Study Protocol: Using Deep-Brain Stimulation, Multimodal Neuroimaging and Neuroethics to Understand and Treat Severe Enduring Anorexia Nervosa.
Study Protocol: Using Deep-Brain Stimulation, Multimodal Neuroimaging and Neuroethics to Understand and Treat Severe Enduring Anorexia Nervosa.
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DOI：
10.3389/fpsyt.2018.00024
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发表时间：
2018
影响因子：
4.7
通讯作者：
Aziz TZ
中科院分区：
文献类型：
--
作者：
Park RJ;Scaife JC;Aziz TZ
研究表明，神经性厌食症（AN）患者改变饮食习惯和追求苗条，部分原因是奖励回路异常。参与奖励处理和强迫性的神经回路明显重叠，这被认为是强迫症、成瘾和饮食失调的一个跨诊断因素。杏仁核（NAcc）是奖励处理和强迫性的核心。在以前的研究中，对NAcc进行脑深部刺激（DBS）已被证明可以改善强迫症和成瘾的神经和症状。此外，在大鼠中，DBS到NAcc内侧壳增加了食物摄入。我们假设这种治疗可能对严重和持久的神经性厌食症（SE-AN）有益，但首先，需要建立可行性和伦理标准。本研究的目的如下：（1）提供DBS至NAcc作为SE-AN治疗的可行性和初步疗效数据;（2）评估任何后续神经变化;（3）制定神经伦理学金标准以指导该治疗的应用。这是对SE-AN>7年的6名个体的纵向研究。它包括一个综合的神经伦理子研究。DBS将应用于NAcc，我们将使用脑磁电描记术，神经心理学和行为学措施来跟踪AN的基础机制。在DBS系统插入前后，将对每名深入研究的患者采取一系列措施。这将允许阐明15个月期间症状变化所涉及的过程，其中包括刺激器开/关的双盲交叉阶段。由于高发病率和死亡率成本，SE-AN迫切需要新的经验性治疗。如果可行和有效，DBS到NAcc可能会改变这种情况的管理。神经伦理学的黄金标准对于最佳地支持这种治疗开发至关重要。本研究正在进行中，并于2013年7月22日注册。它已获得完全的道德和HRA批准（项目ID 128658）。
Research suggests that altered eating and the pursuit of thinness in anorexia nervosa (AN) are, in part, a consequence of aberrant reward circuitry. The neural circuits involved in reward processing and compulsivity overlap significantly, and this has been suggested as a transdiagnostic factor underpinning obsessive compulsive disorder, addictions and eating disorders. The nucleus accumbens (NAcc) is central to both reward processing and compulsivity. In previous studies, deep-brain stimulation (DBS) to the NAcc has been shown to result in neural and symptomatic improvement in both obsessive compulsive disorder and addictions. Moreover, in rats, DBS to the NAcc medial shell increases food intake. We hypothesise that this treatment may be of benefit in severe and enduring anorexia nervosa (SE-AN), but first, feasibility and ethical standards need to be established. The aims of this study are as follows: (1) to provide feasibility and preliminary efficacy data on DBS to the NAcc as a treatment for SE-AN; (2) to assess any subsequent neural changes and (3) to develop a neuroethical gold standard to guide applications of this treatment. This is a longitudinal study of six individuals with SE-AN of >7 years. It includes an integrated neuroethical sub-study. DBS will be applied to the NAcc and we will track the mechanisms underpinning AN using magnetoelectroencephalography, neuropsychological and behavioural measures. Serial measures will be taken on each intensively studied patient, pre- and post-DBS system insertion. This will allow elucidation of the processes involved in symptomatic change over a 15-month period, which includes a double-blind crossover phase of stimulator on/off. Novel, empirical treatments for SE-AN are urgently required due to high morbidity and mortality costs. If feasible and effective, DBS to the NAcc could be game-changing in the management of this condition. A neuroethical gold standard is crucial to optimally underpin such treatment development. The study is ongoing and registered with , , 22 July, 2013. It has full ethical and HRA approval (Project ID 128658).
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