Structural connectivity changes in severe Anorexia Nervosa following Deep Brain Stimulation.
Poster No:
7
Submission Type:
Abstract Submission
Authors:
Kilian Abellaneda-Pérez1, Ignacio Delgado-Martínez2, Purificación Salgado3, José María Gines3, Rocío Guardiola3, Alba Roca-Ventura1, Rosa María Manero3, Víctor Pérez-Sola3, Gloria Villalba-Martínez3
Institutions:
1Institut Guttmann, Barcelona, Spain, 2Universitat Autònoma de Barcelona, Bellaterra, Spain, 3Hospital del Mar, Barcelona, Spain
First Author:
Co-Author(s):
Introduction:
Anorexia nervosa (AN) is a complex mental health disorder characterized by significant weight loss and associated medical and psychological comorbidities. The relapsing nature of AN relates to high levels of disability and mortality, positioning AN as the psychiatric condition with the greatest risk of death (Zipfel et al., 2015). Due to the limited effectiveness of current treatments for severe AN, new strategies, including deep brain stimulation (DBS) are being explored (Villalba-Martínez et al., 2020). However, the neural mechanisms potentially driving DBS interventions in AN are still not completely elucidated. In this vein, the main goal of this investigation was to explore changes in structural connectivity, as examined through diffusion tensor imaging (DTI), in patients with severe AN before and after DBS.
Methods:
In this study, 16 participants (8 AN patients and 8 matched controls) underwent a baseline DTI acquisition. AN patients received DBS targeting either the subcallosal cingulate (DBS-SCC, N=4) or the nucleus accumbens (DBS-NAcc, N=4), based on the presence of anxious-affective comorbidities and AN subtype. Additionally, four AN patients (two from each DBS group) participated in a post-DBS DTI evaluation. We compared fractional anisotropy (FA) values derived from DTI between AN patients and controls and assessed structural connectivity changes pre- vs. post DBS. The analyses were conducted using the TRACULA (TRActs Constrained by UnderLying Anatomy) tool, part of FreeSurfer (Yendiki et al., 2011), and the TBSS (Tract-Based Spatial Statistics) from the FSL (Smith et al., 2006).
Results:
We observed statistically significant differences in numerous white matter tracts between patients with severe AN and controls at baseline, as illustrated in Fig. 1A (p < 0.05; matched controls > AN patients). Moreover, in AN patients two specific white matter tracts proven significant changes pre vs. post DBS at the group level: the anterior thalamic radiation (ATR; p = 0.0204; Fig. 1B) and the superior longitudinal fasciculus – parietal bundle (SLFP; p = 0.0272; Fig. 1B). Remarkably, at the individual level, each subject exhibited an increase in at least one of these two white matter tracts following the DBS intervention.
Conclusions:
Our research provides further support to the notion that white matter integrity is significantly compromised in distinct brain regions in patients with severe AN. Moreover, in AN patients treated with DBS, we originally observed an increase in structural connectivity in two white matter pathways, namely ATR and SLFP, independent of the stimulation target. This change in structural integrity due to DBS may be attributed to the triggering of microstructural neuroplasticity mechanisms following brain stimulation (Antonenko et al., 2023). Altogether, our findings suggest that DTI metrics may serve as a helpful tool for both guiding and tracking brain changes following DBS treatment in psychiatric populations.
Brain Stimulation:
Deep Brain Stimulation 1
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 2
Novel Imaging Acquisition Methods:
Diffusion MRI
Keywords:
Psychiatric
Psychiatric Disorders
White Matter
WHITE MATTER IMAGING - DTI, HARDI, DSI, ETC
Other - anorexia nervosa, deep brain stimulation
1|2Indicates the priority used for review
Provide references using author date format
Smith, S. (2006). 'Tract-based spatial statistics: voxelwise analysis of multi-subject diffusion data', NeuroImage vol. 31,4.
Villalba-Martínez, G. (2020). 'A Randomized Trial of Deep Brain Stimulation to the Subcallosal Cingulate and Nucleus Accumbens in Patients with Treatment-Refractory, Chronic, and Severe Anorexia Nervosa: Initial Results at 6 Months of Follow Up', Journal of Clinical Medicine vol. 9,6 1946.
Yendiki, A. (2011). 'Automated probabilistic reconstruction of white-matter pathways in health and disease using an atlas of the underlying anatomy', Frontiers in Neuroinformatics vol. 5 23.
Zipfel, S. (2015). 'Anorexia nervosa: aetiology, assessment, and treatment', The Lancet Psychiatry vol. 2,12, pp. 1099-111.