Stereotactic surgery on a female patient with severe chronic anorexia nervosa: 10-year follow-up
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CASE REPORT
Stereotactic surgery on a female patient with severe chronic anorexia nervosa: 10‑year follow‑up Fabiola Guerrero Alzola1 · José Casas Rivero1 · Roberto Martínez‑Álvarez2 Received: 4 June 2019 / Accepted: 25 September 2019 © Springer Nature Switzerland AG 2019
Abstract Introduction Anorexia nervosa (AN) is a serious disease with a high rate of chronification. In chronic and serious cases, psychotherapeutic and pharmacological treatments are not sufficient to control the disease. Case report We present the case of a female patient with severe chronic restrictive anorexia nervosa resistant to psychomedical treatment. During the 31 years the illness evolved, the patient required multiple hospital admissions. With a body mass index (BMI) of 12.8 kg/m2 and consequent risk of death, stereotactic cingulotomy was performed comprising bilateral blocking of the anterior cingulate cortex by stereotactic radiofrequency thermocoagulation, confirmed by tractography 5 years later. After 10 years of follow-up, the patient is clinically stable with an increased BMI and improved neuropsychological indicators. Discussion Stereotactic surgery may be an option for patients with chronic anorexia nervosa where conventional treatments have proved insufficient. Keywords Anorexia nervosa · Stereotactic surgery · Body mass index · Cingulotomy
Introduction
Case report
Anorexia nervosa is a serious illness, with a chronicity rate of 20% [1] and the highest mortality rate of all psychiatric disorders [2]. Psychological and pharmacological treatments are not sufficient to improve the prognosis of the disease or the quality of life in this percentage of chronic patients [3]. Neurosurgery for psychiatric disorders is a branch of functional neurosurgery whose objective is to treat a series of specific symptoms arising from psychiatric disorders (e.g., obsessions, compulsions, anxiety or aggression) through surgical blockings that interrupt neural circuits within the limbic system. These blockings are identified by functional neuroimaging, specifically tractography.
A female patient was diagnosed with restrictive anorexia nervosa at 15 years of age resulting in long-term amenorrhea from the age of 18. Weight loss was primarily due to fasting, however, following ingestion of minimal quantities of food, the patient resorted to vomiting on a recurring basis with a frequency that varied from once per day up to 2–3 times per week. The patient presented with two comorbidities: a depressive disorder and an anxiety disorder. Following diagnosis, the patient received successive psychotherapeutic treatments from at least four teams of different professionals who treated her anorexia, as well as the comorbid disorders. Psychopharmacological treatment took the form of up to 30 mg of fluoxetine per day with lorazepam before meals. The patient also required intermittent oral treatment with potassium, zinc, magnesium, calcium and vitamin D for vitamin deficiencies and electrolyte alterations. Adherence by the patient to the pharmacological
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