Comparison of weight gain and energy intake after subthalamic versus pallidal stimulation in Parkinson's disease

Abstract

To compare body mass index (BMI) and daily energy intake (DEI) after subthalamic versus pallidal deep brain stimulation (DBS). Weight gain following DBS in Parkinson's disease patients remains largely unexplained and no comparison of subthalamic and pallidal (GPi) stimulation has yet been performed. BMI and DEI, dopaminergic drug administration and motor scores were recorded in 46 patients with PD before STN (n = 32) or GPi (n = 14) DBS and 3 and 6 months after. At M6, BMI had increased by an average of 8.4% in the STN group and 3.2% in the GPi group. BMI increased in 28 STN and 9 GPi patients. This increase was significantly higher in the STN group (P < 0.048) and the difference remained significant after adjustment for reduced dopaminergic medication; 28.6% of GPi patients were overweight at 6 months (14.3% preoperatively) versus 37.5% of STN patients (21.9% preoperatively). Changes in BMI were negatively correlated with changes in dyskinesia in the GPi-DBS group. Food intake did not change in the two groups, either quantitatively or qualitatively. Frequent weight gain, inadequately explained by motor improvement or reduced dopaminergic drug dosage, occurred in subthalamic DBS patients. The difference between groups suggests additional factors in the STN group, such as homeostatic control center involvement.

Diurnal Variation of Hypothalamic Function and Chronic Subthalamic Nucleus Stimulation in Parkinson's Disease

“…Nevertheless, 2 patients of our small study cohort experienced relevant psychiatric side effects and a significant increase of body weight and BMI was also observed over the entire group which is in line with previous reports [7,41]. Moreover, global cognitive functioning measured with the MDRS deteriorated in our DBS cohort.…”

Body weight and food intake in Parkinson's disease. A review of the association to non-motor symptoms

“…Compared with the Globus pallidum (GP), the Subthalamic Nucleus (STN) is more strongly associated with weight gain, even if not all studies are consistent with this finding (Mills, Scherzer, Starr, & Ostrem, 2012;Sauleau et al, 2009 but see Locke et al, 2011;Volkmann et al, 2001).…”

“…Recently, it has been proposed to name eating abnormalities after DBS "hypo-dopaminergic snacking" rather than Binge Eating, thus emphasizing the role of dopaminergic reduction in the occurrence of these abnormalities (Kistner et al, 2014). As a final remark, the majority of the studies do not report an increase in food intake among PD patients with DBS or an improvement in appetite or change in eating habits (Bannier et al, 2009;Macia et al, 2004;Montaurier et al, 2007;Perlemoine et al, 2005;Rieu et al, 2011;Sauleau et al, 2009) but few studies report such findings (Jorgensen, Werdelin, Lokkegaard, Westerterp, & Simonsen, 2012;Nirenberg & Waters, 2006). However, as we have already argued in this review, the evaluation of food intake, via self-reported measures, may be imprecise and inaccurate.…”

Body weight gain and deep brain stimulation

“…Studies showed a significant weight gain both in patients who have undergone unilateral pallidotomy or pallidal stimulation and in those who have undergone stimulation of the subthalamic nucleus [25][26][27]. However, recently Sauleau et al, compared the effect of setting in place deep brain stimulation in the subthalamic position (STN) and the pallidal position (GPi) on weight gain and BMI, in 46 patients with PD.…”