47 Deep Brain Stimulation of the Ventral Anterior Limb of the Capsula Interna in Patients with Chronic Treatment-Refractory Anorexia Nervosa M.S. Oudijn, MD; R.J.T. Mocking, MD PhD; R.R. Wijnker, MD; A. Lok, MD PhD; P.R. Schuurman, MD PhD; P. van den Munckhof, MD PhD, A.A. van Elburg, MD PhD; D.A.P.J. Denys, MD PhD (full manuscript) ABSTRACT Background Pilot studies showed mixed but promising effects of deep brain stimulation (DBS) as a last-resort treatment option for life-threatening treatment-refractory anorexia nervosa (AN). The ventral anterior limb of the capsula interna (vALIC) is an effective DBS target in related psychiatric disorders. This is the first DBS study targeting the vALIC in AN. Objective To investigate the efficacy, feasibility and safety of vALIC DBS in chronic, treatment-refractory AN. Methods Four female patients with AN received DBS of the vALIC between November 2016 and June 2020. Primary effectiveness was assessed using physical (Body Mass Index, BMI), psychological (Yale-Brown-Cornell Eating Disorder Scale, YBC-EDS), Eating Disorder Quality of Life (ED-QOL) and safety outcomes up to 22-months follow-up. Results Following stimulation, average BMI increased 5.32 kg/m2 (+42.8%, P=.017), with two patients achieving a normal BMI. The YBC-EDS improved 23.9% (P=.024), and the ED-QOL improved 50% on physical health (P=.005). The Hamilton Rating Scale for Depression (HAM-D) improved 37% and the Hamilton Anxiety Rating Scale (HAM-A) nearly 50%. Overall, the procedure was relatively well tolerated. Side effects were on average mild, but adverse events possibly related to the intervention were (hypo) mania, impulsiveness, self-destructive behavior, migraine, seizures, and pain at battery site. Conclusion This first study of vALIC DBS in AN supports its effectiveness and feasibility as a last-resort treatment in chronic, treatment-refractory patients. Although the procedure was well tolerated and relatively safe, the severely compromised somatic and psychiatric condition of the patients made the study challenging, also touching on several ethical dilemmas.
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