Skip to main content
SpringerLink
Log in

Changes in eating behavior after deep brain stimulation for anorexia nervosa. A case study

  • Case Report
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate changes in the nutritional status, body image concerns, and eating behaviors occurring in a patient who underwent deep brain stimulation (DBS) of the bed nucleus of the stria terminalis for treatment-refractory anorexia nervosa (AN).

Methods

Bilateral DBS of the bed nucleus of the stria terminalis was performed in a 37-year-old woman affected by refractory AN. Pre- and post-surgical evaluations were conducted via an array of validated testing instruments, which took into account the weight variations, body image concerns, eating behavior, quality of life, and nutritional status.

Results

Overall, eating behavior-, body image concern-, and nutritional status-related testing instruments demonstrated improvements starting from the first post-operative month. Normal body weight was restored after 4 months of stimulation.

Discussion

Only a few cases of DBS for AN have been conducted to determine the efficacy of surgery based upon weight variation and psychometric scales for anxiety and affective disorders. In contrast, we have designed a comprehensive approach taking into account the most important aspects of this disease. This approach should be considered in future studies dealing with the neurosurgical treatment of AN.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Graat I, Figee M, Denys D (2017) The application of deep brain stimulation in the treatment of psychiatric disorders. Int Rev Psychiatry 29:178–190. https://doi.org/10.1080/09540261.2017.1282439

    Article  PubMed  Google Scholar 

  2. Israël M, Steiger H, Kolivakis T et al (2010) Deep brain stimulation in the subgenual cingulate cortex for an intractable eating disorder. Biol Psychiatry 67(9):e53–e54. https://doi.org/10.1016/j.biopsych.2009.11.016

    Article  PubMed  Google Scholar 

  3. Blomstedt P, Naesström M, Bodlund O (2017) Deep brain stimulation in the bed nucleus of the stria terminalis and medial forebrain bundle in a patient with major depressive disorder and anorexia nervosa. Clin Case Rep 5(5):679–684. https://doi.org/10.1002/ccr3.856

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wu H, Van Dyck-Lippens PJ, Santegoeds R et al (2013) Deep-brain stimulation for anorexia nervosa. World Neurosurg 80(3–4): S29-e1–S29-e10. https://doi.org/10.1016/j.wneu.2012.06.039

    Article  Google Scholar 

  5. Lipsman N, Lam E, Volpini M et al (2017) Deep brain stimulation of the subcallosal cingulate for treatment-refractory anorexia nervosa: 1 year follow-up of an open-label trial. Lancet Psychiatry 4(4):285–294. https://doi.org/10.1016/S2215-0366(17)30076-7

    Article  PubMed  Google Scholar 

  6. Winter L, Heitland I, Saryyeva A et al (2018) Acute effects of electrical stimulation of the bed nucleus of the stria terminalis/internal capsule in obsessive-compulsive disorder. World Neurosurg 111:e471–e477. https://doi.org/10.1016/j.wneu.2017.12.084

    Article  PubMed  Google Scholar 

  7. Park RJ, Singh I, Pike AC, Tan JOA (2017) Deep brain stimulation in anorexia nervosa: hope for the hopeless or exploitation of the vulnerable? The Oxford neuroethics gold standard framework. Front Psychiatry 8:44. https://doi.org/10.3389/fpsyt.2017.00044

    Article  Google Scholar 

  8. Manuelli M, Blundell JE, Biino G, Cena H (2018) Body composition and resting energy expenditure in women with anorexia nervosa: is hyperactivity a protecting factor? Clin Nutr ESPEN 29:160–164. https://doi.org/10.1016/j.clnesp.2018.10.015

    Article  PubMed  Google Scholar 

  9. Federico F, Benedetta D, Claudia M et al (2017) A disconnection between nutritional status (in terms of body mass index and phase angle) and psychopathology in anorexia nervosa. Psychiatry Res 252:196–200. https://doi.org/10.1016/j.psychres.2017.02.043

    Article  Google Scholar 

  10. Lipsman N, Woodside DB, Giacobbe P et al (2013) Subcallosal cingulate deep brain stimulation for treatment—refractory anorexia nervosa: a phase 1 pilot trial. Lancet 381(9875):1361–1370. https://doi.org/10.1016/S0140-6736(12)62188-6

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Moosa S., MD, for the language editing of the manuscript.

Funding

No funding was received for this study.

Author information

Author notes

  1. Matteo Manuelli and Andrea Franzini contributed equally to this work.

Authors and Affiliations

  1. Dietetics and Clinical Nutrition Laboratory, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy

    Matteo Manuelli & Hellas Cena

  2. IRCCS Orthopedic Institute Galeazzi, Tourette’s Syndrome and Movement Disorders Centre, Milan, Italy

    Andrea Franzini, Roberta Galentino, Roberta Bidone, Mauro Porta & Domenico Servello

  3. Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA

    Andrea Franzini

  4. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Bernardo Dell’Osso

  5. Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA

    Bernardo Dell’Osso

  6. CRC “Aldo Ravelli” for Neuro-technology and Experimental Brain Therapeutics, University of Milan, Milan, Italy

    Bernardo Dell’Osso

  7. Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, University of Pavia, Pavia, Italy

    Hellas Cena

Authors
  1. Matteo Manuelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Franzini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberta Galentino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roberta Bidone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernardo Dell’Osso
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mauro Porta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Domenico Servello
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hellas Cena
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matteo Manuelli.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest (financial or non-financial).

Ethical approval

All procedures were performed in accordance with ethical standards of the relevant institutional commitee and with the 1964 Helsinki declaration and its later amendements.

Informed consent

Informed consent for publishing was obtained from the patient.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Manuelli, M., Franzini, A., Galentino, R. et al. Changes in eating behavior after deep brain stimulation for anorexia nervosa. A case study. Eat Weight Disord 25, 1481–1486 (2020). https://doi.org/10.1007/s40519-019-00742-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-019-00742-4

Keywords

Search

Navigation