Efficacy of deep brain stimulation for the treatment of anorexia nervosa: a systematic review and network meta-analysis of patient-level data.

Autor:	Shaffer A; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana; and., Naik A; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana; and., Bederson M; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana; and., Arnold PM; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana; and.; 2Department of Neurosurgery, Carle Foundation Hospital, Urbana, Illinois., Hassaneen W; 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana; and.; 2Department of Neurosurgery, Carle Foundation Hospital, Urbana, Illinois.
Jazyk:	angličtina
Zdroj:	Neurosurgical focus [Neurosurg Focus] 2023 Feb; Vol. 54 (2), pp. E5.
DOI:	10.3171/2022.11.FOCUS22616
Abstrakt:	Objective: Deep brain stimulation (DBS) has been approved as a therapy for movement disorders and obsessive-compulsive disorder. Recently, DBS has been studied in patients with anorexia nervosa (AN), which is a debilitating and life-threatening psychiatric disorder. Several stimulation locations have been tested without a clear indication of the best region. In this systematic review and network meta-analysis, the authors used patient-level data to identify stimulation targets with the greatest evidence for efficacy in increasing body mass index (BMI). Methods: A systematic search was performed on or before August 4, 2022, using PubMed/MEDLINE, Ovid, and Scopus. Articles were included if patient-level data were presented, patients were diagnosed with AN and treated with DBS, and 6 months or more of postoperative follow-up data were reported. Quality and risk of bias were assessed with the NIH assessment tools. Patient data were collected and stratified by stimulation location. A network meta-analysis was performed. This review was written in accordance with PRISMA guidelines for systematic reviews. Results: Eleven studies consisting of 36 patients were included. The mean age and BMI at the time of surgery were 38.07 (SD 11.64) years and 12.58 (SD 1.4) kg/m2, respectively. After 6 months of DBS, a significant difference in percentage change in BMI was found between the nucleus accumbens and subcallosal cingulate cortex (SCC) (SMD 0.78; 95% CI 0.10, 1.45) and between the SCC and ventral anterior limb of the internal capsule (SMD -1.51; 95% CI -2.39, -0.62). Similarly, at 9-12 months, a significant difference in percentage change in BMI was found between the SCC and ventral anterior limb of the internal capsule (SMD -1.18; 95% CI -2.21, -0.15). With hierarchical ranking, this study identified SCC as the most supported stimulation location for BMI change at 6 and 9-12 months (P-scores 0.9449 and 0.9771, respectively). Conclusions: Several DBS targets have been tested for AN, and this study identified the SCC as the most supported region for BMI change. However, further studies with blinded on/off periods are necessary to confirm this finding.
Databáze:	MEDLINE
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