Neurosurgery and neuromodulation for anorexia nervosa in the 21st century: a systematic review of treatment outcomes

As current psychosocial and pharmacological interventions show limited efficacy in the treatment of anorexia nervosa (AN), interest in the potential value of neurosurgical intervention and neuromodulation in managing severe and enduring illness has grown. We conducted a systematic review of 20 trials of neurosurgical and neuromodulatory treatments for AN, including neurosurgical ablation, deep brain stimulation (DBS), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS). Overall, there is evidence to support the role of stereotactic ablation and DBS in the treatment of AN. In contrast, results for rTMS and tDCS have been modest and generally more mixed. Neurosurgical treatment may offer important new avenues for the treatment of AN. Additional randomized clinical trials with comparable patient populations will be needed, in which change in affective, cognitive, and perceptual symptom phenomena, and interrogation of targeted circuits, pre- and post-intervention, are carefully documented.

Automated summary

The limited efficacy of current psychosocial and pharmacological interventions for anorexia nervosa has led to an increased interest in neurosurgical intervention and neuromodulation. A systematic review of 20 trials found that stereotactic ablation and deep brain stimulation show evidence of being effective in the treatment of anorexia nervosa, while repetitive transcranial magnetic stimulation and transcranial direct current stimulation have shown more modest and mixed results. Neurosurgical treatment may provide important new avenues for the treatment of anorexia nervosa, but further randomized clinical trials are needed.