Cognitive Task Performance During Titration Predicts Deep Brain Stimulation Treatment Efficacy: Evidence From a Case Study

Abstract

Device titration is a major challenge when using deep brain stimulation (DBS) to treat behavioral disorders. Unlike in movement disorders, there is no reliable real-time clinical feedback for changes in complex behaviors resulting from DBS. Here, a female patient receiving DBS of the nucleus accumbens for the treatment of morbid obesity underwent cognitive testing via the flanker task alongside traditional methods of device titration. One set of stimulation parameters administered during titration resulted in acute cognitive improvement (p = 0.033) and increased frontal engagement as measured by electroencephalography (left anterior: p = 0.007, right anterior: p = 0.005) relative to DBS-OFF. The same parameters resulted in the most weight-loss during long-term continuous stimulation (47.8 lbs lost in 129 days) compared to the results of other stimulation settings. Diffusion tensor imaging analyses showed increased connectivity to dorsal attention networks and decreased connectivity to the default mode network for optimal parameters (p < 0.01). Our results provide evidence that targeted cognitive testing is a potentially useful tool for capturing acute effects of DBS stimulation during titration and predicting long-term treatment outcomes.

The utility of deep brain stimulation surgery for treating eating disorders: A systematic review

“…The EDs treated with DBS reported in the literature include AN and obesity. [ 3 , 16 , 22 , 27 - 29 , 31 , 32 , 41 , 43 , 44 , 46 , 47 ] Despite the inclusion of bulimi* in our preliminary search for papers, no studies on DBS for bulimia met the inclusion criteria. The most common cooccurring conditions included OCD, major depressive disorder, and anxiety disorders.…”

“…[ 22 , 32 , 47 ] Of the remaining 53 patients, 42.3% (22/53) achieved a BMI within the healthy range at the end of their respective follow-up period, which ranged from 6 to 39 months. [ 3 , 16 , 27 , 29 , 31 , 41 , 44 , 46 ] When comparing success rates in treating AN and obesity, 45.8% (22/48) of AN patients achieved a BMI in the healthy range compared to 0% (0/48) of obesity patients. [ 3 , 16 , 22 , 27 , 29 , 31 , 32 , 41 , 44 , 46 , 47 ]…”

“…Significant decrease in BMI was seen in all obesity-related studies[ 16 , 41 , 43 , 44 ] except for in one patient;[ 44 ] however, none of the BMI’s entered a healthy range posttreatment. Although one study did not observe significant decreases in BMI, they reported increases in resting metabolic rate and sleeping energy expenditure during DBS treatment.…”

“…[ 44 ] Reaction times and prefrontal cortex connectivity improved during treatment in one study. [ 41 ] One patient had increased food cravings and an increase in her BMI during periods of no treatment (OFF periods), but her symptoms and BMI improved after resuming DBS. [ 16 ]…”

“…Of the 11 included studies, only one study did not use any neuropsychological testing or questionnaires. [ 41 ] Administered tests included Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), Social Disability Screening Schedule (SDSS), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Eating Attitudes Test (EAT-26), cognitive neuropsychology tests, mean quality of life, and questionnaires regarding the patient’s attitude toward food.…”