Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA.
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA.
Eat Disord. 2022 Jan-Feb;30(1):26-53. doi: 10.1080/10640266.2020.1790270. Epub 2020 Sep 29.
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.
目前，心理社会和药物干预在治疗神经性厌食症（AN）方面效果有限，因此人们对神经外科干预和神经调节在治疗严重和持久疾病方面的潜在价值产生了兴趣。我们对 20 项神经外科和神经调节治疗 AN 的试验进行了系统回顾，包括神经外科消融、深部脑刺激（DBS）、重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS）。总的来说，有证据支持立体定向消融和 DBS 在治疗 AN 中的作用。相比之下，rTMS 和 tDCS 的结果则较为温和，且通常更为混杂。神经外科治疗可能为 AN 的治疗提供重要的新途径。需要进行更多具有可比性患者群体的随机临床试验，在这些试验中，需要仔细记录干预前后情感、认知和感知症状现象的变化，以及对靶向回路的检测。
