77 Efficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysis performed such a meta-analysis, combining all available evidence from treatment trials. Based on previous case reports, we hypothesized a beneficial effect of DBS on weight restoration, quality of life, and reduction of psychiatric symptoms in AN patients. Results of this meta-analysis may justify further clinical application in future and more extensive naturalistic research. METHODS AND MATERIALS Following PRISMA guidelines (21), the systematic review and meta-analysis protocol was registered in PROSPERO (22). Search strategy A literature search was performed on MEDLINE, Embase, and PsycInfo, in the period between the last week of August 2020 and up to the 1st of November 2021 (Appendix 1). Publication date was not a restriction. Selection process Two independent reviewers (DMK, PC) screened titles and abstracts of found studies. We included clinical studies investigating the effects of DBS in patients with AN. Duplicates, case reports, and reviews were excluded. Articles were excluded if they did not cover AN and/or DBS, were based on animals, or contained <four participants. We did not exclude studies based on the availability of a control group, studies comparing outcomes before and after DBS will also be included. Inconsistencies were solved by means of discussion, if necessary, with a third and fourth reviewer (MSO, RJTM). Appendix 2 shows a list of studies that were excluded at the full-text screening stage. Critical appraisal and quality assessment Critical appraisal of all included studies was performed independently in duplicate (DK, PC) by using the ROBINS-I tool (Risk Of Bias In Non-randomised Studies—of Interventions) (23). Furthermore, we used GRADE (24) for assessing the overall quality of evidence. Inconsistencies were solved by means of discussion. Data extraction and outcome data The extracted data consisted of the following study characteristics: number of participants, number of time points, participants’ characteristics, study duration, and study outcome data. BMI change after DBS was considered our primary outcome. One study used the mean BMI achieved either in the year or in the 3-month prior to surgery, chosen depending on the characteristics of every patient (25). The combined effect on psychiatric symptoms at the last observation was considered our secondary outcome. In this meta-analysis no other eating disorder related symptoms than BMI could be used as primary outcome data, because of inconsistencies
RkJQdWJsaXNoZXIy MjY0ODMw