Efficacy of Deep Brain Stimulation for the Treatment of Anorexia Nervosa: A Systematic Review and Network Meta-analysis of Patient-level Data

Introduction: Deep brain stimulation (DBS) has been approved as a therapy for movement disorders and obsessive-compulsive disorder (OCD). Recently, DBS has been studied in patients with anorexia nervosa (AN), which is a deadly psychiatric disorder. Several stimulation locations have been tested without a clear indication of the best region. In this systematic review and network meta-analysis, we utilize patient-level data to identify stimulation targets with the greatest evidence for efficacy in increasing body mass index (BMI).

Methods: A systematic search was performed on or before 8/4/2022 using PubMed/MEDLINE, Ovid, and Scopus. Articles were included if patient-level data was presented, patients were diagnosed with AN and treated with DBS, and six months or more of postoperative follow-up data was reported. Quality and risk of bias were assessed with the National Institutes of Health assessment tools. Patient data was collected and stratified by stimulation location. A network meta-analysis was performed.

Results: Eleven studies consisting of 36 patients were included. Mean age and BMI at the time of surgery were 38.07 (SD 11.64) years and 12.58 (1.4) kg/m2, respectively. After six months of DBS stimulation, a significant difference in percentage change BMI was found between the Nac and SCC (SMD 0.78; 95% CI [0.10; 1.45]) and between the SCC and VALC (SMD -1.51; 95% CI [-2.39; -0.62]). Similarly, at 9-12 months, a significant difference in percentage change BMI was found between the SCC and VALC (SMD -1.18; 95% CI [-2.21; -0.15). With hierarchical ranking, this study identified SCC as the most supported stimulation location for BMI change at six and 9-12 months (P-Scores 0.9449 and 0.9771, respectively).

Conclusion : Several DBS targets have been tested for AN, and this study identified the SCC as the most supported region for BMI change. However, further studies with blinded on/off periods are necessary to confirm this finding.