Chronic stress-like syndrome as a consequence of medial site subthalamic stimulation in Parkinson's disease

A systematic review of body mass gain after deep brain stimulation of the subthalamic nucleus in patients with Parkinson's disease

“…In the 25 studies (N = 696) with complete UPDRS III datasets , the overall pooled mean UPDRS III in the DBS ON state decreased from 34.7 (range 6.4 – 67.6) at baseline to 16.7 at the latest follow‐up (range 5.0 – 39.3; 95% CI, 12.48, 23.53; p < .0001). Similarly, DBS led to an improvement of the mean dyskinesia score in the UPDRS IV from 4.87 (range 1.45 – 11.00) to 1.88 (range 0.15 – 2.55; 95% CI, 1.54, 4.43; N = 252; p = .0014) postoperatively.…”

“…The literature search identified 206 potentially relevant articles of which 154 studies were assessed for a more detailed evaluation (Figure ). Following the selection process, 54 studies fulfilled the inclusion criteria as described above. For the analysis, 38 studies could be included of which 18 (47%) were prospective case studies, 12 (32%) were prospective case‐control studies, 4 (11%) were retrospective case studies, 2 (5%) were retrospective case‐control studies, 1 (2.5%) was a cross‐sectional, and 1 (2.5%) was a retrospective survey study.…”

“…One assumption for these endocrine alterations is that the spread of stimulation current beyond the borders of the STN may influence the hypothalamic regulation of hormone secretion, energy homeostasis, and may disrupt the melanocortin system, which has been linked to obesity. The disrupted hypothalamic hormone secretion leads to alterations in the central appetite mechanism.…”

“…Moreover, it has been shown that cortisol levels are normalized after STN DBS and the respective anabolic effect of this normalization process has been hypothesized to drive the body mass gain. In addition, it has been shown that cortisol levels decreased over time after DBS and that this decrease was correlated with the position of the active electrode in the STN. The more medially the electrode was located, the greater was the decrease in cortisol levels.…”

“…Overall, there is strong evidence that cortisol modulates food intake and therefore impacts on body weight, but also different stressors are known to elicit different cortisol responses . Thus, STN DBS may mimic the effect of chronic stress and disturbed limbic and motivational systems. However, these findings are still contradictory, because one study revealed that hormone levels of the hypothalamic‐adrenal‐, hypothalamic‐somatotropic‐, hypothalamic‐gonadal‐axis were 3 or 6 months after DBS device implantation considered as normal.…”