University of California, Irvine, School of Medicine, Orange, California, USA.
University of Florida, College of Medicine, Gainesville, Florida, USA.
World Neurosurg. 2022 Dec;168:179-189. doi: 10.1016/j.wneu.2022.09.114. Epub 2022 Oct 1.
OBJECTIVE: Anorexia nervosa and obesity are common appetite disorders, which may be life threatening if not treated and often coincide with psychiatric disorders. We sought to investigate whether deep brain stimulation (DBS) of specific regions within the brain could aid in the treatment of these disorders. This review aims to organize the literature regarding the feasibility of DBS via clinical outcomes and synthesize the data on patient demographics and electrode parameters for future optimization. METHODS: PubMed, Scopus, and Web of Science databases were all queried on 7 June 2022 to identify studies reporting the effect of DBS in treatment of either anorexia nervosa or obesity. We included studies involving 1) DBS, 2) treatment of anorexia nervosa or obesity, and 3) body mass index (BMI) as the primary outcome variable. Case reports, retrospective cohort studies, and randomized controlled trials were all eligible for inclusion. Exclusion of articles was based on the following criteria: 1) meta-analyses or systematic reviews or 2) describes diseases other than only anorexia or obesity. Screening of the 999 articles returned by an initial search yielded 23 studies for inclusion and further data extraction. Qualitative assessment of included studies was subsequently conducted in accordance with Newcastle-Ottawa Scale criteria. RESULTS: We included 23 articles (17 anorexia, 5 obesity) that met our inclusion and exclusion criteria, which included 8 case reports, 13 case series, and 1 case-control study. Our primary variables of interest were location of DBS, change in BMI after intervention, electrode parameters, and psychiatric comorbidities. A total of 131 patients were included and analyzed, 118 of those belonging in the anorexia cohort. For patients with anorexia, we found that the most common place for DBS was the subcallosal cingulate followed by the nucleus accumbens, resulting in an overall increase in BMI by 24.82% over the span of a mean 17.1 months. Psychiatric comorbidities (major depressive disorder, obsessive-compulsive disorder, and anxiety) were common in the anorexia cohort. For patients with obesity, DBS was most common in the lateral hypothalamus followed by the nucleus accumbens, resulting in a small decrease in BMI by 3.97% over a mean 17.2 months. Data were insufficient for this cohort to report on additional psychiatric comorbidities or calculate the duration from diagnosis to treatment. CONCLUSIONS: DBS seems to be a promising solution in addressing treatment-refractory anorexia, but additional prospective studies are still needed to confirm this same usefulness for the treatment of obesity. Primary limitations included the apparent lack of data on DBS for obesity as well as the dearth of cohort studies assessing efficacy of DBS compared with control treatments. Although these limitations could not be addressed in the current review, this study may incentivize future trials to assess DBS in patients with appetite disorders in a more controlled fashion.
目的:神经性厌食症和肥胖症是常见的食欲障碍,如果不加以治疗,可能会危及生命,而且常与精神障碍同时发生。我们试图研究大脑特定区域的深部脑刺激(DBS)是否有助于治疗这些疾病。本综述旨在通过临床结果组织关于 DBS 的文献,并综合患者人口统计学和电极参数的数据,以进行未来的优化。
方法:于 2022 年 6 月 7 日在 PubMed、Scopus 和 Web of Science 数据库中检索报告 DBS 治疗神经性厌食症或肥胖症效果的研究。我们纳入了涉及以下内容的研究:1)DBS,2)治疗神经性厌食症或肥胖症,3)体重指数(BMI)作为主要结局变量。病例报告、回顾性队列研究和随机对照试验均符合纳入标准。排除文章的标准如下:1)荟萃分析或系统评价,或 2)描述除神经性厌食症或肥胖症以外的疾病。对初步搜索返回的 999 篇文章进行筛选,纳入 23 篇研究进行进一步的数据提取。随后按照纽卡斯尔-渥太华量表标准对纳入的研究进行定性评估。
结果:我们纳入了 23 篇符合纳入和排除标准的文章(17 篇关于神经性厌食症,5 篇关于肥胖症),其中包括 8 篇病例报告、13 篇病例系列研究和 1 篇病例对照研究。我们主要关注的变量是 DBS 的位置、干预后 BMI 的变化、电极参数和精神共病。共纳入 131 名患者进行分析,其中 118 名属于神经性厌食症队列。对于神经性厌食症患者,我们发现 DBS 最常见的部位是胼胝体下扣带,其次是伏隔核,导致平均 17.1 个月内 BMI 总体增加 24.82%。精神共病(重度抑郁症、强迫症和焦虑症)在神经性厌食症队列中很常见。对于肥胖症患者,DBS 最常见的部位是外侧下丘脑,其次是伏隔核,导致平均 17.2 个月内 BMI 略有下降 3.97%。由于肥胖症队列中缺乏数据,无法报告其他精神共病或计算从诊断到治疗的时间,因此无法报告这些数据。
结论:DBS 似乎是治疗难治性神经性厌食症的一种有前途的方法,但仍需要更多的前瞻性研究来证实其对肥胖症治疗的同样有效性。主要限制包括缺乏肥胖症 DBS 数据以及缺乏与对照治疗相比评估 DBS 疗效的队列研究。尽管这些限制在目前的综述中无法得到解决,但本研究可能会鼓励未来的试验以更受控的方式评估食欲障碍患者的 DBS。
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