Kris van Kuyck

Towards a neurocircuitry in anorexia nervosa: Evidence from functional neuroimaging studies

Functional neuroimaging is widely used to unravel changes in brain functioning in psychiatric disorders. In the current study, we review single-photon emission tomography (SPECT), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) studies in anorexia nervosa (AN), a difficult-to-treat eating disorder with the highest mortality rate among psychiatric disorders. We discuss the role of the parietal cortex, anterior and subgenual cingulate cortex, frontal cortex and temporal lobe in light of the cardinal symptoms of AN. The insights of the current review may ultimately lead to the development of new treatments.

Electrical stimulation of the anterior limbs of the internal capsules in patients with severe obsessive-compulsive disorder: anecdotal reports

Anterior capsular stimulation induces some improvement in severe treatment-resistant OCD patients. At this stage, not all stimulation-induced effects can be explained. The effects are a valuable source for further neurophysiologic and neuroanatomic research. It was reassuring that when the group of Drs Rasmussen, Greenberg, and Friehs in Providence and the group of Drs Rezai, Montgomery, and Malone in Cleveland started to operate on OCD patients using exactly the same technique, similar effects were seen in the patients. The authors still want to stress that anterior capsular stimulation remains investigational and needs optimization, especially to try to solve the problem of the short battery life of the stimulators.

Deep-Brain Stimulation for Anorexia Nervosa

OBJECTIVE Anorexia nervosa (AN) is a complex and severe, sometimes life-threatening, psychiatric disorder with high relapse rates under standard treatment. After decades of brain-lesioning procedures offered as a last resort, deep-brain stimulation (DBS) has come under investigation in the last few years as a treatment option for severe and refractory AN. METHODS AND RESULTS In this jointly written article, Sun et al. (the Shanghai group) report an average of 65% increase in body weight in four severe and refractory patients with AN after they underwent the DBS procedure (average follow-up: 38 months). All patients weighed greater than 85% of expected body weight and thus no longer met the diagnostic criteria of AN at last follow-up. Nuttin et al. (the Leuven group) describe other clinical studies that provide evidence for the use of DBS for AN and further discuss patient selection criteria, target selection, and adverse event of this evolving therapy. CONCLUSION Preliminary results from the Shanghai group and other clinical centers showed that the use of DBS to treat AN may be a valuable option for weight restoration in otherwise-refractory and life-threatening cases. The nature of this procedure, however, remains investigational and should not be viewed as a standard clinical treatment option. Further scientific investigation is essential to warrant the long-term efficacy and safety of DBS for AN.

Comparative study of the effects of electrical stimulation in the nucleus accumbens, the mediodorsal thalamic nucleus and the bed nucleus of the stria terminalis in rats with schedule-induced polydipsia

In the schedule-induced polydipsia model, hungry rats receiving a food pellet every minute will display excessive drinking behaviour (compulsive behaviour). We aimed 1) to evaluate if electrical stimulation in the nucleus accumbens (N ACC), the mediodorsal thalamic nucleus (MD) or the bed nucleus of the stria terminalis (BST) can decrease water intake in the schedule-induced polydipsia model; 2) to compare water intake between these groups for different stimulation amplitudes; and 3) to compare the effect of low frequency (2 Hz) with high frequency (100 Hz) stimulation. Rats were randomly divided into four groups: electrode implanted in the 1) N ACC (n=7), 2) MD (n=8), 3) BST (n=8), or 4) a sham-operated control group (n=7). Postoperatively, each rat of group 1, 2 and 3 was randomly tested in the model using pulses with a frequency of 2 Hz and 100 Hz, each at an amplitude of 0.1, 0.2, 0.3, 0.4 and 0.5 mA, or without stimulation. Group 4 was tested 11 times without stimulation. Each day the rats were tested in random order. High-frequency electrical stimulation in all three brain areas decreased water intake significantly at an amplitude of 0.2 mA or higher, however, without differences between the brain areas. Based on these results, we expect a decrease in compulsions in patients suffering from treatment-resistant obsessive-compulsive disorder during electrical stimulation in the N ACC, the MD and the BST. However, we foresee no difference in energy consumption to decrease symptoms during electrical stimulation between these brain areas.

Contextual conditioning in rats as an animal model for generalized anxiety disorder.

Animal models of psychiatric disorders are important translational tools for exploring new treatment options and gaining more insight into the disease. Thus far, there is no systematically validated animal model for generalized anxiety disorder (GAD), a severely impairing and difficult-to-treat disease. In this review, we propose contextual conditioning (CC) as an animal model for GAD. We argue that this model has sufficient face validity (there are several symptom similarities), predictive validity (it responds to clinically effective treatments), and construct validity (the underlying mechanisms are comparable). Although the refinement and validation of an animal model is a never-ending process, we want to give a concise overview of the currently available evidence. We suggest that the CC model might be a valuable preclinical tool to enhance the development of new treatment strategies and our understanding of GAD.

