Striatal/Capsule Deep Brain Stimulation Relates to Connectivity to the Bed Nucleus of the Stria Terminalis and Hypothalamus. Brain Sci 2019; 9:brainsci9100264. [PMID: 31623328 PMCID: PMC6826646 DOI: 10.3390/brainsci9100264] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/30/2019] [Indexed: 01/28/2023] Open
Abstract
Weight changes are insufficiently understood adverse events of deep brain stimulation. In this context, exploring neural networks of weight control may inform novel treatment strategies for weight-related disorders. In this study, we investigated weight changes after deep brain stimulation of the ventral striatum/ventral capsule and to what extent changes are associated with connectivity to feeding-related networks. We retrospectively analyzed 25 patients undergoing deep brain stimulation for obsessive-compulsive disorder or substance dependency. Weight changes were assessed preoperatively and six to twelve months after surgery and then matched with individual stimulation sites and stimulation-dependent functional connectivity to a priori defined regions of interest that are involved in food intake. We observed a significant weight gain after six to twelve months of continuous stimulation. Weight increases were associated with medial/apical localization of stimulation sites and with connectivity to hypothalamic areas and the bed nucleus. Thus, deep brain stimulation of the ventral striatum/ventral capsule influences weight depending on localization and connectivity of stimulation sites. Bearing in mind the significance of weight-related disorders, we advocate further prospective studies investigating the neuroanatomical and neuropsychological underpinnings of food intake and their neuromodulatory therapeutic potential.
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27
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Sobstyl M, Stapińska-Syniec A, Sokół-Szawłowska M, Kupryjaniuk A. Deep brain stimulation for the treatment of severe intractable anorexia nervosa. Br J Neurosurg 2019; 33:601-607. [PMID: 31550921 DOI: 10.1080/02688697.2019.1667484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Anorexia nervosa (AN) is a challenging multifactorial disorder with the highest mortality rate among all psychiatric disorders. Due to the low rate of long-term treatment success, new treatment options are needed. Here, we review Deep Brain Stimulation (DBS) as a treatment of Severe Intractable AN. The mechanisms of AN have shown significant involvement of the central nervous system especially the same brain regions which are involved with obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). AN and OCD display many similarities in psychiatric practice such as compulsive behaviours and anxiety levels, which are related to networks in the brain, that can be altered using DBS. Our literature search revealed 8 studies totalling 28 individuals with AN and comorbid OCD or MDD. The most common stereotactic targets included the sub-callosal cingulate cortex (Brodmann area 25)/medial forebrain bundle (MFB) for AN and comorbid MDD and nucleus accumbens (NAc)/ventral striatum for AN and comorbid OCD. In most cases bilateral DBS of various structures of the reward system achieved good results in BMI, and core AN symptoms and psychiatric comorbidities showed sustained improvement. DBS is a promising treatment modality for AN and comorbid OCD or MDD. These results highlight promise and hope for patients with AN. However, further studies with larger patient populations are needed to shed light on the long-term outcomes of DBS and its effects in AN treatment.
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Affiliation(s)
- Michał Sobstyl
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | | | - Anna Kupryjaniuk
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
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28
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Wickramasuriya DS, Amin MR, Faghih RT. Skin Conductance as a Viable Alternative for Closing the Deep Brain Stimulation Loop in Neuropsychiatric Disorders. Front Neurosci 2019; 13:780. [PMID: 31447627 PMCID: PMC6692489 DOI: 10.3389/fnins.2019.00780] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/11/2019] [Indexed: 01/17/2023] Open
Abstract
Markers from local field potentials, neurochemicals, skin conductance, and hormone concentrations have been proposed as a means of closing the loop in Deep Brain Stimulation (DBS) therapy for treating neuropsychiatric and movement disorders. Developing a closed-loop DBS controller based on peripheral signals would require: (i) the recovery of a biomarker from the source neural stimuli underlying the peripheral signal variations; (ii) the estimation of an unobserved brain or central nervous system related state variable from the biomarker. The state variable is application-specific. It is emotion-related in the case of depression or post-traumatic stress disorder, and movement-related for Parkinson's or essential tremor. We present a method for closing the DBS loop in neuropsychiatric disorders based on the estimation of sympathetic arousal from skin conductance measurements. We deconvolve skin conductance via an optimization formulation utilizing sparse recovery and obtain neural impulses from sympathetic nerve fibers stimulating the sweat glands. We perform this deconvolution via a two-step coordinate descent procedure that recovers the sparse neural stimuli and estimates physiological system parameters simultaneously. We next relate an unobserved sympathetic arousal state to the probability that these neural impulses occur and use Bayesian filtering within an Expectation-Maximization framework for estimation. We evaluate our method on a publicly available data-set examining the effect of different types of stress on peripheral signal changes including body temperature, skin conductance and heart rate. A high degree of arousal is estimated during cognitive tasks, as are much lower levels during relaxation. The results demonstrate the ability to decode psychological arousal from neural activity underlying skin conductance signal variations. The complete pipeline from recovering neural stimuli to decoding an emotion-related brain state using skin conductance presents a promising methodology for the ultimate realization of a closed-loop DBS controller. Closed-loop DBS treatment would additionally help reduce unnecessary power consumption and improve therapeutic gains.
