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16. Functional brain abnormalities in anorexia nervosa, The Journal of Pediatrics

(C) Mosby-Year Book Inc. 2001. All Rights Reserved.

Volume 139(1), July 2001, p 4A

Functional brain abnormalities in anorexia nervosa
[The Editors' Perspective]

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In the past, investigation of neurologic and psychologic illness was limited to
imaging of the structure of the brain. This was sometimes helpful in understanding
the pathology but more often was uninformative. In patients with anorexia
nervosa, imaging studies showed cortical atrophy. However, this was usually
interpreted as a consequence of disordered eating and nutrition rather than as a
cause. Gordon et al used positron emission tomographic measurement of regional
cerebral blood flow to study patients with anorexia nervosa. They exposed the
patients to 3 stimuli, including high-calorie foods, low-calorie foods, and
non-food items. This approach allowed the investigators to study brain function
as it related to structure. They found elevated regional cerebral blood flow
within bilateral medial temporal lobes of patients with anorexia nervosa
compared with those of control subjects. The findings in patients with anorexia
nervosa are similar to those in patients with psychotic disorders. They also
found greater activation in the left occipital cortex and right temporal-occipital
cortex for high-calorie versus low-calorie foods in patients with anorexia
compared with control subjects. This may represent an exaggerated response in
the visual association cortex related to high-calorie food phobia. As Ball
points out in his editorial, this study represents an important new direction
for research. However, it is far from uncovering all the answers to the
pathophysiology of anorexia nervosa.

-Stephen R. Daniels, MD, PhD
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