Efficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysis
Abstract Background Several pioneering studies investigated deep brain stimulation (DBS) in treatment-refractory anorexia nervosa (AN) patients, but overall effects remain yet unclear. Aim of this study was to obtain estimates of efficacy of DBS in AN-patients using meta-analysis. Methods We searche...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Publishing Group
2022-08-01
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| Series: | Translational Psychiatry |
| Online Access: | https://doi.org/10.1038/s41398-022-02102-w |
| _version_ | 1828434558162305024 |
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| author | Dominika Karaszewska Patrick Cleintuar Marloes Oudijn Anja Lok Annemarie van Elburg Damiaan Denys Roel Mocking |
| author_facet | Dominika Karaszewska Patrick Cleintuar Marloes Oudijn Anja Lok Annemarie van Elburg Damiaan Denys Roel Mocking |
| author_sort | Dominika Karaszewska |
| collection | DOAJ |
| description | Abstract Background Several pioneering studies investigated deep brain stimulation (DBS) in treatment-refractory anorexia nervosa (AN) patients, but overall effects remain yet unclear. Aim of this study was to obtain estimates of efficacy of DBS in AN-patients using meta-analysis. Methods We searched three electronic databases until 1st of November 2021, using terms related to DBS and AN. We included trials that investigated the clinical effects of DBS in AN-patients. We obtained data including psychiatric comorbidities, medication use, DBS target, and study duration. Primary outcome was Body Mass Index (BMI), secondary outcome was quality of life, and the severity of psychiatric symptoms, including eating disorder, obsessive-compulsive, depressive, and anxiety symptoms. We assessed the risk of bias using the ROBINS-I tool. Results Four studies were included for meta-analysis, with a total of 56 patients with treatment-refractory AN. Follow-up ranged from 6–24 months. Random effects meta-analysis showed a significant increase in BMI following DBS, with a large effect size (Hedges’s g = 1 ∙ 13; 95% CI = 0 ∙ 80 to 1 ∙ 46; Z-value = 6 ∙ 75; P < 0 ∙ 001), without heterogeneity (I 2 = 0 ∙ 00, P = 0 ∙ 901). Random effects meta-analysis also showed a significant increase in quality of life (Hedges’s g = 0 ∙ 86; 95% CI = 0 ∙ 44 to 1 ∙ 28; Z-value = 4 ∙ 01, P < 0 ∙ 001). Furthermore, DBS decreased the severity of psychiatric symptoms (Hedges’s g = 0 ∙ 89; 95% CI = 0 ∙ 57 to 1 ∙ 21; Z-value = 5 ∙ 47; P < 0 ∙ 001, I 2 = 4 ∙ 29, P = 0 ∙ 371). Discussion In this first meta-analysis, DBS showed statistically large beneficial effects on weight restoration, quality of life, and reduction of psychiatric symptoms in patients with treatment-refractory AN. These outcomes call for more extensive naturalistic studies to determine the clinical relevance for functional recovery. This study is preregistered in PROSPERO,CRD42022295712. |
| first_indexed | 2024-12-10T18:52:54Z |
| format | Article |
| id | doaj.art-c049ca1fec5344fab5423595768f9892 |
| institution | Directory Open Access Journal |
| issn | 2158-3188 |
| language | English |
| last_indexed | 2024-12-10T18:52:54Z |
| publishDate | 2022-08-01 |
| publisher | Nature Publishing Group |
| record_format | Article |
| series | Translational Psychiatry |
| spelling | doaj.art-c049ca1fec5344fab5423595768f98922022-12-22T01:37:16ZengNature Publishing GroupTranslational Psychiatry2158-31882022-08-011211710.1038/s41398-022-02102-wEfficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysisDominika Karaszewska0Patrick Cleintuar1Marloes Oudijn2Anja Lok3Annemarie van Elburg4Damiaan Denys5Roel Mocking6Department of Psychiatry, Amsterdam UMC, location Academic Medical Center, University of AmsterdamDepartment of Psychiatry, Amsterdam UMC, location Academic Medical Center, University of AmsterdamDepartment of Psychiatry, Amsterdam UMC, location Academic Medical Center, University of AmsterdamDepartment of Psychiatry, Amsterdam UMC, location Academic Medical Center, University of AmsterdamFaculty of Social Sciences, University of UtrechtDepartment of Psychiatry, Amsterdam UMC, location Academic Medical Center, University of AmsterdamDepartment of Psychiatry, Amsterdam UMC, location Academic Medical Center, University of AmsterdamAbstract Background Several pioneering studies investigated deep brain stimulation (DBS) in treatment-refractory anorexia nervosa (AN) patients, but overall effects remain yet unclear. Aim of this study was to obtain estimates of efficacy of DBS in AN-patients using meta-analysis. Methods We searched three electronic databases until 1st of November 2021, using terms related to DBS and AN. We included trials that investigated the clinical effects of DBS in AN-patients. We obtained data including psychiatric comorbidities, medication use, DBS target, and study duration. Primary outcome was Body Mass Index (BMI), secondary outcome was quality of life, and the severity of psychiatric symptoms, including eating disorder, obsessive-compulsive, depressive, and anxiety symptoms. We assessed the risk of bias using the ROBINS-I tool. Results Four studies were included for meta-analysis, with a total of 56 patients with treatment-refractory AN. Follow-up ranged from 6–24 months. Random effects meta-analysis showed a significant increase in BMI following DBS, with a large effect size (Hedges’s g = 1 ∙ 13; 95% CI = 0 ∙ 80 to 1 ∙ 46; Z-value = 6 ∙ 75; P < 0 ∙ 001), without heterogeneity (I 2 = 0 ∙ 00, P = 0 ∙ 901). Random effects meta-analysis also showed a significant increase in quality of life (Hedges’s g = 0 ∙ 86; 95% CI = 0 ∙ 44 to 1 ∙ 28; Z-value = 4 ∙ 01, P < 0 ∙ 001). Furthermore, DBS decreased the severity of psychiatric symptoms (Hedges’s g = 0 ∙ 89; 95% CI = 0 ∙ 57 to 1 ∙ 21; Z-value = 5 ∙ 47; P < 0 ∙ 001, I 2 = 4 ∙ 29, P = 0 ∙ 371). Discussion In this first meta-analysis, DBS showed statistically large beneficial effects on weight restoration, quality of life, and reduction of psychiatric symptoms in patients with treatment-refractory AN. These outcomes call for more extensive naturalistic studies to determine the clinical relevance for functional recovery. This study is preregistered in PROSPERO,CRD42022295712.https://doi.org/10.1038/s41398-022-02102-w |
| spellingShingle | Dominika Karaszewska Patrick Cleintuar Marloes Oudijn Anja Lok Annemarie van Elburg Damiaan Denys Roel Mocking Efficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysis Translational Psychiatry |
| title | Efficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysis |
| title_full | Efficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysis |
| title_fullStr | Efficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysis |
| title_full_unstemmed | Efficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysis |
| title_short | Efficacy and safety of deep brain stimulation for treatment-refractory anorexia nervosa: a systematic review and meta-analysis |
| title_sort | efficacy and safety of deep brain stimulation for treatment refractory anorexia nervosa a systematic review and meta analysis |
| url | https://doi.org/10.1038/s41398-022-02102-w |
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