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Affiliation(s)
| | | | - Rose T. Faghih
- Computational Medicine Laboratory, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, United States
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29
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Lee DJ, Lozano CS, Dallapiazza RF, Lozano AM. Current and future directions of deep brain stimulation for neurological and psychiatric disorders. J Neurosurg 2019; 131:333-342. [PMID: 31370011 DOI: 10.3171/2019.4.jns181761] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 11/06/2022]
Abstract
Deep brain stimulation (DBS) has evolved considerably over the past 4 decades. Although it has primarily been used to treat movement disorders such as Parkinson's disease, essential tremor, and dystonia, recently it has been approved to treat obsessive-compulsive disorder and epilepsy. Novel potential indications in both neurological and psychiatric disorders are undergoing active study. There have been significant advances in DBS technology, including preoperative and intraoperative imaging, surgical approaches and techniques, and device improvements. In addition to providing significant clinical benefits and improving quality of life, DBS has also increased the understanding of human electrophysiology and network interactions. Despite the value of DBS, future developments should be aimed at developing less invasive techniques and attaining not just symptom improvement but curative disease modification.
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Affiliation(s)
- Darrin J Lee
- 1Department of Neurological Surgery, University of Southern California, Los Angeles, California
| | - Christopher S Lozano
- 2Department of Neurological Surgery, University of Toronto, Ontario, Canada; and
| | | | - Andres M Lozano
- 2Department of Neurological Surgery, University of Toronto, Ontario, Canada; and
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30
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Santaniello S, Gale JT, Sarma SV. Systems approaches to optimizing deep brain stimulation therapies in Parkinson's disease. WILEY INTERDISCIPLINARY REVIEWS. SYSTEMS BIOLOGY AND MEDICINE 2018; 10:e1421. [PMID: 29558564 PMCID: PMC6148418 DOI: 10.1002/wsbm.1421] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/29/2018] [Accepted: 02/01/2018] [Indexed: 01/17/2023]
Abstract
Over the last 30 years, deep brain stimulation (DBS) has been used to treat chronic neurological diseases like dystonia, obsessive-compulsive disorders, essential tremor, Parkinson's disease, and more recently, dementias, depression, cognitive disorders, and epilepsy. Despite its wide use, DBS presents numerous challenges for both clinicians and engineers. One challenge is the design of novel, more efficient DBS therapies, which are hampered by the lack of complete understanding about the cellular mechanisms of therapeutic DBS. Another challenge is the existence of redundancy in clinical outcomes, that is, different DBS programs can result in similar clinical benefits but very little information (e.g., predictive models, longitudinal data, metrics, etc.) is available to select one program over another. Finally, there is high variability in patients' responses to DBS, which forces clinicians to carefully adjust the stimulation settings to each patient via lengthy programming sessions. Researchers in neural engineering and systems biology have been tackling these challenges over the past few years with the specific goal of developing novel DBS therapies, design methodologies, and computational tools that optimize the therapeutic effects of DBS in each patient. Furthermore, efforts are being made to automatically adapt the DBS treatment to the fluctuations of disease symptoms. A review of the quantitative approaches currently available for the treatment of Parkinson's disease is presented here with an emphasis on the contributions that systems theoretical approaches have provided to understand the global dynamics of complex neuronal circuits in the brain under DBS. This article is categorized under: Translational, Genomic, and Systems Medicine > Therapeutic Methods Analytical and Computational Methods > Computational Methods Analytical and Computational Methods > Dynamical Methods Physiology > Mammalian Physiology in Health and Disease.
