Advertisement

Surgical Treatments for Anorexia Nervosa

  • Bomin SunEmail author
  • Dianyou Li
  • Wei Liu
  • Shikun Zhan
  • Yixin Pan
  • Xiaoxiao Zhang
Chapter

Abstract

Anorexia nervosa (AN) is a severe psychiatric disorder with high rates of morbidity and mortality. An estimated 21 % of patients experience a chronic course despite treatment with the best available medications and behavioral therapies. Existing data suggest that lesioning and deep brain stimulation can benefit a large proportion (ranging from 60 to 80 %) of patients with medically intractable AN. Long-term serious adverse events are very infrequent. Functional neuroimaging studies have increased our understanding of the mechanisms of disease development and therapeutic action. At our institution, we grade AN on a four-point scale based on patient clinical characteristics and our surgical experience over the past 8 years. This scale is particularly useful for guiding the selection of surgical procedures. Such treatment options include deep brain stimulation or lesioning of the nucleus accumbens , anterior capsulotomy, and anterior cingulotomy. Data suggest that surgical treatment is a viable option for intractable AN, and can alleviate suffering and improve the quality of life of patients with these disabling disorders.

Keywords

Anorexia nervosa Surgery Deep brain stimulation Capsulotomy Cingulotomy 

Notes

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

References

  1. 1.
    Steiner H, et al. Risk and protective factors for juvenile eating disorders. Eur Child Adolesc Psychiatry. 2003;12(Suppl 1):i38–46.PubMedGoogle Scholar
  2. 2.
    Yager J, Andersen AE. Clinical practice. Anorexia nervosa. N Engl J Med. 2005;353(14):1481–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Keski-Rahkonen A, et al. Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry. 2007;164(8):1259–65.PubMedCrossRefGoogle Scholar
  4. 4.
    Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003;34(4):383–96.PubMedCrossRefGoogle Scholar
  5. 5.
    Berkman ND, Lohr KN, Bulik CM. Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord. 2007;40(4):293–309.PubMedCrossRefGoogle Scholar
  6. 6.
    Forcano L, et al. Suicide attempts in anorexia nervosa subtypes. Compr Psychiatry. 2011;52(4):352–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Norrington A, et al. Medical management of acute severe anorexia nervosa. Arch Dis Child Educ Pract Ed. 2012;97(2):48–54.PubMedCrossRefGoogle Scholar
  8. 8.
    Herpertz-Dahlmann B. Adolescent eating disorders: definitions, symptomatology, epidemiology and comorbidity. Child Adolesc Psychiatr Clin North Am. 2009;18(1):31–47.CrossRefGoogle Scholar
  9. 9.
    Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–93.PubMedCrossRefGoogle Scholar
  10. 10.
    Bulik CM, et al. Alcohol use disorder comorbidity in eating disorders: a multicenter study. J Clin Psychiatry. 2004;65(7):1000–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Strober M, Freeman R, Morrell W. The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord. 1997;22(4):339–60.PubMedCrossRefGoogle Scholar
  12. 12.
    Steinhausen HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002;159(8):1284–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Herzog DB, et al. Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study. J Am Acad Child Adolesc Psychiatry. 1999;38(7):829–37.PubMedCrossRefGoogle Scholar
  14. 14.
    Connan F, et al. A neurodevelopmental model for anorexia nervosa. Physiol Behav. 2003;79(1):13–24.PubMedCrossRefGoogle Scholar
  15. 15.
    Clarke TK, Weiss AR, Berrettini WH. The genetics of anorexia nervosa. Clin Pharmacol Ther. 2012;91(2):181–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Noordenbos G, Seubring A. Criteria for recovery from eating disorders according to patients and therapists. Eat Disord. 2006;14(1):41–54.PubMedCrossRefGoogle Scholar
  17. 17.
    Kaye WH, et al. Neurocircuity of eating disorders. Curr Top Behav Neurosci. 2011;6:37–57.PubMedCrossRefGoogle Scholar
  18. 18.
    Kaye WH, Fudge JL, Paulus M. New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci. 2009;10(8):573–84.PubMedCrossRefGoogle Scholar
  19. 19.
    Frank GK, et al. Increased dopamine D2/D3 receptor binding after recovery from anorexia nervosa measured by Positron emission tomography and [11C] raclopride. Biol Psychiatry. 2005;58(11):908–12.PubMedCrossRefGoogle Scholar
  20. 20.
