Decrease in Blood Cortisol Corresponds to Weight Gain following Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease

Růžička, Evžen; Nováková, Lucie; Jech, Robert; Urgošík, Dušan; Růžička, Filip; Haluzı́k, Martin

doi:10.1159/000341707

Cited by 16 publications

(9 citation statements)

References 14 publications

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“…In some studies, STN DBS induced no significant changes in blood levels of these hormones . In other studies, DBS was suggested to induce a deregulation of the metabolism on the basis of observations of a decrease in cortisol levels, an increase in leptin, ghrelin, or neuropeptide Y levels, or modifications of the glucose metabolism . Thus, we cannot eliminate the hypothesis that the changes that we observed in the metabolism of some brain areas reflect or induce hormonal changes leading to WG.…”

Section: Discussionmentioning

confidence: 68%

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Weight gain following subthalamic nucleus deep brain stimulation: A PET study

et al. 2014

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Several hypotheses have been put forward to explain weight gain after deep brain stimulation (DBS), but none provides a fully satisfactory account of this adverse effect. We analyzed the correlation between changes in brain metabolism (using positron emission tomography [PET] imaging) and weight gain after bilateral subthalamic nucleus DBS in patients with Parkinson's disease. Body mass index was calculated and brain activity prospectively measured using 2-deoxy-2[18F]fluoro-D-glucose 3 months before and 4 months after the start of subthalamic nucleus deep brain stimulation in 23 patients with Parkinson's disease. Motor complications (United Parkinson's Disease Rating Scale [UPDRS]-IV scores) and dopaminergic medication were included in the analysis to control for their possible influence on brain metabolism. Mean ± standard deviation (SD) body mass index increased significantly by 0.8 ± 1.5 kg/m(2) (P = 0.03). Correlations were found between weight gain and changes in brain metabolism in limbic and associative areas, including the orbitofrontal cortex (Brodmann areas [BAs] 10 and 11), lateral and medial parts of the temporal lobe (BAs 20, 21, 22,39 and 42), anterior cingulate cortex (BA 32), and retrosplenial cortex (BA 30). However, we found no correlation between weight gain and metabolic changes in sensorimotor areas. These findings suggest that changes in associative and limbic processes contribute to weight gain after subthalamic nucleus DBS in Parkinson's disease.

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Section: Discussionmentioning

confidence: 68%

“…The involvement of the hypothalamus, either directly or indirectly through hypothalamic fibers, has been suggested . Conflicting results have been found concerning changes in hormones regulating energy homeostasis or appetite . In some studies, STN DBS induced no significant changes in blood levels of these hormones .…”

Section: Discussionmentioning

confidence: 99%

Weight gain following subthalamic nucleus deep brain stimulation: A PET study

et al. 2014

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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This systematic review investigated the effects of deep brain stimulation of the subthalamic nucleus on extent and time course of body mass changes in patients with Parkinson's disease. A computerized search identified relevant articles using a priori defined inclusion and exclusion criteria. A descriptive analysis was calculated for the main outcome parameters body mass and BMI. Thirty-eight out of 206 studies fulfilled the inclusion criteria (979 patients aged 59.0±7.5 years). Considering the longest follow-up time for each study, body mass and BMI showed a mean increase across studies of +5.71kg (p < .0001; d = 0.64) and +1.8kg/m 2 (p < .0001; d = 1.61). The time course of body mass gain revealed a continuous increase ranging from +3.25kg (d = 0.69) at 3 months, +3.88kg (d = 0.21) at 6 months, +6.35kg (d = 0.72) at12 months, and +6.11kg (d = 1.02) greater than 12 months. Changes in BMI were associated with changes in disease severity (r = 0.502, p = .010) and pharmacological treatment (r = 0.440, p = .0231). Data suggest that body mass gain is one of the most common side effects of deep brain stimulation going beyond normalization of preoperative weight loss. Considering the negative health implications of overweight, we recommend the development of tailored therapies to prevent overweight and associated metabolic disorders following this treatment.

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“…Indeed, previous studies have illustrated that a change in body weight is the direct result of STN-DBS on the regulation of the dietary and metabolic nucleus (in the lateral region of the thalamus and the marginal portion of the STN) (30)(31)(32)(33)(34). STN-DBS may have a regional effect on the hypothalamicpituitary-adrenal homeostatic control of EE by diffusion of the electrical pulse to the hypothalamus (35,36). Results of the direct effects of STN-DBS on hypothalamic catabolic/anabolic regulators including blood cortisol (36), ghrelin, neuropeptide Y, and leptin peptides (37)(38)(39) remain inconsistent and require further study.…”

Section: Discussionmentioning

confidence: 99%

Weight Change After Subthalamic Nucleus Deep Brain Stimulation in Patients With Isolated Dystonia

Lai

et al. 2021

Front. Neurol.

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Purpose: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment method for advanced Parkinson's disease (PD) and isolated dystonia and provides marked improvement of major motor symptoms. In addition, non-motor effects have been reported including weight gain (WG) in patients with PD after STN-DBS. However, it is still unclear whether patients with isolated dystonia also experience WG.Methods: Data from 47 patients with isolated dystonia who underwent bilateral STN-DBS surgery between October 2012 and June 2019 were retrospectively collected. The severity of dystonia was assessed via the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Changes in the body mass index (BMI) and BFMDRS score were analyzed using paired Student's t-tests. Regression analysis was performed to identify factors that affected the BMI after surgery.Results: Postoperative WG was observed in 78.7% of patients. The percentage of overweight and obese patients increased from 25.5% (before STN-DBS) to 48.9% (at the last follow-up). The mean BMI and mean percentage change in BMI increased by 1.32 ± 1.83 kg/m2 (P < 0.001) and 6.28 ± 8.34%, respectively. BMI increased more in female than in male patients. At the last follow-up, BFMDRS movement and disability scores improved by 69.76 ± 33.23% and 65.66 ± 31.41%, respectively (both P < 0.001). The final regression model analysis revealed that sex and preoperative BMI alone were independently associated with BMI change (P < 0.05).Conclusions: STN-DBS is associated with postoperative WG with patients with isolated dystonia. WG is more prominent in female patients and is associated with preoperative weight but not with the efficacy of STN-DBS on motor symptoms.

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Decrease in Blood Cortisol Corresponds to Weight Gain following Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease

Cited by 16 publications

References 14 publications

Weight gain following subthalamic nucleus deep brain stimulation: A PET study

Weight gain following subthalamic nucleus deep brain stimulation: A PET study

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

Weight Change After Subthalamic Nucleus Deep Brain Stimulation in Patients With Isolated Dystonia

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