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Affiliation(s)
- Sabato Santaniello
- Biomedical Engineering Department and CT Institute for the Brain and Cognitive Sciences, University of Connecticut; ORCID-ID: 0000-0002-2133-9471
| | - John T. Gale
- Department of Neurosurgery, Emory University School of Medicine
| | - Sridevi V. Sarma
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University
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31
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Taghipour M, Derakhshan N, Saffarian A, Eghbal K, Yazdanpanah H. Deep Brain Stimulation of Nucleus Accumbens: High Hopes for Simulating Orgasm in Spinal Cord Injury Patients. World Neurosurg 2018; 116:492-493. [PMID: 30049042 DOI: 10.1016/j.wneu.2018.05.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Mousa Taghipour
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Derakhshan
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Arash Saffarian
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Yazdanpanah
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
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32
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Zanello M, Duriez P, Pallud J, Roux A, Sharshar T, Gorwood P, Devaux B. Letter: Long-Term Follow-up Study of MRI-Guided Bilateral Anterior Capsulotomy in Patients With Refractory Anorexia Nervosa. Neurosurgery 2018; 83:E39-E40. [PMID: 29912370 DOI: 10.1093/neuros/nyy123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Marc Zanello
- Department of Neurosurgery Sainte-Anne Hospital Paris, France.,Paris Descartes University Paris, France
| | - Philibert Duriez
- Paris Descartes University Paris, France.,CMME (Groupe Hospitalier Sainte-Anne) Paris Descartes University Paris, France
| | - Johan Pallud
- Department of Neurosurgery Sainte-Anne Hospital Paris, France.,Paris Descartes University Paris, France
| | - Alexandre Roux
- Department of Neurosurgery Sainte-Anne Hospital Paris, France.,Paris Descartes University Paris, France
| | - Tarek Sharshar
- Paris Descartes University Paris, France.,Anaesthesia and Intensive Care Unit Sainte-Anne Hospital Paris, France
| | - Philip Gorwood
- Paris Descartes University Paris, France.,CMME (Groupe Hospitalier Sainte-Anne) Paris Descartes University Paris, France
| | - Bertrand Devaux
- Department of Neurosurgery Sainte-Anne Hospital Paris, France.,Paris Descartes University Paris, France
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33
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Zhang C, Li D, Lin G, Sun B. In Reply: Long-Term Follow-up Study of MRI-Guided Bilateral Anterior Capsulotomy in Patients With Refractory Anorexia Nervosa. Neurosurgery 2018; 83:E41-E42. [PMID: 29912441 DOI: 10.1093/neuros/nyy124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chencheng Zhang
- Department of Functional Neurosurgery Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Dianyou Li
- Department of Functional Neurosurgery Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Guozhen Lin
- Department of Psychiatry Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Bomin Sun
- Department of Functional Neurosurgery Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai, China
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34
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Kisely S, Li A, Warren N, Siskind D. A systematic review and meta-analysis of deep brain stimulation for depression. Depress Anxiety 2018; 35:468-480. [PMID: 29697875 DOI: 10.1002/da.22746] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Deep brain stimulation is increasingly being used for treatment-resistant depression. Blinded, randomized controlled trials of active versus sham treatment have been limited to small numbers. METHOD We performed a systematic review and meta-analysis on the effectiveness of deep brain stimulation (DBS) in depression. Cochrane Central Register of Controlled Trials, PubMed/Medline, Embase and PsycINFO, Chinese Biomedical Literature Service System, and China Knowledge Resource Integrated Database were searched for single- or double placebo-controlled, crossover, and parallel-group trials in which DBS was compared with sham treatment using validated scales. RESULTS Ten papers from nine studies met inclusion criteria, all but two of which were double-blinded RCTs. The main outcome was a reduction in depressive symptoms. It was possible to combine data for 190 participants. Patients on active, as opposed to sham, treatment had a significantly higher response (OR = 5.50; 95% CI = 2.79, 10.85; p < .0001) and reductions in mean depression score (SMD = -0.42; 95% CI = -0.72, -0.12; p = .006). However, the effect was attenuated on some of the subgroup and sensitivity analyses, and there were no differences for most other outcomes. In addition, 84 participants experienced a total of 131 serious adverse effects, although not all could be directly associated with the device or surgery. Finally, publication bias was possible. CONCLUSIONS DBS may show promise for treatment-resistant depression but remains an experimental treatment until further data are available.
