ABSTRACT

As current psychosocial and pharmacological interventions show limited efficacy in the treatment of anorexia nervosa (AN), interest in the potential value of neurosurgical intervention and neuromodulation in managing severe and enduring illness has grown. We conducted a systematic review of 20 trials of neurosurgical and neuromodulatory treatments for AN, including neurosurgical ablation, deep brain stimulation (DBS), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS). Overall, there is evidence to support the role of stereotactic ablation and DBS in the treatment of AN. In contrast, results for rTMS and tDCS have been modest and generally more mixed. Neurosurgical treatment may offer important new avenues for the treatment of AN. Additional randomized clinical trials with comparable patient populations will be needed, in which change in affective, cognitive, and perceptual symptom phenomena, and interrogation of targeted circuits, pre- and post-intervention, are carefully documented.

摘要

由于目前的社会心理和药物干预在治疗神经性厌食症 (AN) 方面的疗效有限，因此人们对神经外科干预和神经调节在管理严重和持久疾病方面的潜在价值的兴趣与日俱增。我们对 AN 的 20 项神经外科和神经调节治疗试验进行了系统评价，包括神经外科消融、深部脑刺激 (DBS)、重复经颅磁刺激 (rTMS) 和经颅直流电刺激 (tDCS)。总体而言，有证据支持立体定向消融和 DBS 在 AN 治疗中的作用。相比之下，rTMS 和 tDCS 的结果是适度的，而且通常更加复杂。神经外科治疗可能为治疗 AN 提供重要的新途径。