    Kaye WH, et al. Nothing tastes as good as skinny feels: the neurobiology of anorexia nervosa. Trends Neurosci. 2013;36(2):110–20.PubMedCrossRefGoogle Scholar
  21. 21.
    Friederich HC, et al. Neurocircuit function in eating disorders. Int J Eat Disord. 2013;46(5):425–32.PubMedCrossRefGoogle Scholar
  22. 22.
    Kaye WH, et al. Abnormalities in CNS monoamine metabolism in anorexia nervosa. Arch Gen Psychiatry. 1984;41(4):350–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Bergen AW, et al. Association of multiple DRD2 polymorphisms with anorexia nervosa. Neuropsychopharmacology. 2005;30(9):1703–10.PubMedCrossRefGoogle Scholar
  24. 24.
    Friederich HC, et al. Differential motivational responses to food and pleasurable cues in anorexia and bulimia nervosa: a startle reflex paradigm. Psychol Med. 2006;36(9):1327–35.PubMedCrossRefGoogle Scholar
  25. 25.
    Halford JC, Cooper GD, Dovey TM. The pharmacology of human appetite expression. Curr Drug Targets. 2004;5(3):221–40.PubMedCrossRefGoogle Scholar
  26. 26.
    Nunn K, et al. The fault is not in her parents but in her insula–a neurobiological hypothesis of anorexia nervosa. Eur Eat Disord Rev. 2008;16(5):355–60.PubMedCrossRefGoogle Scholar
  27. 27.
    Phillips ML, et al. Neurobiology of emotion perception II: Implications for major psychiatric disorders. Biol Psychiatry. 2003;54(5):515–28.PubMedCrossRefGoogle Scholar
  28. 28.
    Phillips ML, et al. Neurobiology of emotion perception I: the neural basis of normal emotion perception. Biol Psychiatry. 2003;54(5):504–14.PubMedCrossRefGoogle Scholar
  29. 29.
    Shin LM, Liberzon I. The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology. 2010;35(1):169–91.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Giel KE, et al. Attentional processing of food pictures in individuals with anorexia nervosa–an eye-tracking study. Biol Psychiatry. 2011;69(7):661–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Zhang H-W, et al. Metabolic imaging of deep brain stimulation in anorexia nervosa: a 18F-FDG PET/CT study. Clin Nucl Med. 2013;38(12):943–8.PubMedGoogle Scholar
  32. 32.
    Lipsman N, et al. Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial. Lancet. 2013;381(9875):1361–70.PubMedCrossRefGoogle Scholar
  33. 33.
    Frank GK. Altered brain reward circuits in eating disorders: chicken or egg? Curr Psychiatry Rep. 2013;15(10):396.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Focker M, Knoll S, Hebebrand J. Anorexia nervosa. Eur Child Adolesc Psychiatry. 2013;22:S29–35.PubMedCrossRefGoogle Scholar
  35. 35.
    Guarda AS. Treatment of anorexia nervosa: insights and obstacles. Physiol Behav. 2008;94(1):113–20.PubMedCrossRefGoogle Scholar
  36. 36.
    Wade TD, Treasure J, Schmidt U. A case series evaluation of the Maudsley model for treatment of adults with anorexia nervosa. Eur Eat Disord Rev. 2011;19(5):382–9.PubMedGoogle Scholar
  37. 37.
    Bulik CM, et al. Anorexia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007;40(4):310–20.PubMedCrossRefGoogle Scholar
  38. 38.
    Brewerton TD. Antipsychotic agents in the treatment of anorexia nervosa: neuropsychopharmacologic rationale and evidence from controlled trials. Curr Psychiatry Rep. 2012;14(4):398–405.PubMedCrossRefGoogle Scholar
  39. 39.
    McKnight RF, Park RJ. Atypical antipsychotics and anorexia nervosa: a review. Eur Eat Disord Rev. 2010;18(1):10–21.PubMedCrossRefGoogle Scholar
  40. 40.
    Wilson GT, Shafran R. Eating disorders guidelines from NICE. Lancet. 2005;365(9453):79–81.PubMedCrossRefGoogle Scholar
  41. 41.
    Couturier J, Lock J. What is recovery in adolescent anorexia nervosa? Int J Eat Disord. 2006;39(7):550–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Drury MO. An emergency leucotomy. Br Med J. 1950;2(4679):609.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Crisp AH, Kalucy RS. The effect of leucotomy in intractable adolescent weight phobia (primary anorexia nervosa). Postgrad Med J. 1973;49(578):883–93.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Morgan JF, Crisp AH. Use of leucotomy for intractable anorexia nervosa: a long-term follow-up study. Int J Eat Disord. 2000;27(3):249–58.PubMedCrossRefGoogle Scholar
  45. 45.
    Birley JL. Modified frontal leucotomy: a review of 106 cases. Br J Psychiatry. 1964;110:211–21.PubMedCrossRefGoogle Scholar
  46. 46.
    Carmody JT, Vibber FL. Anorexia nervosa treated by prefrontal lobotomy. Ann Intern Med. 1952;36(2:2):647–52.PubMedGoogle Scholar
  47. 47.