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Affiliation(s)
- Steve Kisely
- The University of Queensland Southern Clinical School, Queensland, Australia.,Metro South Health Service, Woolloongabba, Australia.,Griffith Institute of Health, Griffith University, Queensland, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - Amy Li
- The University of Queensland Southern Clinical School, Queensland, Australia
| | - Nicola Warren
- The University of Queensland Southern Clinical School, Queensland, Australia.,Metro South Health Service, Woolloongabba, Australia
| | - Dan Siskind
- The University of Queensland Southern Clinical School, Queensland, Australia.,Metro South Health Service, Woolloongabba, Australia
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35
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Park RJ, Scaife JC, Aziz TZ. Study Protocol: Using Deep-Brain Stimulation, Multimodal Neuroimaging and Neuroethics to Understand and Treat Severe Enduring Anorexia Nervosa. Front Psychiatry 2018; 9:24. [PMID: 29681866 PMCID: PMC5898619 DOI: 10.3389/fpsyt.2018.00024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/22/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Research suggests that altered eating and the pursuit of thinness in anorexia nervosa (AN) are, in part, a consequence of aberrant reward circuitry. The neural circuits involved in reward processing and compulsivity overlap significantly, and this has been suggested as a transdiagnostic factor underpinning obsessive compulsive disorder, addictions and eating disorders. The nucleus accumbens (NAcc) is central to both reward processing and compulsivity. In previous studies, deep-brain stimulation (DBS) to the NAcc has been shown to result in neural and symptomatic improvement in both obsessive compulsive disorder and addictions. Moreover, in rats, DBS to the NAcc medial shell increases food intake. We hypothesise that this treatment may be of benefit in severe and enduring anorexia nervosa (SE-AN), but first, feasibility and ethical standards need to be established. The aims of this study are as follows: (1) to provide feasibility and preliminary efficacy data on DBS to the NAcc as a treatment for SE-AN; (2) to assess any subsequent neural changes and (3) to develop a neuroethical gold standard to guide applications of this treatment. METHOD This is a longitudinal study of six individuals with SE-AN of >7 years. It includes an integrated neuroethical sub-study. DBS will be applied to the NAcc and we will track the mechanisms underpinning AN using magnetoelectroencephalography, neuropsychological and behavioural measures. Serial measures will be taken on each intensively studied patient, pre- and post-DBS system insertion. This will allow elucidation of the processes involved in symptomatic change over a 15-month period, which includes a double-blind crossover phase of stimulator on/off. DISCUSSION Novel, empirical treatments for SE-AN are urgently required due to high morbidity and mortality costs. If feasible and effective, DBS to the NAcc could be game-changing in the management of this condition. A neuroethical gold standard is crucial to optimally underpin such treatment development. CLINICAL TRIAL REGISTRATION The study is ongoing and registered with www.ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT01924598, 22 July, 2013. It has full ethical and HRA approval (Project ID 128658).
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Affiliation(s)
- Rebecca J. Park
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Jessica C. Scaife
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Tipu Z. Aziz
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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36
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Lee DJ, Elias GJB, Lozano AM. Neuromodulation for the treatment of eating disorders and obesity. Ther Adv Psychopharmacol 2018; 8:73-92. [PMID: 29399320 PMCID: PMC5788100 DOI: 10.1177/2045125317743435] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/24/2017] [Indexed: 12/25/2022] Open
Abstract
Eating disorders and obesity adversely affect individuals both medically and psychologically, leading to reduced life expectancy and poor quality of life. While there exist a number of treatments for anorexia, morbid obesity and bulimia, many patients do not respond favorably to current behavioral, medical or bariatric surgical management. Neuromodulation has been postulated as a potential treatment for eating disorders and obesity. In particular, deep brain stimulation and transcranial non-invasive brain stimulation have been studied for these indications across a variety of brain targets. Here, we review the neurobiology behind eating and eating disorders as well as the current status of preclinical and clinical neuromodulation trials for eating disorders and obesity.
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Affiliation(s)
- Darrin J Lee
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, 399 Bathurst St., West Wing 4-431, Toronto, ON M5T 2S8, Canada
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37
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Prinz P, Stengel A. Deep Brain Stimulation-Possible Treatment Strategy for Pathologically Altered Body Weight? Brain Sci 2018; 8:brainsci8010019. [PMID: 29361753 PMCID: PMC5789350 DOI: 10.3390/brainsci8010019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 12/11/2022] Open
Abstract
The treatment of obesity and eating disorders such as binge-eating disorder or anorexia nervosa is challenging. Besides lifestyle changes and pharmacological options, bariatric surgery represents a well-established and effective-albeit invasive-treatment of obesity, whereas for binge-eating disorder and anorexia nervosa mostly psychotherapy options exist. Deep brain stimulation (DBS), a method that influences the neuronal network, is by now known for its safe and effective applicability in patients with Parkinson’s disease. However, the use does not seem to be restricted to these patients. Recent preclinical and first clinical evidence points towards the use of DBS in patients with obesity and eating disorders as well. Depending on the targeted area in the brain, DBS can either inhibit food intake and body weight or stimulate energy intake and subsequently body weight. The current review focuses on preclinical and clinical evidence of DBS to modulate food intake and body weight and highlight the different brain areas targeted, stimulation protocols applied and downstream signaling modulated. Lastly, this review will also critically discuss potential safety issues and gaps in knowledge to promote further studies.
