Neuromodulation in eating disorders and obesity: a promising way of treatment?

Neuromodulation can affect the functioning of the central nervous system (CNS), and emotional/eating behavior is an exciting facet of that functioning. Therefore, it would be possible to offer an alternative (or complement) treatment to psychotropic medications and different psychological and nutritional approaches to both eating disorders (EDs) and obesity. Although there are a number of publications in these areas, a systematic review has not been conducted to date. Abstracts, letters, conference reports, dissertations, and reviews were excluded. Clinical trials and controlled human clinical trials were filtered and included in this study. Articles included were based on the population suffering from anorexia nervosa, bulimia nervosa, binge ED, overweight, and obesity. No restrictions were placed on the sample size. Only trials investigating the effect of neuromodulation by means of deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), and transcranial magnetic stimulation (TMS) were included. The following databases were used to conduct the search: MEDLINE/ PubMed, PsycINFO, PsycArticles, and Cochrane (Search Trials, CENTRAL). Study selection was performed following the PRISMA process (PRISMA 2009 Checklist). The total number of participants in all the trials was 562 (DBS, 25; tDCS, 138; TMS, 399; range, 3-90; median, 23.5). As a result, 50% of the studies had samples of between 14 and 38 participants. Neuro-modulation in ED seems to have certain clinical potential, and therefore, this is a promising area for further research. Developments in ED neuromodulation will be linked to neuroimaging to identify potential stimulation targets and possible biomarkers of treatment response. To date, TMS and/or direct current stimulation (DCS) is not the first-line treatment yet, but it could become a preferred option of treatment in the future. Further studies should avoid small sample sizes and the use of different methodologies. Currently, neuromodulation techniques are in the experimental phase, and they are not an evidence-based treatment for ED.

Body Mass Index and sagittal lumbar balance. A geometric morphometrics approach

Geometric Morphometrics (GM) offers a new and interactive way for shape analysis, rarely used in spine morphology study. We used GM to investigate the relationships between being overweight and lumbar sagittal configuration. Age, sex, weight, height and BMI of 152 consecutive spine MRI were retrospectively collected. 66 landmarks were digitized on each midsagittal T2-weighted images. Procrustes superimpositions, Principal Component analysis (PCA), Canonical Variate analysis (CVA), and other multivariate techniques were used to find mean shape consensus and possible shape-BMI covariations. A strong correlation between sagittal lumbar shape and BMI was found. Morphological changes such as telescoping, lordosis and variations in vertebral-disk shape were found to be related with BMI, as well as other common variables such as sex and age. GM helps understand the way in which being overweight influences the lumbar shape. These techniques offer a powerful, reproducible and dynamically interactive method to explore spine shape, with diagnostic, therapeutic and preventive implications. A more extensive use of Geometric Morphometrics in spine shape investigation is proposed

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Are Modic Changes Able to Help Us in Our Clinical Practice? A Study of the Modic Changes in Young Adults During Working Age.

STUDY DESIGN: Modic changes [vertebral endplate spinal changes (VESC)] have been related to degenerative disk disease, and in past decades it was thought that their presence justified the surgical treatment, in particular spinal fusion. OBJECTIVE: The aim of the present study is to investigate its prevalence and features in a population of young workers suffering from low back pain, and explore the eventual relationship with the treatment applied in each case. BACKGROUND DATA: We conducted a retrospectively review of 450 magnetic resonance images from our hospital, in patients with low back pain or sciatica and age below 40. MATERIALS AND METHODS: Age, sex, symptoms predominance, concurrence with other spine disease, VESC type, evolution, level/s of involvement and placement, affected disk location and extent of the disease, disk height, and status of the endplate were recorded. The applied treatment was divided in groups according to the degree of invasiveness of the procedure. RESULTS: Prevalence of VESC was 13.05% predominant in patients over 30 years, and 100% associated to disk degenerative changes. Most frequent features were: type I (54%), lower lumbar region (98%), along with a decreased disk height (68%), and distortion of the disk endplates (98%, P<0.01). The patients with VESC presented a favorable outcome with conservative treatment, but were more frequently associated with invasive treatment, compared with non-VESC patients (P<0.024). CONCLUSIONS: VESC prevalence increases with age, underlying the degenerative causative etiology. Surgical indication should not be stated on the basis of the VESC findings alone, the main factor for indicating surgery depends more on other associated degenerative spinal changes.

[Image analysis and processing. Fundaments and applications in neurology and neurosurgery]. / Análisis y proceso de imagen. Fundamentos y aplicaciones en neurología y neurocirugía.

In recent years, image techniques have transformed the diagnosis in Medicine. Nevertheless, they are, by now, far from a widespread clinic and surgical use. Beyond the simple picture inspection, DICOM digital files can be explored by using image analysis/processing techniques in a better way. In practice, clinicians and surgeons usually are limited to 'see' pictures delivered by Radiology. However, image analysis/processing techniques allow the 'client' (neurologist or neuro-surgeon) to accomplish interactive image visualizations, multiplanar or 3D rendering, measurements, pathway visualizations, etc. All these tasks, offer a great advantage in diagnosis, surgical planning, teaching and investigation. This paper revise the fundaments of image analysis techniques in order to emphasize their utility, and to widespread its utilization not in the server (Radiological Department) but, principally, in the client side. Some examples of cranio-spinal pathologies are presented aiming to these objectives.

Análisis y proceso de imagen. Fundamentos y aplicaciones en neurología y neurocirugía / Image analysis and processing. Fundaments and applications in neurology and neurosurgery

Resumen. Las técnicas de diagnóstico por imagen han revolucionado los métodos de detección de enfermedades. Sin embargo, su plena utilización en el ámbito clínico y quirúrgico está lejos de alcanzarse. Más allá de la mera inspección de la imagen, los ficheros digitales pueden explorarse mediante técnicas de análisis y proceso de imagen de una manera muy eficaz. Considerado como un sistema cliente-servidor, el cliente (neurólogo o neurocirujano) sólo puede, habitualmente, visualizar las imágenes suministradas desde el servicio de radiodiagnóstico. Las técnicas de análisis y proceso de imagen, sin embargo, empleadas en el área cliente, permiten visualizaciones interactivas, reconstrucciones, mediciones y otras tareas de gran ayuda en el diagnóstico, planificación operatoria, docencia e investigación. El presente trabajo persigue revisar las bases de estas técnicas, enfatizar su utilidad y extender su empleo no en el lado servidor (radiodiagnóstico), sino en el cliente. Estos procedimientos resultan de especial utilidad en neurociencia. Se analizan diversos ejemplos procedentes de la patología craneoespinal con este objetivo (AU)

Summary. In recent years, image techniques have transformed the diagnosis in Medicine. Nevertheless, they are, by now, far from a widespread clinic and surgical use. Beyond the simple picture inspection, DICOM digital files can be explored by using image analysis/processing techniques in a better way. In practice, clinicians and surgeons usually are limited to ‘see’ pictures delivered by Radiology. However, image analysis/processing techniques allow the ‘client’ (neurologist or neurosurgeon) to accomplish interactive image visualizations, multiplanar or 3D rendering, measurements, pathway visualizations, etc. All these tasks, offer a great advantage in diagnosis, surgical planning, teaching and investigation. This paper revise the fundaments of image analysis techniques in order to emphasize their utility, and to widespread its utilization not in the server (Radiological Department) but, principally, in the client side. Some examples of cranio-spinal pathologies are presented aiming to these objectives (AU)