TY - JOUR
T1 - Efficacy of deep brain stimulation for the treatment of anorexia nervosa
T2 - a systematic review and network meta-analysis of patient-level data
AU - Shaffer, Annabelle
AU - Naik, Anant
AU - Bederson, Maria
AU - Arnold, Paul M.
AU - Hassaneen, Wael
N1 - Publisher Copyright:
© AANS 2023, except where prohibited by US copyright law
PY - 2022
Y1 - 2022
N2 - OBJECTIVE Deep brain stimulation (DBS) has been approved as a therapy for movement disorders and obsessivecompulsive 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. https://thejns.org/doi/abs/10.3171/2022.11.FOCUS22616
AB - OBJECTIVE Deep brain stimulation (DBS) has been approved as a therapy for movement disorders and obsessivecompulsive 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. https://thejns.org/doi/abs/10.3171/2022.11.FOCUS22616
KW - anorexia nervosa
KW - deep brain stimulation
KW - eating disorder
KW - psychiatric disease
UR - http://www.scopus.com/inward/record.url?scp=85147235075&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85147235075&partnerID=8YFLogxK
U2 - 10.3171/2022.11.FOCUS22616.
DO - 10.3171/2022.11.FOCUS22616.
M3 - Article
C2 - 36724522
AN - SCOPUS:85147235075
SN - 1092-0684
VL - 54
JO - Neurosurgical focus
JF - Neurosurgical focus
IS - 2
M1 - E5
ER -