Treatment of intractable anorexia nervosa with inactivation of the nucleus accumbens using stereotactic surgery.

ABSTRACT

BACKGROUND: For 30% of anorexia nervosa (AN) patients, conventional treatments are unsuccessful; this is termed intractable AN. OBJECTIVES: This study investigates whether ablation of the nucleus accumbens (NAc) using stereotactic surgery can arouse the physiological drive to eat in intractable AN patients. METHODS: Eight patients with intractable AN were included 6 patients underwent bilateral stereotactic radio frequency ablation in the NAc and 2 patients received bilateral NAc deep brain stimulation (DBS). Observations were made for basic vital signs, body mass index (BMI), menstruation, depression, anxiety, obsessive-compulsive disorder, personality, intelligence, memory, quality of life, social functioning, as well as complications and adverse events associated with the treatment. RESULTS: Basic vital signs, BMI and menstruation had recovered 1 year after the operation. Depression, anxiety and obsessive-compulsive disorder were improved 1 year postoperatively. There were changes in personality scores for psychoticism, neuroticism and lie tendencies that seemed to be helpful to the recovery from AN. Intelligence and memory improved after 6 months postoperatively. Quality of life and social functioning were dramatically improved at 1 year postoperatively. CONCLUSIONS: The results of this study reveal that ablation of the NAc can increase the AN patients' physiological drive to eat. Furthermore, there were no severe and/or life-influencing complications associated with the treatment.