BACKGROUND Given that anorexia nervosa (AN) is a life-threatening mental disorder and has poor clinical outcomes, novel effective treatments are warranted, especially for severe and persistent cases. OBJECTIVE To investigate the safety, feasibility, and clinical outcomes of using deep brain stimulation (DBS) of the nucleus accumbens (NAcc) in treatment-refractory AN patients. METHODS A total of 28 women with refractory AN underwent NAcc-DBS and completed this 2-year follow-up study. The clinical outcomes, including body mass index (BMI) and mood, anxiety, and obsessive symptoms, were assessed using a series of psychiatric scales at 6 and 24 months post operation. RESULTS While no fatalities were reported during this study, 1 patient showed device rejection. The most common short-term side effect observed was varying degrees of pain at the incision sites (n = 22), which usually disappeared 3-4 days following the operation. No severe surgical adverse events were observed. Compared to presurgical levels, significant increases in BMI and improvement in psychiatric scale scores were noted during the 6-month follow-up and were maintained at the 2-year review. Finally, a post-hoc analysis revealed that the NAcc-DBS was less effective for weight restoration in patients with the binge-eating/purge subtype of AN than in those with the restricting subtype (R-AN). CONCLUSION Our long-term follow-up study suggests that NAcc-DBS is safe and effective for improving the BMI and psychiatric symptoms of patients with refractory AN. Although NAcc-DBS appears to be more suitable for patients with R-AN, strict inclusion criteria must be applied considering surgery-related complications.

中文翻译：

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伏隔核深部脑刺激治疗难治性神经性厌食症：长期随访研究

背景 鉴于神经性厌食症 (AN) 是一种危及生命的精神障碍并且临床结果不佳，因此需要新的有效治疗方法，特别是对于严重和持续的病例。目的 探讨伏隔核 (NAcc) 深部脑刺激 (DBS) 治疗难治性 AN 患者的安全性、可行性和临床结果。方法 共有 28 名患有难治性 AN 的女性接受了 NAcc-DBS 并完成了这项为期 2 年的随访研究。在术后 6 个月和 24 个月，使用一系列精神病学量表评估临床结果，包括体重指数 (BMI) 和情绪、焦虑和强迫症状。结果 虽然在本研究期间没有报告死亡病例，但 1 名患者出现了设备排斥反应。观察到的最常见的短期副作用是切口部位不同程度的疼痛（n = 22），通常在手术后 3-4 天消失。没有观察到严重的手术不良事件。与术前水平相比，在 6 个月的随访期间观察到 BMI 显着增加和精神病学量表评分改善，并在 2 年回顾时保持不变。最后，事后分析显示，与限制性亚型 (R-AN) 相比，NAcc-DBS 对 AN 暴食/清除亚型患者的体重恢复效果较差。结论 我们的长期随访研究表明，NAcc-DBS 可安全有效地改善难治性 AN 患者的 BMI 和精神症状。尽管 NAcc-DBS 似乎更适合 R-AN 患者，