Eating disorders should raise up from dysfunction of neural processing in brain areas that are involved in emotional control, appetite regulation and body schema representations. In this context, eating disorders are located in the interface between the mind, body and the sense of self-agency.
It has been suggested that changes of the cognitive control exerted by the dorsolateral prefrontal cortex on the anterior ventral striatal pathway (a center predisposed to appetite regulation according to feelings of positive or negative reward) could trigger bulimic or anorexic behaviors.
One of the best evidence of such control cortical mechanisms on appetite regulation is the “Gourmand Syndrome” described by T. Landis and coll. Such a syndrome, which was identified in stroke patients with right hemisphere anterior lesions, consists of developing passion or manic thoughts for fine food and eating.
Even if the localizations and psychological mechanisms were globally known it would be still difficult to understand cortical changes in the brain in term of more specific circuits and neurotransmitters. To proceed to such a knowledge systematic studies with specific questionnaires or experimental cognitive eating paradigms (coupled with functional neuroimaging) should be conducted on patients with focal brain lesions or focal epilepsies.
Repetitive magnetic stimulation or transcranial direct current stimulation therapies, based on the result of those researches, would be tempted on patients (without brain lesions) and with eating disorders such as bulimia or anorexia or on patients with malnutrition or obesity
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