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Review article
peer-reviewed

Deep Brain Stimulation for Obesity



Abstract

Obesity is now the third leading cause of preventable death in the US, accounting for 216,000 deaths annually and nearly 100 billion dollars in health care costs. Despite advancements in bariatric surgery, substantial weight regain and recurrence of the associated metabolic syndrome still occurs in almost 20-35% of patients over the long-term, necessitating the development of novel therapies. Our continually expanding knowledge of the neuroanatomic and neuropsychiatric underpinnings of obesity has led to increased interest in neuromodulation as a new treatment for obesity refractory to current medical, behavioral, and surgical therapies. Recent clinical trials of deep brain stimulation (DBS) in chronic cluster headache, Alzheimer’s disease, and depression and obsessive-compulsive disorder have demonstrated the safety and efficacy of targeting the hypothalamus and reward circuitry of the brain with electrical stimulation, and thus provide the basis for a neuromodulatory approach to treatment-refractory obesity. In this study, we review the literature implicating these targets for DBS in the neural circuitry of obesity. We will also briefly review ethical considerations for such an intervention, and discuss genetic secondary-obesity syndromes that may also benefit from DBS. In short, we hope to provide the scientific foundation to justify trials of DBS for the treatment of obesity targeting these specific regions of the brain.



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Review article
peer-reviewed

Deep Brain Stimulation for Obesity


Author Information

Allen L. Ho Corresponding Author

Department of Neurosurgery, Stanford University School of Medicine

Eric S. Sussman

Department of Neurosurgery, Stanford University School of Medicine

Michael Zhang

Department of Neurosurgery, Stanford University School of Medicine

Arjun V. Pendharkar

Department of Neurosurgery, Stanford University School of Medicine

Dan E. Azagury

Department of Surgery, Stanford University School of Medicine

Cara Bohon

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine

Casey H. Halpern

Department of Neurosurgery, Stanford University School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Conflicts of interest: The authors have declared that no conflicts of interest exist.


Review article
peer-reviewed

Deep Brain Stimulation for Obesity


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Review article
peer-reviewed

Deep Brain Stimulation for Obesity

  • Author Information
    Allen L. Ho Corresponding Author

    Department of Neurosurgery, Stanford University School of Medicine

    Eric S. Sussman

    Department of Neurosurgery, Stanford University School of Medicine

    Michael Zhang

    Department of Neurosurgery, Stanford University School of Medicine

    Arjun V. Pendharkar

    Department of Neurosurgery, Stanford University School of Medicine

    Dan E. Azagury

    Department of Surgery, Stanford University School of Medicine

    Cara Bohon

    Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine

    Casey H. Halpern

    Department of Neurosurgery, Stanford University School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: March 25, 2015

    DOI

    10.7759/cureus.259

    Cite this article as:

    Ho A L, Sussman E S, Zhang M, et al. (March 25, 2015) Deep Brain Stimulation for Obesity. Cureus 7(3): e259. doi:10.7759/cureus.259

    Publication history

    Received by Cureus: January 12, 2015
    Peer review began: January 13, 2015
    Peer review concluded: March 24, 2015
    Published: March 25, 2015

    Copyright

    © Copyright 2015
    Ho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Obesity is now the third leading cause of preventable death in the US, accounting for 216,000 deaths annually and nearly 100 billion dollars in health care costs. Despite advancements in bariatric surgery, substantial weight regain and recurrence of the associated metabolic syndrome still occurs in almost 20-35% of patients over the long-term, necessitating the development of novel therapies. Our continually expanding knowledge of the neuroanatomic and neuropsychiatric underpinnings of obesity has led to increased interest in neuromodulation as a new treatment for obesity refractory to current medical, behavioral, and surgical therapies. Recent clinical trials of deep brain stimulation (DBS) in chronic cluster headache, Alzheimer’s disease, and depression and obsessive-compulsive disorder have demonstrated the safety and efficacy of targeting the hypothalamus and reward circuitry of the brain with electrical stimulation, and thus provide the basis for a neuromodulatory approach to treatment-refractory obesity. In this study, we review the literature implicating these targets for DBS in the neural circuitry of obesity. We will also briefly review ethical considerations for such an intervention, and discuss genetic secondary-obesity syndromes that may also benefit from DBS. In short, we hope to provide the scientific foundation to justify trials of DBS for the treatment of obesity targeting these specific regions of the brain.



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Create a free account to continue reading this article.

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Allen L. Ho, M.D., Resident Physician

Department of Neurosurgery, Stanford University School of Medicine

For correspondence:
allenlho@gmail.com

Eric S. Sussman

Department of Neurosurgery, Stanford University School of Medicine

Michael Zhang, None

Department of Neurosurgery, Stanford University School of Medicine

Arjun V. Pendharkar, M.D., Resident Physician

Department of Neurosurgery, Stanford University School of Medicine

Dan E. Azagury

Department of Surgery, Stanford University School of Medicine

Cara Bohon

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine

Casey H. Halpern, M.D.

Department of Neurosurgery, Stanford University School of Medicine

Allen L. Ho, M.D., Resident Physician

Department of Neurosurgery, Stanford University School of Medicine

For correspondence:
allenlho@gmail.com

Eric S. Sussman

Department of Neurosurgery, Stanford University School of Medicine

Michael Zhang, None

Department of Neurosurgery, Stanford University School of Medicine

Arjun V. Pendharkar, M.D., Resident Physician

Department of Neurosurgery, Stanford University School of Medicine

Dan E. Azagury

Department of Surgery, Stanford University School of Medicine

Cara Bohon

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine

Casey H. Halpern, M.D.

Department of Neurosurgery, Stanford University School of Medicine