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Affiliation(s)
- Philip Prinz
- Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12200 Berlin, Germany.
| | - Andreas Stengel
- Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12200 Berlin, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany.
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39
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Lipsman N, Lozano AM, Hamani C. Neuromodulation in Anorexia Nervosa. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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40
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Mols K, Musa S, Nuttin B, Lagae L, Bonin V. In vivo characterization of the electrophysiological and astrocytic responses to a silicon neuroprobe implanted in the mouse neocortex. Sci Rep 2017; 7:15642. [PMID: 29142267 PMCID: PMC5688150 DOI: 10.1038/s41598-017-15121-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/23/2017] [Indexed: 12/04/2022] Open
Abstract
Silicon neuroprobes hold great potential for studies of large-scale neural activity and brain computer interfaces, but data on brain response in chronic implants is limited. Here we explored with in vivo cellular imaging the response to multisite silicon probes for neural recordings. We tested a chronic implant for mice consisting of a CMOS-compatible silicon probe rigidly implanted in the cortex under a cranial imaging window. Multiunit recordings of cortical neurons with the implant showed no degradation of electrophysiological signals weeks after implantation (mean spike and noise amplitudes of 186 ± 42 µVpp and 16 ± 3.2 µVrms, respectively, n = 5 mice). Two-photon imaging through the cranial window allowed longitudinal monitoring of fluorescently-labeled astrocytes from the second week post implantation for 8 weeks (n = 3 mice). The imaging showed a local increase in astrocyte-related fluorescence that remained stable from the second to the tenth week post implantation. These results demonstrate that, in a standard electrophysiology protocol in mice, rigidly implanted silicon probes can provide good short to medium term chronic recording performance with a limited astrocyte inflammatory response. The precise factors influencing the response to silicon probe implants remain to be elucidated.
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Affiliation(s)
- Katrien Mols
- Neuro-Electronics Research Flanders, Kapeldreef 75, 3001, Leuven, Belgium.,imec, Department of Life Science Technologies, Kapeldreef 75, 3001, Leuven, Belgium.,KU Leuven, Department of Neurosciences, 3000, Leuven, Belgium
| | - Silke Musa
- imec, Department of Life Science Technologies, Kapeldreef 75, 3001, Leuven, Belgium
| | - Bart Nuttin
- KU Leuven, Department of Neurosciences, 3000, Leuven, Belgium
| | - Liesbet Lagae
- imec, Department of Life Science Technologies, Kapeldreef 75, 3001, Leuven, Belgium.,KU Leuven, Department of Physics and Astronomy, 3001, Leuven, Belgium
| | - Vincent Bonin
- Neuro-Electronics Research Flanders, Kapeldreef 75, 3001, Leuven, Belgium. .,Vlaams Instituut voor Biotechnologie (VIB), 3001, Leuven, Belgium. .,KU Leuven, Department of Biology, 3000, Leuven, Belgium.
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Liu W, Li D, Sun F, Zhang X, Wang T, Zhan S, Pan Y, Huang P, Jin H, Li Y, Sun B. Long-Term Follow-up Study of MRI-Guided Bilateral Anterior Capsulotomy in Patients With Refractory Anorexia Nervosa. Neurosurgery 2017; 83:86-92. [DOI: 10.1093/neuros/nyx366] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/09/2017] [Indexed: 02/05/2023] Open
Abstract
Abstract
BACKGROUND
Anorexia nervosa (AN) is one of the most challenging psychiatric disorders to treat. The poor clinical outcomes warrant novel treatments for AN, especially in severe and persistent cases.
OBJECTIVE
To explore the feasibility of magnetic resonance imaging-guided bilateral anterior capsulotomy in the treatment of refractory AN.
METHODS
Seventy-four patients diagnosed with refractory AN who underwent capsulotomy completed this 3-yr follow-up study. Outcomes included body mass index (BMI) and results from a series of psychiatric scales (for obsessive, depressive, and anxious symptoms) that were implemented at baseline (presurgery), and 1 mo, 1 yr, and 3 yr after surgery.
