Deep brain stimulation for obesity: rationale and approach to trial design

Ho, Allen L.; Sussman, Eric S; Pendharkar, Arjun V; Azagury, Dan E.; Bohon, Cara; Halpern, Casey H.

doi:10.3171/2015.3.focus1538

Cited by 22 publications

(13 citation statements)

References 95 publications

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“…In particular, patients with PWS may represent a target group for treatment with DBS, given the overlap between the obesity secondary to hyperphagia and the dysregulation reward circuitry observed in this disorder (abnormal basal activity in the lateral hypothalamus and the nucleus accumbens). Clinical trials will have to evaluate the efficacy of DBS for genetic forms of obesity [ 73 ].…”

Section: Perspectivesmentioning

confidence: 99%

Rare Genetic Forms of Obesity: Clinical Approach and Current Treatments in 2016

Huvenne

Dubern²,

Clément³

et al. 2016

Obes Facts

183

191

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Obesity results from a synergistic relationship between genes and the environment. The phenotypic expression of genetic factors involved in obesity is variable, allowing to distinguish several clinical pictures of obesity. Monogenic obesity is described as rare and severe early-onset obesity with abnormal feeding behavior and endocrine disorders. This is mainly due to autosomal recessive mutations in genes of the leptin-melanocortin pathway which plays a key role in the hypothalamic control of food intake. Melanocortin 4 receptor(MC4R)-linked obesity is characterized by the variable severity of obesity and no notable additional phenotypes. Mutations in the MC4R gene are involved in 2-3% of obese children and adults; the majority of these are heterozygous. Syndromic obesity is associated with mental retardation, dysmorphic features, and organ-specific developmental abnormalities. Additional genes participating in the development of hypothalamus and central nervous system have been regularly identified. But to date, not all involved genes have been identified so far. New diagnostic tools, such as whole-exome sequencing, will probably help to identify other genes. Managing these patients is challenging. Indeed, specific treatments are available only for specific types of monogenic obesity, such as leptin deficiency. Data on bariatric surgery are limited and controversial. New molecules acting on the leptin-melanocortin pathway are currently being developed.

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Section: Perspectivesmentioning

confidence: 99%

Rare Genetic Forms of Obesity: Clinical Approach and Current Treatments in 2016

Huvenne

Dubern²,

Clément³

et al. 2016

Obes Facts

183

191

View full text Add to dashboard Cite

show abstract

“…We did find a trend towards a decline in BMI in the subgroup of patients with (morbid) obesity, but we did not see a replication of the substantial weight loss previously described [1]. The vALIC is currently being explored as a potential target for DBS in obesity for its assumed role in reward-related behavior [4,5,6]. Evidence for the involvement of the NAc/vALIC in compulsive eating and obesity is limited to preclinical studies that show low D2-binding in the striatum in obese individuals after food-related sensory stimuli, and in animal studies that show reduced caloric intake and weight loss associated with an upregulation of the D2 receptor.…”

Section: Discussionmentioning

confidence: 77%

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

Linssen¹,

Oudijn²,

Mantione³

et al. 2017

Stereotact Funct Neurosurg

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Background: In 2010, we published an often-cited case report describing smoking cessation and substantial weight loss after deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) in an obese patient. To test whether this single observation was also observed in the treated population at large, the weight changes of a larger cohort of patients who underwent DBS for OCD or major depressive disorder (MDD) were studied. Results: Data were available for 46 patients (30 OCD and 16 MDD patients; mean age 46.2 years, SD 10.9) with an average baseline body mass index (BMI) of 28.0 (SD 7.3), 26 of whom (57%) were overweight (n = 11), obese (n = 12), or morbidly obese (n = 3). Mean follow-up was 3.8 years (range 10 months to 8.7 years, SD 2.3), after which the average BMI was 28.1 (SD 7.0), not significantly different from baseline. The average BMI of the 15 patients with (morbid) obesity at baseline decreased from 36.8 to 34.6 (ns), while the average BMI of the 31 normal or “only” overweight patients at baseline increased from 23.8 to 25.0 (ns). Conclusion: There was no significant change in body weight on group level after DBS for either OCD or MDD.

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“…Deep brain stimulation (DBS), an invasive brain stimulation method and a reversible neurosurgical procedure that drives continuous and high-frequency stimulation of the targeted brain areas (Schlaepfer et al 2010), has been proposed for treatment of obesity and Prader Willi syndrome (Ho et al 2015) -a genetic disorder causing compulsive eating and obese phenotype (Bittel et al 2005). Moreover, DBS has also shown to be effective in treating alcoholism (Müller et al 2009) and obsessive-compulsive disorder (de Koning et al 2011, Figee et al 2013) in which impulsivity is known to be a common trait.…”

Section: Neural Stimulation Therapiesmentioning

confidence: 99%

Dürtüsellik ve Aşırı Yeme Arasındaki İlişki: Psikolojik ve Nörobiyolojik Yaklaşımlar

Atalayer¹

2018

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry

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ÖzEn temel tanımıyla dürtüsellik özdenetim olmadan davranma eğilimidir. Dürtüsellik eğilimi, aşırı yeme ve bununla ilgili belirtilerin ortaya çıkışı ve devamında da önemli bir rol oynamaktadır. Daha detaylı olarak; yüksek düzeydeki dürtüselliğin ve bununla ilişkili olan tepki kontrolünde zorluk, heyecana eğilim, ödül zafiyeti ve olumsuz duygulanım durumlarının, tıkınırcasına yeme bozukluğu-na ve obeziteye kadar ilerleyebilen duygusal yeme üzerinde bir etkileşim etkisine sahip olduğu bulunmuştur. Bu derlemenin amacı, dürtüselliğin aşırı yeme üzerindeki olası rolüne yönelik bilişsel ve nöropsikoloji alanında yapılan çalışmalardan elde edilen kanıtları bir araya getirmek ve bunun yanında obezite ve tıkınırcasına yemek bozukluğunun tedavi yöntemlerine, dürtüsellik özelliği göz önüne alınarak yapılabilecek olası değişiklik ve eklemelere önerme yapmaktır.Anahtar sözcükler: Dürtüsellik, aşerme, tıkınırcasına yeme, obezite, dışsal yeme örüntüsü. AbstractIn most basic terms impulsivity is defined as a tendency to act without control. Impulsivity has been implicated in the onset, symptomatic expression, and maintenance of overeating. Specifically, high impulsivity and associated poor inhibitory control, along with sensation seeking and reward sensitivity, as well as negative affect have been found to have an interaction effect on emotional eating, which may lead to binge eating and obesity. Moreover, associations between overeating and impulsive behaviors such as difficulty in response inhibition, planning, attention, addiction, or risk taking etc. have been previously shown. The purpose of this review is to summarize the evidence from psychology regarding the potential role of the impulsivity trait in overeating, with implications on the treatments for obesity and binge eating.

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Deep brain stimulation for obesity: rationale and approach to trial design

Cited by 22 publications

References 95 publications

Rare Genetic Forms of Obesity: Clinical Approach and Current Treatments in 2016

Rare Genetic Forms of Obesity: Clinical Approach and Current Treatments in 2016

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

Dürtüsellik ve Aşırı Yeme Arasındaki İlişki: Psikolojik ve Nörobiyolojik Yaklaşımlar

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