Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.
Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.
Acta Neurochir (Wien). 2024 Sep 12;166(1):364. doi: 10.1007/s00701-024-06258-w.
Anorexia nervosa (AN) is a mental health disorder characterized by significant weight loss and associated medical and psychological comorbidities. Conventional treatments for severe AN have shown limited effectiveness, leading to the exploration of novel interventional strategies, including deep brain stimulation (DBS). However, the neural mechanisms driving DBS interventions, particularly in psychiatric conditions, remain uncertain. This study aims to address this knowledge gap by examining changes in structural connectivity in patients with severe AN before and after DBS.
Sixteen participants, including eight patients with AN and eight controls, underwent baseline T1-weigthed and diffusion tensor imaging (DTI) acquisitions. Patients received DBS targeting either the subcallosal cingulate (DBS-SCC, N = 4) or the nucleus accumbens (DBS-NAcc, N = 4) based on psychiatric comorbidities and AN subtype. Post-DBS neuroimaging evaluation was conducted in four patients. Data analyses were performed to compare structural connectivity between patients and controls and to assess connectivity changes after DBS intervention.
Baseline findings revealed that structural connectivity is significantly reduced in patients with AN compared to controls, mainly regarding callosal and subcallosal white matter (WM) tracts. Furthermore, pre- vs. post-DBS analyses in AN identified a specific increase after the intervention in two WM tracts: the anterior thalamic radiation and the superior longitudinal fasciculus-parietal bundle.
This study supports that structural connectivity is highly compromised in severe AN. Moreover, this investigation preliminarily reveals that after DBS of the SCC and NAcc in severe AN, there are WM modifications. These microstructural plasticity adaptations may signify a mechanistic underpinning of DBS in this psychiatric disorder.
神经性厌食症（AN）是一种以明显体重减轻和相关的医学及心理合并症为特征的心理健康障碍。针对严重 AN 的常规治疗方法已显示出疗效有限，因此正在探索新的介入策略，包括深部脑刺激（DBS）。然而，驱动 DBS 干预的神经机制，特别是在精神疾病中，仍不确定。本研究旨在通过检查严重 AN 患者在 DBS 前后的结构连接变化来填补这一知识空白。
16 名参与者，包括 8 名 AN 患者和 8 名对照，进行了基线 T1 加权和弥散张量成像（DTI）采集。根据精神共病和 AN 亚型，对 8 名患者进行了 DBS 治疗，分别针对扣带回下（DBS-SCC，N=4）或伏隔核（DBS-NAcc，N=4）。对四名患者进行了 DBS 后神经影像学评估。数据分析比较了患者与对照组之间的结构连接，并评估了 DBS 干预后的连接变化。
基线研究发现，与对照组相比，AN 患者的结构连接显著减少，主要是胼胝体和扣带回下的白质（WM）束。此外，对 AN 患者的预 DBS-vs. 后 DBS 分析发现，干预后有两个 WM 束的连接明显增加：前丘脑辐射和上纵束-顶叶束。
本研究支持严重 AN 患者的结构连接高度受损。此外，本研究初步表明，在严重 AN 中对 SCC 和 NAcc 进行 DBS 后，WM 发生了改变。这些微观结构的可塑性适应可能是 DBS 在这种精神障碍中的机制基础。
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