King's College London, Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Curr Opin Psychiatry. 2017 Nov;30(6):458-473. doi: 10.1097/YCO.0000000000000361.
Psychological interventions are the treatment of choice for most eating disorders; however, significant proportions of patients do not recover with these. Advances in understanding of the neurobiology of eating disorders have led to the development of targeted treatments, such as deep brain stimulation (DBS), noninvasive brain stimulation (NIBS), and neurofeedback. We review the emerging clinical evidence for the use of these interventions in eating disorders and obesity, together with their theoretical rationale. Finally, we reflect on future developments.
During the last 20 months, seven case studies/series and seven randomized controlled trials (RCTs) of NIBS or neurofeedback in different eating disorders, obesity, or food craving have appeared. These have largely had promising results. One NIBS trial, using a multisession protocol, was negative. A case series of subcallosal DBS in anorexia nervosa has also shown promise. A search of trial registries identified a further 21 neuromodulation/feedback studies in progress, indicating that neuromodulation/feedback is an area of growing interest.
At present, neuromodulation and neurofeedback are largely experimental interventions; however, growing understanding of the mechanisms involved, together with the rising number of studies in this area, means that the clinical utility of these interventions is likely to become clearer soon.
心理干预是大多数进食障碍的首选治疗方法；然而，仍有相当一部分患者无法通过这些方法康复。对进食障碍神经生物学的理解的进步，导致了靶向治疗的发展，如深部脑刺激（DBS）、非侵入性脑刺激（NIBS）和神经反馈。我们综述了这些干预措施在进食障碍和肥胖症中的新兴临床证据，以及它们的理论依据。最后，我们反思了未来的发展。
在过去的 20 个月中，出现了七项关于不同进食障碍、肥胖症或食物渴望的 NIBS 或神经反馈的病例研究/系列和七项随机对照试验（RCT）。这些研究在很大程度上取得了可喜的成果。一项使用多疗程方案的 NIBS 试验结果为阴性。一项关于厌食症患者使用扣带回下 DBS 的病例系列研究也显示出了前景。对试验登记处的搜索发现，另有 21 项神经调节/反馈研究正在进行中，这表明神经调节/反馈是一个日益受到关注的领域。
目前，神经调节和神经反馈在很大程度上是实验性干预措施；然而，对所涉及机制的理解不断加深，以及该领域研究数量的增加，意味着这些干预措施的临床应用很快就会变得更加清晰。