    Kay DW. Anorexia nervosa: a study in prognosis. Proc R Soc Med. 1953;46(8):669–74.PubMedCentralPubMedGoogle Scholar
  48. 48.
    Sargant W. Leucotomy in psychosomatic disorders. Lancet. 1951;2(6673):87–91.PubMedCrossRefGoogle Scholar
  49. 49.
    Sifneos PE. A case of anorexia nervosa treated successfully by leucotomy. Am J Psychiatry. 1952;109(5):356–60.PubMedGoogle Scholar
  50. 50.
    Zamboni R, et al. Dorsomedial thalamotomy as a treatment for terminal anorexia: a report of 2 cases. Acta Neurochirurgica. 1993;34–35.Google Scholar
  51. 51.
    Kelly D, Mitchell-Heggs N. Stereotactic limbic leucotomy—a follow-up study of thirty patients. Postgrad Med J. 1973;49(578):865–82.PubMedCentralPubMedCrossRefGoogle Scholar
  52. 52.
    Mitchell-Heggs N, Kelly D, Richardson A. Stereotactic limbic leucotomy–a follow-up at 16 months. Br J Psychiatry. 1976;128:226–40.PubMedCrossRefGoogle Scholar
  53. 53.
    Barbier J, et al. Successful anterior capsulotomy in comorbid anorexia nervosa and obsessive-compulsive disorder: case report. Neurosurgery. 2011;69(3):E745–51; discussion E751.Google Scholar
  54. 54.
    Bomin S, Li D, Zhan S (2007) DBS for anorexia nervosa. The eighth world congress of International Neuromodulation Society. Acapulco, Mexico.Google Scholar
  55. 55.
    Wu H, et al. Deep-brain stimulation for anorexia nervosa. World Neurosurg. 2012;80(3-4):S29 e1–10.Google Scholar
  56. 56.
    Deuschl G, et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med. 2006;355(9):896–908.PubMedCrossRefGoogle Scholar
  57. 57.
    Mueller J, et al. Pallidal deep brain stimulation improves quality of life in segmental and generalized dystonia: results from a prospective, randomized sham-controlled trial. Mov Disord. 2008;23(1):131–4.PubMedCrossRefGoogle Scholar
  58. 58.
    O’Sullivan D, Pell M. Long-term follow-up of DBS of thalamus for tremor and STN for Parkinson’s disease. Brain Res Bull. 2009;78(2–3):119–21.PubMedCrossRefGoogle Scholar
  59. 59.
    Goodman WK, Alterman RL. Deep brain stimulation for intractable psychiatric disorders. Annu Rev Med. 2011;63:511–24.PubMedCrossRefGoogle Scholar
  60. 60.
    Wang J, et al. Treatment of intractable anorexia nervosa with inactivation of the nucleus accumbens using stereotactic surgery. Stereotact Funct Neurosurg. 2013;91(6):364–72.PubMedCrossRefGoogle Scholar
  61. 61.
    Zhan S, et al. Long-term follow-up of bilateral anterior capsulotomy in patients with refractory obsessive-compulsive disorder. Clin Neurol Neurosurg. 2014;119:91–5.PubMedCrossRefGoogle Scholar
  62. 62.
    Zuo C, et al. Metabolic imaging of bilateral anterior capsulotomy in refractory obsessive compulsive disorder: an FDG PET study. J Cereb Blood Flow Metab. 2013;33(6):880–7.PubMedCentralPubMedCrossRefGoogle Scholar
  63. 63.
    Christmas D, et al. Long term outcome of thermal anterior capsulotomy for chronic, treatment refractory depression. J Neurol Neurosurg Psychiatry. 2011;82(6):594–600.PubMedCrossRefGoogle Scholar
  64. 64.
    Hurwitz TA, et al. Bilateral anterior capsulotomy for intractable depression. J Neuropsychiatry Clin Neurosci. 2012;24(2):176–82.PubMedCrossRefGoogle Scholar
  65. 65.
    Cosgrove GR, Rauch SL. Stereotactic cingulotomy. Neurosurg Clin N Am. 2003;14(2):225–35.PubMedCrossRefGoogle Scholar
  66. 66.
    Dougherty DD, et al. Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessive-compulsive disorder. Am J Psychiatry. 2002;159(2):269–75.PubMedCrossRefGoogle Scholar
  67. 67.
    Baer L, et al. Cingulotomy for intractable obsessive-compulsive disorder. Prospective long-term follow-up of 18 patients. Arch Gen Psychiatry. 1995;52(5):384–92.PubMedCrossRefGoogle Scholar
  68. 68.
    van der Plasse G, et al. Deep brain stimulation reveals a dissociation of consummatory and motivated behaviour in the medial and lateral nucleus accumbens shell of the rat. PLoS One. 2012;7(3):e33455.PubMedCentralPubMedCrossRefGoogle Scholar
  69. 69.
    Bhatia S, et al. Surgical complications of deep brain stimulation. Stereotact Funct Neurosurg. 2008;86(6):367–72.PubMedCrossRefGoogle Scholar

Copyright information

© Shanghai Jiao Tong University Press, Shanghai and Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Bomin Sun
    • 1
    Email author
  • Dianyou Li
    • 1
  • Wei Liu
    • 1
  • Shikun Zhan
    • 1
  • Yixin Pan
    • 1
  • Xiaoxiao Zhang
    • 1
  1. 1.Department of Stereotactic and Functional NeurosurgeryRuijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina

Personalised recommendations