Long-Term Follow-up Study of MRI-Guided Bilateral Anterior Capsulotomy in Patients With Refractory Anorexia Nervosa. Issue 1 (18th August 2017)

• Record Type: Journal Article
• Authors: Liu, Wei; Li, Dianyou; Sun, Fafa; Zhang, Xiaoxiao; Wang, Tao; Zhan, Shikun; Pan, Yixin; Huang, Peng; Jin, Haiyan; Li, Yongchao; Sun, Bomin
• Is Part Of: Neurosurgery. Volume 83:Issue 1(2018)
• Page Start: 86
• Page End: 92
• Publication Date: 2017-08-18
• Subjects: Anorexia nervosa -- Body mass index -- Capsulotomy -- Long-term follow-up -- STROBE; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyx366
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Anorexia nervosa (AN) is one of the most challenging psychiatric disorders to treat. The poor clinical outcomes warrant novel treatments for AN, especially in severe and persistent cases. OBJECTIVE: To explore the feasibility of magnetic resonance imaging-guided bilateral anterior capsulotomy in the treatment of refractory AN. METHODS: Seventy-four patients diagnosed with refractory AN who underwent capsulotomy completed this 3-yr follow-up study. Outcomes included body mass index (BMI) and results from a series of psychiatric scales (for obsessive, depressive, and anxious symptoms) that were implemented at baseline (presurgery), and 1 mo, 1 yr, and 3 yr after surgery. RESULTS: Compared to presurgical levels, BMI increased significantly at 1-yr and 3-yr follow-ups. Compared to presurgery scores, psychiatric scale scores were significantly improved at 1-mo postsurgery, and continued to remain low at the 1-yr and 3-yr follow-ups. In addition, Mini-Mental State Examination (MMSE) scores were in the normal range during the long-term follow-up. The most common short-term side effects included urinary incontinence ( n = 7), sleep disorders ( n = 8), and fatigue ( n = 6). Long-term complications included disinhibition ( n = 6), memory loss ( n = 3), and lethargy ( n = 4). No patient in this study experienced death or disability. CONCLUSION: Capsulotomy enabled patients with refractory AN to normalize their weight, especially those in life-threatening conditions. While it appears to be an acceptable life-saving treatment, it is indicated only when fulfilling strict criteria given its complications and irreversibility.