Early-onset anorexia nervosa: is there evidence of limbic system imbalance?
OBJECTIVE
This study, part of a continuing effort to understand the pathophysiology of the brain in early-onset anorexia nervosa, attempts to validate findings from an earlier study of regional cerebral blood flow and to correlate any abnormalities in blood flow with eating disorder psychopathology.


METHODS
Fifteen newly referred children and adolescents with a diagnosis of anorexia nervosa (AN) underwent regional cerebral blood flow (rCBF) examination using single-photon computerized tomography (SPECT) and the Eating Disorders Examination (EDE) for children.


RESULTS
Mean age was 14 years 11 months (SD = 1.35). Mean weight for height ratio was 82.79 % (SD = 10.66). SPECT findings showed that 11 (73%) had asymmetry (hypoperfusion) of blood flow in at least one area. Regions of the brain showing hypoperfusion included the temporal lobe (n = 9), parietal lobe (n = 5), frontal lobe (n = 3), thalamus (n = 3), and the caudate nuclei (n = 1). The median EDE subscale scores were high for all four subscales. Those patients with hypoperfusion had higher median EDE subscale scores than those without hypoperfusion, although the differences were not statistically significant.


CONCLUSIONS
Most patients in our study had abnormal rCBF, predominantly affecting the temporal lobe, confirming our previous findings. There was no association with the EDE scores. The findings support earlier suggestions of an imbalance in neural pathways or circuits, possibly within the limbic system. This hypothesis is considered within the context of current knowledge and suggestions made with regard to how it might be tested.
Chowdhury
Uttom
U
Great Ormond Street Hospital for Children, London, United Kingdom.
Gordon
Isky
I
Lask
Bryan
B
Watkins
Beth
B
Watt
Hilary
H
Christie
Deborah
D
D000293:Adolescent; D000856:Anorexia Nervosa / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001835:Body Weight / Q000502:physiology; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging; D002421:Caudate Nucleus / Q000098:blood supply / Q000000981:diagnostic imaging; D002540:Cerebral Cortex / Q000098:blood supply / Q000000981:diagnostic imaging; D002648:Child; D004292:Dominance, Cerebral / Q000502:physiology*; D005260:Female; D006801:Humans; D008032:Limbic System / Q000000981:diagnostic imaging* / Q000503:physiopathology; D009415:Nerve Net / Q000503:physiopathology; D009434:Neural Pathways / Q000503:physiopathology; D012039:Regional Blood Flow / Q000502:physiology; D015203:Reproducibility of Results; D013702:Temporal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging; D013788:Thalamus / Q000098:blood supply / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon