PMID- 29681866
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240214
IS  - 1664-0640 (Print)
IS  - 1664-0640 (Electronic)
IS  - 1664-0640 (Linking)
VI  - 9
DP  - 2018
TI  - Study Protocol: Using Deep-Brain Stimulation, Multimodal Neuroimaging and 
      Neuroethics to Understand and Treat Severe Enduring Anorexia Nervosa.
PG  - 24
LID - 10.3389/fpsyt.2018.00024 [doi]
LID - 24
AB  - BACKGROUND: 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. 
      METHOD: 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. DISCUSSION: 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. CLINICAL TRIAL REGISTRATION: The study is ongoing and 
      registered with www.ClinicalTrials.gov, 
      https://clinicaltrials.gov/ct2/show/NCT01924598, 22 July, 2013. It has full 
      ethical and HRA approval (Project ID 128658).
FAU - Park, Rebecca J
AU  - Park RJ
AD  - Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford Health 
      NHS Foundation Trust, Oxford, United Kingdom.
FAU - Scaife, Jessica C
AU  - Scaife JC
AD  - Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford Health 
      NHS Foundation Trust, Oxford, United Kingdom.
FAU - Aziz, Tipu Z
AU  - Aziz TZ
AD  - Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, 
      United Kingdom.
LA  - eng
SI  - ClinicalTrials.gov/NCT01924598
GR  - MC_PC_12020/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
DEP - 20180406
PL  - Switzerland
TA  - Front Psychiatry
JT  - Frontiers in psychiatry
JID - 101545006
PMC - PMC5898619
OTO - NOTNLM
OT  - anorexia nervosa
OT  - clinical trial
OT  - compulsivity
OT  - deep-brain stimulation
OT  - reward
OT  - treatment
EDAT- 2018/04/24 06:00
MHDA- 2018/04/24 06:01
PMCR- 2018/04/06
CRDT- 2018/04/24 06:00
PHST- 2017/10/03 00:00 [received]
PHST- 2018/01/22 00:00 [accepted]
PHST- 2018/04/24 06:00 [entrez]
PHST- 2018/04/24 06:00 [pubmed]
PHST- 2018/04/24 06:01 [medline]
PHST- 2018/04/06 00:00 [pmc-release]
AID - 10.3389/fpsyt.2018.00024 [doi]
PST - epublish
SO  - Front Psychiatry. 2018 Apr 6;9:24. doi: 10.3389/fpsyt.2018.00024. eCollection 
      2018.