Body Weight Changes after Deep Brain Stimulation for Obsessive-Compulsive Disorder or Depression

Linssen, Rosalie S.N.; Oudijn, Marloes; Mantione, Mariska; Munckhof, Pepijn van den; Denys, Damiaan; Schuurman, P. Richard

doi:10.1159/000480665

Cited by 4 publications

(2 citation statements)

References 8 publications

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“…Finally, because of its assumed role in reward-related behavior, the ventral anterior limb of the internal capsule (vALIC) could be a potential target for obesity DBS. However, Linssen et al (2017) reported no significant change in body weight on a group level after vALIC DBS (mean follow-up was 3.8 years, range 10 months to 8.7 years) for either obsessive-compulsive disorder ( n = 30) or major depressive disorder ( n = 16). The average baseline BMI in their sample of 46 patients was 28.0 (SD 7.3), with 26 (57%) being overweight (BMI 25–30, n = 11), obese (BMI 30–40, n = 12), or morbidly obese (BMI ≥ 40, n = 3).…”

Section: Nucleus Accumbens Dbsmentioning

confidence: 98%

Deep Brain Stimulation for Obesity: A Review and Future Directions

et al. 2019

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The global prevalence of obesity has been steadily increasing. Although pharmacotherapy and bariatric surgeries can be useful adjuvants in the treatment of morbid obesity, they may lose long-term effectiveness. Obesity result largely from unbalanced energy homeostasis. Palatable and densely caloric foods may affect the brain overlapped circuits involved with homeostatic hypothalamus and hedonic feeding. Deep brain stimulation (DBS) consists of delivering electrical impulses to specific brain targets to modulate a disturbed neuronal network. In selected patients, DBS has been shown to be safe and effective for movement disorders. We review all the cases reports and series of patients treated with DBS for obesity using a PubMed search and will address the following obesity-related issues: (i) the hypothalamic regulation of homeostatic feeding; (ii) the reward mesolimbic circuit and hedonic feeding; (iii) basic concepts of DBS as well as the rationale for obesity treatment; (iv) perspectives and challenges in obesity DBS. The small number of cases provides preliminary evidence for the safety and the tolerability of a potential DBS approach. The ventromedial ( n = 2) and lateral ( n = 8) hypothalamic nuclei targets have shown mixed and disappointing outcomes. Although nucleus accumbens ( n = 7) targets were more encouraging for the outcomes of body weight reduction and behavioral control for eating, there was one suicide reported after 27 months of follow-up. The authors did not attribute the suicide to DBS therapy. The identification of optimal brain targets, appropriate programming strategies and the development of novel technologies will be important as next steps to move DBS closer to a clinical application. The identification of electrical control signals may provide an opportunity for closed-loop adaptive DBS systems to address obesity. Metabolic and hormonal sensors such as glycemic levels, leptin, and ghrelin levels are candidate control signals for DBS. Focused excitation or alternatively inhibition of regions of the hypothalamus may provide better outcomes compared to non-selective DBS. Utilization of the NA delta oscillation or other physiological markers from one or multiple regions in obesity-related brain network is a promising approach. Experienced multidisciplinary team will be critical to improve the risk-benefit ratio for this approach.

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Section: Nucleus Accumbens Dbsmentioning

confidence: 98%

Deep Brain Stimulation for Obesity: A Review and Future Directions

et al. 2019

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“…Notably, there is scarce systematic data on the effects of VS/VC DBS on weight. In a retrospective study, Linssen and colleagues [9] did not observe weight change after DBS of the ALIC. In this study, data from different time points of observation for each patient were pooled, whereby the follow-up period ranged from 10 months to 8.7 years, making it difficult to draw clear conclusions from the study.…”

Section: Introductionmentioning

confidence: 99%

Weight Change after Striatal/Capsule Deep Brain Stimulation Relates to Connectivity to the Bed Nucleus of the Stria Terminalis and Hypothalamus

et al. 2019

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Weight changes are insufficiently understood adverse events of deep brain stimulation. In this context, exploring neural networks of weight control may inform novel treatment strategies for weight-related disorders. In this study, we investigated weight changes after deep brain stimulation of the ventral striatum/ventral capsule and to what extent changes are associated with connectivity to feeding-related networks. We retrospectively analyzed 25 patients undergoing deep brain stimulation for obsessive-compulsive disorder or substance dependency. Weight changes were assessed preoperatively and six to twelve months after surgery and then matched with individual stimulation sites and stimulation-dependent functional connectivity to a priori defined regions of interest that are involved in food intake. We observed a significant weight gain after six to twelve months of continuous stimulation. Weight increases were associated with medial/apical localization of stimulation sites and with connectivity to hypothalamic areas and the bed nucleus. Thus, deep brain stimulation of the ventral striatum/ventral capsule influences weight depending on localization and connectivity of stimulation sites. Bearing in mind the significance of weight-related disorders, we advocate further prospective studies investigating the neuroanatomical and neuropsychological underpinnings of food intake and their neuromodulatory therapeutic potential.

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