RESULTS
Compared to presurgical levels, BMI increased significantly at 1-yr and 3-yr follow-ups. Compared to presurgery scores, psychiatric scale scores were significantly improved at 1-mo postsurgery, and continued to remain low at the 1-yr and 3-yr follow-ups. In addition, Mini-Mental State Examination (MMSE) scores were in the normal range during the long-term follow-up. The most common short-term side effects included urinary incontinence (n = 7), sleep disorders (n = 8), and fatigue (n = 6). Long-term complications included disinhibition (n = 6), memory loss (n = 3), and lethargy (n = 4). No patient in this study experienced death or disability.
CONCLUSION
Capsulotomy enabled patients with refractory AN to normalize their weight, especially those in life-threatening conditions. While it appears to be an acceptable life-saving treatment, it is indicated only when fulfilling strict criteria given its complications and irreversibility.
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Affiliation(s)
- Wei Liu
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Fafa Sun
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxiao Zhang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Shikun Zhan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Pan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Huang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School, of Medicine, Shanghai, China
| | - Yongchao Li
- Department of Psychiatry, Shanghai YangPu District Mental Health Center, Shanghai, China
| | - Bomin Sun
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
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Abstract
Eating disorders (EDs), including anorexia nervosa, bulimia nervosa, and binge-eating disorder, constitute a class of common and deadly psychiatric disorders. While numerous studies in humans highlight the important role of neurobiological alterations in the development of ED-related behaviors, the precise neural substrate that mediates this risk is unknown. Historically, pharmacological interventions have played a limited role in the treatment of eating disorders, typically providing symptomatic relief of comorbid psychiatric issues, like depression and anxiety, in support of the standard nutritional and psychological treatments. To date there are no Food and Drug Administration-approved medications or procedures for anorexia nervosa, and only one Food and Drug Administration-approved medication each for bulimia nervosa (fluoxetine) and binge-eating disorder (lisdexamfetamine). While there is little primary interest in drug development for eating disorders, postmarket monitoring of medications and procedures approved for other indications has identified several novel treatment options for patients with eating disorders. In this review, I utilize searches of the PubMed and ClinicalTrials.gov databases to highlight emerging treatments in eating disorders.
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Affiliation(s)
- Michael Lutter
- Eating Recovery Center of Dallas, 4716 Alliance Blvd. #400, Plano, TX, 75093, USA.
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43
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Roy HA, Green AL, Aziz TZ. State of the Art: Novel Applications for Deep Brain Stimulation. Neuromodulation 2017; 21:126-134. [DOI: 10.1111/ner.12604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/19/2017] [Accepted: 03/11/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Holly A. Roy
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
| | - Alexander L. Green
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
| | - Tipu Z. Aziz
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
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44
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Graat I, Figee M, Denys D. The application of deep brain stimulation in the treatment of psychiatric disorders. Int Rev Psychiatry 2017; 29:178-190. [PMID: 28523977 DOI: 10.1080/09540261.2017.1282439] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Ilse Graat
- a Department of Psychiatry , Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
| | - Martijn Figee
- a Department of Psychiatry , Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands.,b Amsterdam Brain and Cognition , Amsterdam , Netherlands
| | - Damiaan Denys
- a Department of Psychiatry , Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands.,b Amsterdam Brain and Cognition , Amsterdam , Netherlands.,c Netherlands Institute for Neuroscience , An Institute of the Royal Netherlands Academy of Arts and Sciences , Amsterdam , Netherlands
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45
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Blomstedt P, Naesström M, Bodlund O. Deep brain stimulation in the bed nucleus of the stria terminalis and medial forebrain bundle in a patient with major depressive disorder and anorexia nervosa. Clin Case Rep 2017; 5:679-684. [PMID: 28469875 PMCID: PMC5412827 DOI: 10.1002/ccr3.856] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 12/10/2016] [Accepted: 12/20/2016] [Indexed: 12/28/2022] Open
Abstract
Deep brain stimulation (DBS) may be considered in severe cases of therapy‐refractory major depressive disorder (MDD). However, DBS for MDD is still an experimental therapy. Therefore, it should only be administered in clinical studies driven by multidisciplinary teams, including surgeons with substantial experience of DBS in the treatment of other conditions.
