One of the potential treatment methods of obesity is deep brain stimulation (DBS) of nucleus accumbens. We describe the case of 19 years old woman with hypothalamic obesity. She weighted 151.4 kg before DBS and the non-surgical methods proved to be inefficient. She was treated with implantation of DBS electrode to nucleus accumbens bilaterally. Results were measured with body mass index and neuropsychological tests. Follow-up was 14 months. Fourteen months after surgery weight was 138 kg, BMI was 48.3. Neuropsychological test results were intact. The presented case supports the thesis of treatment of obesity with nucleus accumbens stimulation.

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Different groups of brain cholinergic neurons display variable susceptibility to similar neurotoxic inputs. The aim of this work was to find out whether changes in cholinergic phenotype may alter the availability of acetyl-CoA in mitochondrial compartment and thereby the viability of cholinergic neurons. Cyclic AMP (cAMP) and retinoic acid caused differentiation (DC) of T17 TrkA(+) cholinergic neuroblastoma cells. In addition, it increased the choline acetyltransferase (ChAT) activity, Ca(2+) accumulation and cytoplasmic acetyl-CoA level, but decreased mitochondrial acetyl-CoA and cell resistance to amyloid-beta(25-35) (Abeta) toxicity. Nerve growth factor (NGF) caused similar alterations in the nondifferentiated cells (NC). On the other hand, in DC NGF suppressed ChAT activity and elevated mitochondrial level of acetyl-CoA but also caused a further increase of Ca(2+) content and cell susceptibility to Abeta. The significant inverse correlation was found between ChAT activity and mitochondrial levels of acetyl-CoA. Abeta markedly reduced the expression of cholinergic phenotype, acetyl-CoA content, and viability of DC. These effects were absent or much less pronounced in NC. Acetyl-L-carnitine reversed suppressing effects of Abeta on acetyl-CoA levels and ChAT activity but did not reverse increased mortality in DC. Presented data indicate that increased transmitter activity in highly differentiated cholinergic neurons, decreased acetyl-CoA level in their mitochondrial compartment, and increased Ca(2+) accumulation can make them more prone to neurotoxic conditions. Phenotype-dependent changes in intracellular distribution of acetyl-CoA thus play an important role in regulation of viability and transmitter function in brain cholinergic neurons.

Background. Motor cortex stimulation is one of the neuromodulation methods of treating refractory central neurogenic pain. Objectives. The aim of this study was to retrospectively evaluate the effects of motor cortex stimulation. Material and Methods. The study group consisted of 14 consecutive patients with thalamic pain, atypical facial pain, post-brachial plexus avulsion injury pain, phantom pain and pain in syringomyelia who were treated with motor cortex stimulation at the Department of Neurosurgery of the Military Research Hospital in Bydgoszcz, Poland, from 2005 to 2013. The procedures were conducted with the use of neurosurgical navigation and intraoperative neurophysiological monitoring. The outcomes were assessed in terms of visual analog scale scores. The long-term follow-up ranged from one to six years. Results. A statistically significant reduction in the intensity of pain was noted in patients treated with motor cortex stimulation (pre-surgery median visual analog scale = 9, short-term result median visual analog scale = 3, p = 0.0009; long-term result median visual analog scale = 5, p = 0.0036). Over the long term, with follow-ups ranging from one to six years, the results were excellent (over 80% reduction in pain) in 31% of the patients and satisfactory (50-80% reduction in pain) in 23% of the patients. Unsatisfactory pain control (less than 50%) was noted in 31% of the patients and no improvement was noted in 15%. Significantly better relief of pain was observed in the early postoperative period. In this series of patients, the highest efficacy of motor cortex stimulation was observed in post-stroke or post-hemorrhagic thalamic pain (5/7 patients -71%). Long-term outcomes were not related to the age or sex of the patient, the preoperative duration of the pain, or to the position or number of implanted electrodes. Conclusions. MCS significantly reduces the intensity of neurogenic pain. The best long-term results in the present study were achieved in patients with thalamic syndrome. No significant predictors were found for a successful final outcome. The authors consider appropriate selection of patients, accurate placement of the electrodes and frequent adjusting of the stimulation parameters to be important factors increasing the efficacy of MCS (Adv Clin Exp Med 2015, 24, 2, 289-296).

Sacral roots stimulation is a non-destructive and minimally invasive neuromodulation method in the treatment of chronic pelvic pain. It can be effective even in the long-term observation but special care is advised to secure aseptic conditions in the implantation and to prevent the infection which leads to removal of the stimulating system.