Neuromodulation for the treatment of eating disorders and obesity

Lee, Darrin J.; Elias, Gavin J B; Lozano, Andrés M.

doi:10.1177/2045125317743435

Cited by 42 publications

(42 citation statements)

References 179 publications

(209 reference statements)

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“…40,61 Other theoretical targets include the medial and lateral orbitofrontal cortex, medial prefrontal cortex, ventral pallidum, caudate, insula, anterior cingulate cortex (ACC), amygdala, putamen, and hippocampus. 55 Similar to other DBS indications, early evidence for DBS treatment originated from the benefits of lesioning procedures, such as leukotomy, 65,69 thalamotomy, 91 and capsulotomy for anorexia nervosa. 6 Moreover, there is evidence for network dysfunction associated with selfawareness (insula, parietal cortex); visual and gustatory sensation (occipital cortex, insula); and the reward pathway (ventral striatum, ACC, subgenual cingulate cortex).…”

Section: Eating Disorders and Obesitymentioning

confidence: 99%

Current and future directions of deep brain stimulation for neurological and psychiatric disorders

Lee

Lozano

Dallapiazza

et al. 2019

Journal of Neurosurgery

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ABBREVIATIONS ACC = anterior cingulate cortex; AD = Alzheimer's disease; ADAS-Cog = Alzheimer's Disease Assessment Scale, Cognitive Subscale; ALIC = anterior limb of the internal capsule; ANT = anterior nucleus of the thalamus; area LC = locus of the caudate neurons; BNST = bed nucleus of the stria terminalis; CMPfc = centromedian-parafascicular complex; DBS = deep brain stimulation; ET = essential tremor; GPi = globus pallidus pars interna; ITP = inferior thalamic peduncle; NAc = nucleus accumbens; nbM = nucleus basalis of Meynert; OCD = obsessive-compulsive disorder; PAG/PVG = periaqueductal gray/periventricular gray; PD = Parkinson's disease; PTSD = posttraumatic stress disorder; STN = subthalamic nucleus; VC/VS = ventral capsule/ventral striatum; Vim = ventral intermediate thalamic nucleus; VPL/VPM = ventral posterior lateral nucleus/ventral posterior medial nucleus.Deep brain stimulation (DBS) has evolved considerably over the past 4 decades. Although it has primarily been used to treat movement disorders such as Parkinson's disease, essential tremor, and dystonia, recently it has been approved to treat obsessive-compulsive disorder and epilepsy. Novel potential indications in both neurological and psychiatric disorders are undergoing active study. There have been significant advances in DBS technology, including preoperative and intraoperative imaging, surgical approaches and techniques, and device improvements. In addition to providing significant clinical benefits and improving quality of life, DBS has also increased the understanding of human electrophysiology and network interactions. Despite the value of DBS, future developments should be aimed at developing less invasive techniques and attaining not just symptom improvement but curative disease modification.https://thejns.org/doi/abs/10.3171/2019.4.JNS181761

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Section: Eating Disorders and Obesitymentioning

confidence: 99%

Current and future directions of deep brain stimulation for neurological and psychiatric disorders

Lee

Lozano

Dallapiazza

et al. 2019

Journal of Neurosurgery

Self Cite

207

134

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“…In 1974, Quaade et al reported on three patients undergoing stereotactic RF ablation of the lateral hypothalamus in an area where electrical stimulation was able to evoke hunger-related responses, which were not further specified. These patients showed a statistically significant, but transient, decrease from preoperative to postoperative spontaneous calorie intake, while body weight decreased slightly and temporarily, not being significantly affected [91,97].…”

Section: Eating Disordersmentioning

confidence: 80%

“…To date, six studies have examined the role of ablative procedures in patients with severe AN [91]. The targets for ablation were the frontal lobe white matter [86,92], the dorsomedial thalamus [93] and more recently the ALIC [94,95] and Nac [96].…”

Section: Eating Disordersmentioning

confidence: 99%

“…However, the study was criticized due to the lack of disease-specific scales to analyze the important cognitive and behavioral aspects of AN, as well as the lack of a control group [95]. Morbid obesity (mOB) is defined by a BMI >40 or >35 kg/m 2 in the presence of a significant obesity-related comorbid condition [91]. To date, one study explored brain ablation for this disorder.…”

Section: Eating Disordersmentioning

confidence: 99%

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Ablative brain surgery: an overview