Motor- and food-related metabolic cerebral changes in the activity-based rat model for anorexia nervosa: a voxel-based microPET study

Anorexia nervosa (AN) is a disorder that is difficult to treat with psycho- or pharmacotherapy. In order to identify involved neurocircuitry, we investigated the cerebral metabolic alterations in the activity-based anorexia (ABA) rat model, where restriction of the food intake period induces hyperactivity and decreased body weight. Cerebral (18)F-fluorodeoxyglucose uptake was investigated in rats in the activity-based anorexia model (n=9) and compared to controls (n=10), using a CTI Focus microPET 220. Regional metabolic changes were investigated using statistical parametric mapping (SPM2) and correlated to weight and hyperactivity measures on a voxel-by-voxel basis. Higher regional metabolism was found in ABA rats in the mediodorsal thalamus, ventral pontine nuclei and cerebellum, while hypometabolism was seen in the left rhinal and bilateral insular cortex, and bilateral ventral striatum (p<0.001). A positive correlation was observed between body weight loss and brain metabolism in the cingulate cortex and surrounding motor and somatosensory cortex (p<0.001). Thus, in the ABA model metabolic changes are present in brain areas related to disease status and weight loss, which share several characteristics with the human disease.

Histological Alterations Induced by Electrode Implantation and Electrical Stimulation in the Human Brain: A Review

Objectives.  Electrical brain stimulation is used as a treatment for patients with intractable chronic pain and movement disorders. However, the implantation of electrodes and electrical stimulation may induce histological changes around the electrode tip. We aimed to review the histological changes in humans that were electrically stimulated in the brain.

Micro-Positron Emission Tomography Imaging of Rat Brain Metabolism during Expression of Contextual Conditioning

Using 18F-fluorodeoxygluose microPET imaging, we investigated the neurocircuitry of contextual anxiety versus control in awake, conditioned rats (n = 7–10 per group). In addition, we imaged a group expressing cued fear. Simultaneous measurements of startle amplitude and freezing time were used to assess conditioning. To the best of our knowledge, no neuroimaging studies in conditioned rats have been conducted thus far, although visualizing and quantifying the metabolism of the intact brain in behaving animals is clearly of interest. In addition, more insight into the neurocircuitry involved in contextual anxiety may stimulate the development of new treatments for anxiety disorders. Our main finding was hypermetabolism in a cluster comprising the bed nucleus of the stria terminalis (BST) in rats expressing contextual anxiety compared with controls. Analysis of a subset of rats showing the best behavioral results (n = 5 per subgroup) confirmed this finding. We also observed hypermetabolism in the same cluster in rats expressing contextual anxiety compared with rats expressing cued fear. Our results provide novel evidence for a role of the BST in the expression of contextual anxiety.

Anodal tDCS over the Primary Motor Cortex Facilitates Long-Term Memory Formation Reflecting Use-Dependent Plasticity.

Previous research suggests that anodal transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) modulates NMDA receptor dependent processes that mediate synaptic plasticity. Here we test this proposal by applying anodal versus sham tDCS while subjects practiced to flex the thumb as fast as possible (ballistic movements). Repetitive practice of this task has been shown to result in performance improvements that reflect use-dependent plasticity resulting from NMDA receptor mediated, long-term potentiation (LTP)-like processes. Using a double-blind within-subject cross-over design, subjects (n=14) participated either in an anodal or a sham tDCS session which were at least 3 months apart. Sham or anodal tDCS (1 mA) was applied for 20 min during motor practice and retention was tested 30 min, 24 hours and one week later. All subjects improved performance during each of the two sessions (p < 0.001) and learning gains were similar. Our main result is that long term retention performance (i.e. 1 week after practice) was significantly better when practice was performed with anodal tDCS than with sham tDCS (p < 0.001). This effect was large (Cohen’s d=1.01) and all but one subject followed the group trend. Our data strongly suggest that anodal tDCS facilitates long-term memory formation reflecting use-dependent plasticity. Our results support the notion that anodal tDCS facilitates synaptic plasticity mediated by an LTP-like mechanism, which is in accordance with previous research.

Electrolytic lesions of the bed nucleus of the stria terminalis disrupt freezing and startle potentiation in a conditioned context

Expression of contextual anxiety in a previously shocked context is a widely used model of anxiety, with the main behavioral measures being freezing or startle amplitude. There is extensive evidence that the bed nucleus of the stria terminalis (BST) is involved in several anxiety paradigms, e.g., BST lesions disrupt contextual freezing. Surprisingly, studies investigating the effect on startle potentiation in a conditioned context are still lacking in the literature. In the present study, we found that post-training bilateral electrolytic lesions in the BST completely disrupted the expression of contextual anxiety, as quantified with combined measurements of startle amplitude and freezing.