Affiliation:
1. Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana; and
2. Department of Neurosurgery, Carle Foundation Hospital, Urbana, Illinois
Abstract
OBJECTIVE
Deep brain stimulation (DBS) has been approved as a therapy for movement disorders and obsessive-compulsive disorder. Recently, DBS has been studied in patients with anorexia nervosa (AN), which is a debilitating and life-threatening psychiatric disorder. Several stimulation locations have been tested without a clear indication of the best region. In this systematic review and network meta-analysis, the authors used patient-level data to identify stimulation targets with the greatest evidence for efficacy in increasing body mass index (BMI).
METHODS
A systematic search was performed on or before August 4, 2022, using PubMed/MEDLINE, Ovid, and Scopus. Articles were included if patient-level data were presented, patients were diagnosed with AN and treated with DBS, and 6 months or more of postoperative follow-up data were reported. Quality and risk of bias were assessed with the NIH assessment tools. Patient data were collected and stratified by stimulation location. A network meta-analysis was performed. This review was written in accordance with PRISMA guidelines for systematic reviews.
RESULTS
Eleven studies consisting of 36 patients were included. The mean age and BMI at the time of surgery were 38.07 (SD 11.64) years and 12.58 (SD 1.4) kg/m2, respectively. After 6 months of DBS, a significant difference in percentage change in BMI was found between the nucleus accumbens and subcallosal cingulate cortex (SCC) (SMD 0.78; 95% CI 0.10, 1.45) and between the SCC and ventral anterior limb of the internal capsule (SMD −1.51; 95% CI −2.39, −0.62). Similarly, at 9–12 months, a significant difference in percentage change in BMI was found between the SCC and ventral anterior limb of the internal capsule (SMD −1.18; 95% CI −2.21, −0.15). With hierarchical ranking, this study identified SCC as the most supported stimulation location for BMI change at 6 and 9–12 months (P-scores 0.9449 and 0.9771, respectively).
CONCLUSIONS
Several DBS targets have been tested for AN, and this study identified the SCC as the most supported region for BMI change. However, further studies with blinded on/off periods are necessary to confirm this finding.
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Subject
Neurology (clinical),General Medicine,Surgery
Reference43 articles.
1. Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden;van Hoeken D,2020
2. Treatment outcome reporting in anorexia nervosa: time for a paradigm shift?;Murray SB,2018
3. Prevalence and correlates of DSM-5-defined eating disorders in a nationally representative sample of U.S. adults;Udo T,2018
4. Mortality in anorexia nervosa;Sullivan PF,1995
5. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies;Arcelus J,2011
Cited by
6 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献