Campos-Fajardo Santiago, Lacouture-Silgado Isabella, Agudelo-Arrieta Mariana, Zorro Óscar F
Neurosurgery Research Group, Pontificia Universidad Javeriana, Bogotá, Colombia.
Neurosurgery Research Group, Pontificia Universidad Javeriana, Bogotá, Colombia.
Clin Neurol Neurosurg. 2025 Jun 25;256:109029. doi: 10.1016/j.clineuro.2025.109029.
Eating disorders are disabling, deadly, and costly diseases that considerably impair physical health and disrupt psychosocial functioning. The nucleus accumbens, with its involvement in hedonic feeling, satiety signaling, and reward-based learning, has garnered attention as a potential target to understand the pathophysiology of eating disorders. Despite the advancement in conservative therapeutic strategies, treatment-resistant cases remain a significant concern, highlighting the need for novel approaches. This scoping review aims to explore the emerging role of deep brain stimulation (DBS) targeting the nucleus accumbens (NAc) as a potential intervention for eating disorders, shedding light on its therapeutic efficacy in this context.
The completed review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). It was justified to systematically summarize primary research as there is no relevant summary describing the deep brain stimulation of the nucleus accumbens to treat eating disorders. A comprehensive search was conducted in PubMed and Embase databases, from which eight studies were obtained. The review included research articles that involved patients suffering from eating disorders (mainly anorexia nervosa, binge eating disorder, obesity and loss of control over food consumption) treated with NAc-DBS, with a total of n = 71.
Over a 12-month follow-up period, the results from the studies reviewed showed a consistent increase in body mass index over time as well as significant improvements in quality of life, cognitive performance, and affective symptoms. However, the results also highlight the complexity and challenges associated with this approach, including the heterogeneity in patients, parameters and outcomes, the need for individualized patient approaches, and the lack of large randomized high-quality studies.
While NAc-DBS represents a significant advancement in neuromodulation for eating disorders, offering new avenues for personalized and effective interventions, it is still in its experimental stages. The findings of this review underscore the need for further research to fully understand its efficacy and mechanisms of action. As our understanding of the NAc and the effects of its modulation through DBS continues to evolve, so too will our ability to effectively treat eating disorders. This review presents compelling evidence that NAc-DBS has potential as a treatment for eating disorders, however, more research is needed to elucidate its functions and the effects of its modulation through DBS.
饮食失调是致残、致命且代价高昂的疾病，会严重损害身体健康并扰乱心理社会功能。伏隔核参与享乐感觉、饱腹感信号传递和基于奖励的学习，作为理解饮食失调病理生理学的潜在靶点已受到关注。尽管保守治疗策略有所进展，但难治性病例仍是重大问题，凸显了采用新方法的必要性。本范围综述旨在探讨针对伏隔核（NAc）的深部脑刺激（DBS）作为饮食失调潜在干预措施的新兴作用，阐明其在此背景下的治疗效果。
本完成的综述依据系统评价和Meta分析扩展的范围综述首选报告项目（PRISMA-ScR）进行报告。由于尚无描述伏隔核深部脑刺激治疗饮食失调的相关综述，因此有理由对原始研究进行系统总结。在PubMed和Embase数据库中进行了全面检索，从中获得了八项研究。该综述纳入了涉及接受NAc-DBS治疗的饮食失调患者（主要是神经性厌食症、暴饮暴食症、肥胖症和食物摄入失控）的研究文章，共计n = 71例。
在12个月的随访期内，所综述研究的结果显示，体重指数随时间持续增加，生活质量、认知表现和情感症状也有显著改善。然而，结果也凸显了这种方法的复杂性和挑战，包括患者、参数和结果的异质性、对患者个体化方法的需求以及缺乏大型随机高质量研究。
虽然NAc-DBS代表了饮食失调神经调节方面的重大进展，为个性化和有效干预提供了新途径，但它仍处于实验阶段。本综述的结果强调了进一步研究以充分了解其疗效和作用机制的必要性。随着我们对NAc及其通过DBS调节作用的理解不断发展，我们有效治疗饮食失调的能力也将不断提高。本综述提供了令人信服的证据，表明NAc-DBS有作为饮食失调治疗方法的潜力，然而，需要更多研究来阐明其功能及其通过DBS调节的效果。
