Structural connectivity modifications following deep brain stimulation of the subcallosal cingulate and nucleus accumbens in severe anorexia nervosa

• Published in: Acta neurochirurgica Vol. 166; no. 1; p. 364
• Main Authors: Abellaneda-Pérez, Kilian, Delgado-Martínez, Ignacio, Salgado, Purificación, Ginés, José María, Guardiola, Rocío, Vaqué-Alcázar, Lídia, Roca-Ventura, Alba, Molist-Puigdomènech, Roger, Manero, Rosa María, Viles-Garcia, Marc, Medrano-Martorell, Santiago, Bartrés-Faz, David, Pascual-Leone, Alvaro, Pérez-Solà, Víctor, Villalba-Martínez, Gloria
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 12-09-2024; Springer Nature B.V
• Subjects: Adolescent; Adult; Anorexia; Anorexia Nervosa - diagnostic imaging; Anorexia Nervosa - therapy; Comorbidity; Deep brain stimulation; Deep Brain Stimulation - methods; Diffusion Tensor Imaging - methods; Eating disorders; Female; Gyrus Cinguli - diagnostic imaging; Humans; Interventional Radiology; Magnetic resonance imaging; Male; Medicine; Medicine & Public Health; Mental disorders; Minimally Invasive Surgery; Neural networks; Neural Pathways - diagnostic imaging; Neural Pathways - physiopathology; Neuroimaging; Neurology; Neuroradiology; Neurosurgery; Neurosurgery general; Nucleus accumbens; Nucleus Accumbens - diagnostic imaging; Original Article; Substantia alba; Surgical Orthopedics; Thalamus; White Matter - diagnostic imaging; White Matter - pathology; Young Adult; Nucleus accumbens; Psychosurgery; Anorexia nervosa; Deep brain stimulation; Structural connectivity; Subcallosal cingulate
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-024-06258-w

Purpose
Anorexia nervosa (AN) is a mental health disorder characterized by significant weight loss and associated medical and psychological comorbidities. Conventional treatments for severe AN have shown limited effectiveness, leading to the exploration of novel interventional strategies, including deep brain stimulation (DBS). However, the neural mechanisms driving DBS interventions, particularly in psychiatric conditions, remain uncertain. This study aims to address this knowledge gap by examining changes in structural connectivity in patients with severe AN before and after DBS.
Methods
Sixteen participants, including eight patients with AN and eight controls, underwent baseline T1-weigthed and diffusion tensor imaging (DTI) acquisitions. Patients received DBS targeting either the subcallosal cingulate (DBS-SCC,
N
 = 4) or the nucleus accumbens (DBS-NAcc,
N
 = 4) based on psychiatric comorbidities and AN subtype. Post-DBS neuroimaging evaluation was conducted in four patients. Data analyses were performed to compare structural connectivity between patients and controls and to assess connectivity changes after DBS intervention.
Results
Baseline findings revealed that structural connectivity is significantly reduced in patients with AN compared to controls, mainly regarding callosal and subcallosal white matter (WM) tracts. Furthermore, pre- vs. post-DBS analyses in AN identified a specific increase after the intervention in two WM tracts: the anterior thalamic radiation and the superior longitudinal fasciculus-parietal bundle.
Conclusions
This study supports that structural connectivity is highly compromised in severe AN. Moreover, this investigation preliminarily reveals that after DBS of the SCC and NAcc in severe AN, there are WM modifications. These microstructural plasticity adaptations may signify a mechanistic underpinning of DBS in this psychiatric disorder.