Section of Eating Disorders, Institute of Psychiatry, King's College London, London, UK.
Eur Eat Disord Rev. 2013 Nov;21(6):436-55. doi: 10.1002/erv.2256. Epub 2013 Sep 20.
BACKGROUND: Eating disorders (ED) are chronic and sometimes deadly illnesses. Existing treatments have limited proven efficacy, especially in the case of adults with anorexia nervosa (AN). Emerging neural models of ED provide a rationale for more targeted, brain-directed interventions. AIMS: This systematic review has examined the effects of neuromodulation techniques on eating behaviours and body weight and assessed their potential for therapeutic use in ED. METHOD: All articles in PubMed, PsychInfo and Web of Knowledge were considered and screened against a priori inclusion/exclusion criteria. The effects of repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, vagus nerve stimulation (VNS) and deep brain stimulation (DBS) were examined across studies in ED samples, other psychiatric and neurological disorders, and animal models. RESULTS: Sixty studies were identified. There is evidence for ED symptom reduction following rTMS and DBS in both AN and bulimia nervosa. Findings from studies of other psychiatric and neurological disorders and from animal studies demonstrate that increases in food intake and body weight can be achieved following DBS and that VNS has potential value as a means of controlling eating and inducing weight loss. CONCLUSIONS: Neuromodulation tools have potential for reducing ED symptomatology and related behaviours, and for altering food intake and body weight. In response to such findings, and emerging neural models of ED, treatment approaches are highly unlikely to remain 'brainless'. More research is required to evaluate the potential of neuromodulation procedures for improving long-term outcomes in ED.
背景:饮食失调(ED)是一种慢性疾病,有时甚至是致命的疾病。现有的治疗方法疗效有限,特别是对神经性厌食症(AN)的成年人。新兴的 ED 神经模型为更有针对性、针对大脑的干预措施提供了依据。
目的:本系统评价研究了神经调节技术对饮食行为和体重的影响,并评估了它们在 ED 治疗中的潜在应用。
方法:在 PubMed、PsychInfo 和 Web of Knowledge 中搜索所有文章,并根据事先制定的纳入/排除标准进行筛选。考察了重复经颅磁刺激(rTMS)、经颅直流电刺激、迷走神经刺激(VNS)和深部脑刺激(DBS)在 ED 样本、其他精神和神经障碍以及动物模型中的研究中的作用。
结果:确定了 60 项研究。在 AN 和神经性贪食症中,rTMS 和 DBS 均能减轻 ED 症状。其他精神和神经障碍以及动物研究的研究结果表明,DBS 可增加食物摄入和体重,VNS 具有控制饮食和诱导体重减轻的潜在价值。
结论:神经调节工具具有减轻 ED 症状和相关行为、改变食物摄入和体重的潜力。鉴于这些发现和新兴的 ED 神经模型,治疗方法不太可能仍然“无脑”。需要进一步研究评估神经调节程序在改善 ED 长期结局方面的潜力。
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