Deep brain stimulation of the nucleus accumbens for the management of eating disorders: A scoping review.

INTRODUCTION

Eating disorders are disabling, deadly, and costly diseases that considerably impair physical health and disrupt psychosocial functioning. The nucleus accumbens, with its involvement in hedonic feeling, satiety signaling, and reward-based learning, has garnered attention as a potential target to understand the pathophysiology of eating disorders. Despite the advancement in conservative therapeutic strategies, treatment-resistant cases remain a significant concern, highlighting the need for novel approaches. This scoping review aims to explore the emerging role of deep brain stimulation (DBS) targeting the nucleus accumbens (NAc) as a potential intervention for eating disorders, shedding light on its therapeutic efficacy in this context.

METHODS

The completed review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). It was justified to systematically summarize primary research as there is no relevant summary describing the deep brain stimulation of the nucleus accumbens to treat eating disorders. A comprehensive search was conducted in PubMed and Embase databases, from which eight studies were obtained. The review included research articles that involved patients suffering from eating disorders (mainly anorexia nervosa, binge eating disorder, obesity and loss of control over food consumption) treated with NAc-DBS, with a total of n = 71.

RESULTS

Over a 12-month follow-up period, the results from the studies reviewed showed a consistent increase in body mass index over time as well as significant improvements in quality of life, cognitive performance, and affective symptoms. However, the results also highlight the complexity and challenges associated with this approach, including the heterogeneity in patients, parameters and outcomes, the need for individualized patient approaches, and the lack of large randomized high-quality studies.

CONCLUSIONS

While NAc-DBS represents a significant advancement in neuromodulation for eating disorders, offering new avenues for personalized and effective interventions, it is still in its experimental stages. The findings of this review underscore the need for further research to fully understand its efficacy and mechanisms of action. As our understanding of the NAc and the effects of its modulation through DBS continues to evolve, so too will our ability to effectively treat eating disorders. This review presents compelling evidence that NAc-DBS has potential as a treatment for eating disorders, however, more research is needed to elucidate its functions and the effects of its modulation through DBS.