87 Efficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysis An international database, including up-to-date naturalistic data from all AN-patients that are treated with DBS worldwide, may substantially increase power to test for subgroup effects. Clinical implications It is striking to note that deep brain stimulation, being effective in several psychiatric disorders, is relatively understudied in anorexia nervosa, being the world’s most lethal psychiatric disorder. However, it needs to be noted that, as of yet, both the mechanism of action of DBS and the pathophysiology of AN are not fully understood. To be able to understand and treat AN, more insight is needed in the complex dynamics in which this psychiatric disorder comes to expression. Using DBS targeting different brain areas gets us closer to this understanding or even finding the root of this complex disorder. Of note, other forms of neuromodulation (i.e. electro-convulsive therapy) also show promising results in anorexia nervosa, particularly on symptoms of depression (47). Our results suggest that DBS can be an effective last-resort treatment option in severe treatment-refractory AN. Despite the invasive nature of the procedure and the risk of side-effects, we suggest that there is a clinical indication for DBS in selected cases of AN, under strict monitoring and scientific evaluation of effects. Target selection should be based on the available experience of the involved neurosurgeon and psychiatric treatment team. After DBS, the potential effect of concomitant psychological and/or pharmacological therapy should be re-evaluated. CONCLUSION This meta-analysis demonstrated a statistically large beneficial effect of DBS on weight restoration, quality of life, and psychiatric symptoms severity in patients with treatment-refractory AN. Adverse effects were related to surgery and stimulation. The size of the beneficial effects suggest potential clinical relevance as a last-resort treatment option in severe and life-threatening AN. Future, more extensive, naturalistic research could strengthen conclusions regarding clinical relevance and incorporation in guidelines, also in relation to other forms of neuromodulation. These promising outcomes form new inspiration for future research, and may provide a more hopeful perspective for patients that did not yet respond sufficiently to other forms of therapy. Registration and protocol The systematic review and meta-analysis protocol was preregistered in PROSPERO under study’s registration number: CRD42022295712.
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