Franzini

Moosa

Servello

et al. 2019

International Journal of Hyperthermia

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Background: Ablative therapies have been used for the treatment of neurological disorders for many years. They have been used both for creating therapeutic lesions within dysfunctional brain circuits and to destroy intracranial tumors and space-occupying masses. Despite the introduction of new effective drugs and neuromodulative techniques, which became more popular and subsequently caused brain ablation techniques to fall out favor, recent technological advances have led to the resurgence of lesioning with an improved safety profile. Currently, the four main ablative techniques that are used for ablative brain surgery are radiofrequency thermoablation, stereotactic radiosurgery, laser interstitial thermal therapy and magnetic resonance-guided focused ultrasound thermal ablation. Object: To review the physical principles underlying brain ablative therapies and to describe their use for neurological disorders. Methods: The literature regarding the neurosurgical applications of brain ablative therapies has been reviewed. Results: Ablative treatments have been used for several neurological disorders, including movement disorders, psychiatric disorders, chronic pain, drug-resistant epilepsy and brain tumors. Conclusions: There are several ongoing efforts to use novel ablative therapies directed towards the brain. The recent development of techniques that allow for precise targeting, accurate delivery of thermal doses and real-time visualization of induced tissue damage during the procedure have resulted in novel techniques for cerebral ablation such as magnetic resonance-guided focused ultrasound or laser interstitial thermal therapy. However, older techniques such as radiofrequency thermal ablation or stereotactic radiosurgery still have a pivotal role in the management of a variety of neurological disorders.

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“…Advancements in preclinical and neuroimaging research studies and neurosurgical experiences led to a discovery of several targets that could prove beneficial to numerous diseases. DBS in the ventral capsule, the ventral striatum, or nucleus accumbens (NA) has been shown to improve symptoms of obsessive-compulsive disorder [13], while NA stimulation has been shown to reduce the severity of obesity and anorexia [14]. Treating treatment-resistant depression is also possible with DBS; however it requires an individualized approach due to numerous possible targets [15].…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation in Non-motor Symptoms of Neurodegenerative Diseases

Vuletić¹,

Rački²,

Chudy³

et al. 2020

Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice

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Deep brain stimulation (DBS) is a functional neuromodulatory technique that involves the use of a neurostimulator to deliver electrical impulses to the brain. It primarily alleviates the motor symptoms in neurodegenerative diseases; however, it has been found beneficial in a multitude of neurological and psychiatric diseases, such as dystonia, essential tremor, Tourette syndrome, intractable pain, epilepsy, treatmentresistant depression, and obsessive-compulsive disorder. Nonmotor symptoms, such as neurobehavioral disorders, autonomic dysfunction, sleep dysfunction, and somatosensory dysfunction, play an important role in neurodegenerative diseases and have a significant impact on the quality of life. The effects of deep brain stimulation on these symptoms are not yet apparent, although early results are promising and warrant future investigations. The main problem in interpretation is the lack of studies in this field, as most have methodological issues or small sample sizes, which limit the strength of the evidence. However, it is clear that DBS has a promising future in the treatment of neurodegenerative diseases in general and will have a vital role in personalized medicine as functional neuroimaging and our understanding of brain physiology improve.2 becoming more apparent that neurostimulations will have an even more critical role in the future as our understanding of brain physiology and pathways improves with novel imaging techniques. This chapter includes the basics of how deep brain stimulation works, what are the nonmotor symptoms in neurodegenerative diseases, and what is the current evidence on the effects of DBS on nonmotor symptoms. Deep brain stimulation 2.1 How does deep brain stimulation work?The system for DBS consists of three key components: an electrode that is placed in specific cerebral structures, an implantable pulse generator (IPG), and an extension that connects the two. Even though the exact mechanism is not yet known, the current hypothesis is that DBS works via excitation and inhibition of neurons and axons that are in proximity of the placed electrode [5]. The desired effect is achieved by changing the frequency of stimulations, as low-frequency stimulations most often excite nearby neurons [1], while high-frequency stimulations reduce local neuronal activity. Details of the implantation procedure are beyond the scope of this chapter, although it is useful to know that it is implanted stereotactically. In most cases, the stimulation is bilateral, although it is possible to stimulate unilaterally as well. The targets for stimulation are deep brain structures, as well as deep white matter tracts.A key benefit of DBS is the ability to adjust stimulations wirelessly via handheld devices to improve symptom relief and reduce possible side effects [5].Currently used method for DBS function is based on an open-loop system, which enables trained physicians to adjust various settings depending on the patient's condition [6]. This works adequately for most patients; however, changes in patien...

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Neuromodulation for the treatment of eating disorders and obesity

Cited by 42 publications

References 179 publications

Current and future directions of deep brain stimulation for neurological and psychiatric disorders

Current and future directions of deep brain stimulation for neurological and psychiatric disorders

Ablative brain surgery: an overview

Deep Brain Stimulation in Non-motor Symptoms of Neurodegenerative Diseases

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