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Affiliation(s)
- Patric Blomstedt
- Department of Pharmacology and Clinical Neuroscience Umeå University Umeå Sweden
| | - Matilda Naesström
- Department of Clinical Sciences/Psychiatry Umeå University Umeå Sweden
| | - Owe Bodlund
- Department of Clinical Sciences/Psychiatry Umeå University Umeå Sweden
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46
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Fetissov SO. [Hunger and satiety factors in the regulation of pleasure associated with feeding behavior]. Biol Aujourdhui 2017; 210:259-268. [PMID: 28327283 DOI: 10.1051/jbio/2016025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Indexed: 11/14/2022]
Abstract
Feeding is an instinctive behavior accompanied by rewarding feeling of pleasure during obtaining and ingesting food, corresponding to the preparatory and consummatory phases of motivated behavior, respectively. Perception of this emotional state together with alternating feelings of hunger and satiety drives the feeding behavior. Because alterations of feeding behavior including either overeating or anorexia may lead to obesity and cachexia, respectively, understanding the neurochemical mechanisms of regulation of feeding pleasure may help to develop new therapies of these diseases. The dopamine (DA) system of the mesolimbic projections plays a key role in behavioral reward in general and is also involved in regulating feeding-associated pleasure in the forebrain including the nucleus accumbens (NAc) and the lateral hypothalamic area (LHA). It suggests that this DA system can be selectively activated by factors specific to different types of motivated behavior including hunger- and satiety- related hormones. Indeed, central administrations of either orexigenic ghrelin or anorexigenic α-melanocyte-stimulating hormone (α-MSH) increase DA release in the NAc. However, DA has also been shown to inhibit food intake when injected into the LHA, historically known as a « hunger center », indicating DA functional involvement in regulation of both appetite and feeding pleasure. Although both NAc and LHA contain neurons expressing melanocortin receptors, only the LHA receives the α-MSH containing nerve terminals from the α-MSH producing neurons of the hypothalamic arcuate nucleus, the main relay of the peripheral hunger and satiety signals to the brain. A recent study showed that α-MSH in the LHA enhances satiety and inhibits feeding pleasure while potently stimulating DA release in this area during both preparatory and consummatory phases of feeding. It suggests that altered signaling by α-MSH to the DA system in the LHA may be involved in the pathophysiology of obesity and anorexia and the possible underlying mechanisms are discussed.
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47
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Park RJ, Singh I, Pike AC, Tan JOA. Deep Brain Stimulation in Anorexia Nervosa: Hope for the Hopeless or Exploitation of the Vulnerable? The Oxford Neuroethics Gold Standard Framework. Front Psychiatry 2017; 8:44. [PMID: 28373849 PMCID: PMC5357647 DOI: 10.3389/fpsyt.2017.00044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/03/2017] [Indexed: 01/13/2023] Open
Abstract
Neurosurgical interventions for psychiatric disorders have a long and troubled history (1, 2) but have become much more refined in the last few decades due to the rapid development of neuroimaging and robotic technologies (2). These advances have enabled the design of less invasive techniques, which are more focused, such as deep brain stimulation (DBS) (3). DBS involves electrode insertion into specific neural targets implicated in pathological behavior, which are then repeatedly stimulated at adjustable frequencies. DBS has been used for Parkinson's disease and movement disorders since the 1960s (4-6) and over the last decade has been applied to treatment-refractory psychiatric disorders, with some evidence of benefit in obsessive-compulsive disorder (OCD), major depressive disorder, and addictions (7). Recent consensus guidelines on best practice in psychiatric neurosurgery (8) stress, however, that DBS for psychiatric disorders remains at an experimental and exploratory stage. The ethics of DBS-in particular for psychiatric conditions-is debated (1, 8-10). Much of this discourse surrounds the philosophical implications of competence, authenticity, personality, or identity change following neurosurgical interventions, but there is a paucity of applied guidance on neuroethical best practice in psychiatric DBS, and health-care professionals have expressed that they require more (11). This paper aims to redress this balance by providing a practical, applied neuroethical gold standard framework to guide research ethics committees, researchers, and institutional sponsors. We will describe this as applied to our protocol for a particular research trial of DBS in severe and enduring anorexia nervosa (SE-AN) (https://clinicaltrials.gov/ct2/show/NCT01924598, unique identifier NCT01924598), but believe it may have wider application to DBS in other psychiatric disorders.
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Affiliation(s)
- Rebecca J. Park
- OxBREaD Research Group, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ilina Singh
- Neuroscience Ethics and Society Research Group, Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Alexandra C. Pike
- OxBREaD Research Group, Department of Psychiatry, University of Oxford, Oxford, UK
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Valdés-Moreno MI, Alcántara-Alonso V, Estrada-Camarena E, Mengod G, Amaya MI, Matamoros-Trejo G, de Gortari P. Phosphodiesterase-7 inhibition affects accumbal and hypothalamic thyrotropin-releasing hormone expression, feeding and anxiety behavior of rats. Behav Brain Res 2017; 319:165-173. [PMID: 27864049 DOI: 10.1016/j.bbr.2016.11.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/24/2016] [Accepted: 11/14/2016] [Indexed: 12/19/2022]
Abstract
Thyrotropin-releasing hormone (TRH) has anorexigenic and anxiolytic functions when injected intraventricularly. Nucleus accumbens (NAcc) is a possible brain region involved, since it expresses proTRH. TRH from hypothalamic paraventricular nucleus (PVN) has a food intake-regulating role. TRHergic pathways of NAcc and PVN are implicated in anxiety and feeding. Both behaviors depend on cAMP and phosphorylated-cAMP response element binding protein (pCREB) intracellular levels. Intracellular levels of cAMP are controlled by the degrading activity of phosphodiesterases (PDEs). Since TRH transcription is activated by pCREB, a specific inhibitor of PDE7B may regulate TRH-induced effects on anxiety and feeding. We evaluated the effectiveness of an intra-accumbal and intraperitoneal (i.p.) administration of a PDE7 inhibitor (BRL-50481) on rats' anxiety-like behavior and food intake; also on TRH mRNA and protein expression in NAcc and PVN to define its mediating role on the PDE7 inhibitor-induced behavioral changes. Accumbal injection of 4μg/0.3μL of PDE7 inhibitor decreased rats' anxiety. The i.p. injection of 0.2mg/kg of the inhibitor was able to increase the PVN TRH mRNA expression and to decrease feeding but did not change animals' anxiety levels; in contrast, 2mg/kg b.w inhibitor enhanced accumbal TRH mRNA, induced anxiolysis with no change in food intake. PDE7 inhibitor induced anxiolytic and anorexigenic like behavior depending on the dose used. Results supported hypothalamic TRH mediated feeding-reduction effects, and accumbal TRH mediation of inhibitor-induced anxiolysis. Thus, an i.p dose of this inhibitor might be reducing anxiety with no change in feeding, which could be useful for obese patients.
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Affiliation(s)
- M I Valdés-Moreno
- Department of Neuroscience Research, National Institute of Psychiatry RFM, Calzada México Xochimilco 101, Col. San Lorenzo Huipulco, 14370 México City, Mexico; School of Dietetics and Nutrition ISSSTE, Callejón Vía San Fernando 12, Col. San Pedro Apóstol, 14070 México City, Mexico
| | - V Alcántara-Alonso
- Department of Neuroscience Research, National Institute of Psychiatry RFM, Calzada México Xochimilco 101, Col. San Lorenzo Huipulco, 14370 México City, Mexico
| | - E Estrada-Camarena
- Department of Neuroscience Research, National Institute of Psychiatry RFM, Calzada México Xochimilco 101, Col. San Lorenzo Huipulco, 14370 México City, Mexico
| | - G Mengod
- Department of Neurochemistry and Neuropharmachology, Institut d'Investigacions Biòmediques de Barcelona, CSIC, IDIBAPS, CIBERNED, c/Rosselló 161, 6a, E 08036 Barcelona, Spain
| | - M I Amaya
- Department of Neuroscience Research, National Institute of Psychiatry RFM, Calzada México Xochimilco 101, Col. San Lorenzo Huipulco, 14370 México City, Mexico
| | - G Matamoros-Trejo
- Department of Neuroscience Research, National Institute of Psychiatry RFM, Calzada México Xochimilco 101, Col. San Lorenzo Huipulco, 14370 México City, Mexico
| | - P de Gortari
- Department of Neuroscience Research, National Institute of Psychiatry RFM, Calzada México Xochimilco 101, Col. San Lorenzo Huipulco, 14370 México City, Mexico.
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Neumaier F, Paterno M, Alpdogan S, Tevoufouet EE, Schneider T, Hescheler J, Albanna W. Surgical Approaches in Psychiatry: A Survey of the World Literature on Psychosurgery. World Neurosurg 2017; 97:603-634.e8. [DOI: 10.1016/j.wneu.2016.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 12/11/2022]
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50
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Witter DP, Ward HE. Overview of the Current Use of Deep Brain Stimulation in Psychiatric Disorders. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20161003-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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