Deep Brain Stimulation for Obesity: A Review and Future Directions
The global prevalence of obesity has been steadily increasing. Although pharmacotherapy and bariatric surgeries can be useful adjuvants in the treatment of morbid obesity, they may lose long-term effectiveness. Obesity result largely from unbalanced energy homeostasis. Palatable and densely caloric...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-04-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fnins.2019.00323/full |
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| author | Douglas A. Formolo Douglas A. Formolo Joana M. Gaspar Joana M. Gaspar Hiago M. Melo Hiago M. Melo Tuany Eichwald Tuany Eichwald Ramiro Javier Zepeda Alexandra Latini Alexandra Latini Michael S. Okun Roger Walz Roger Walz Roger Walz Roger Walz Roger Walz |
| author_facet | Douglas A. Formolo Douglas A. Formolo Joana M. Gaspar Joana M. Gaspar Hiago M. Melo Hiago M. Melo Tuany Eichwald Tuany Eichwald Ramiro Javier Zepeda Alexandra Latini Alexandra Latini Michael S. Okun Roger Walz Roger Walz Roger Walz Roger Walz Roger Walz |
| author_sort | Douglas A. Formolo |
| collection | DOAJ |
| description | The global prevalence of obesity has been steadily increasing. Although pharmacotherapy and bariatric surgeries can be useful adjuvants in the treatment of morbid obesity, they may lose long-term effectiveness. Obesity result largely from unbalanced energy homeostasis. Palatable and densely caloric foods may affect the brain overlapped circuits involved with homeostatic hypothalamus and hedonic feeding. Deep brain stimulation (DBS) consists of delivering electrical impulses to specific brain targets to modulate a disturbed neuronal network. In selected patients, DBS has been shown to be safe and effective for movement disorders. We review all the cases reports and series of patients treated with DBS for obesity using a PubMed search and will address the following obesity-related issues: (i) the hypothalamic regulation of homeostatic feeding; (ii) the reward mesolimbic circuit and hedonic feeding; (iii) basic concepts of DBS as well as the rationale for obesity treatment; (iv) perspectives and challenges in obesity DBS. The small number of cases provides preliminary evidence for the safety and the tolerability of a potential DBS approach. The ventromedial (n = 2) and lateral (n = 8) hypothalamic nuclei targets have shown mixed and disappointing outcomes. Although nucleus accumbens (n = 7) targets were more encouraging for the outcomes of body weight reduction and behavioral control for eating, there was one suicide reported after 27 months of follow-up. The authors did not attribute the suicide to DBS therapy. The identification of optimal brain targets, appropriate programming strategies and the development of novel technologies will be important as next steps to move DBS closer to a clinical application. The identification of electrical control signals may provide an opportunity for closed-loop adaptive DBS systems to address obesity. Metabolic and hormonal sensors such as glycemic levels, leptin, and ghrelin levels are candidate control signals for DBS. Focused excitation or alternatively inhibition of regions of the hypothalamus may provide better outcomes compared to non-selective DBS. Utilization of the NA delta oscillation or other physiological markers from one or multiple regions in obesity-related brain network is a promising approach. Experienced multidisciplinary team will be critical to improve the risk-benefit ratio for this approach. |
| first_indexed | 2024-12-11T15:58:57Z |
| format | Article |
| id | doaj.art-7dc0042e30fb4e7998b920979f16bf81 |
| institution | Directory Open Access Journal |
| issn | 1662-453X |
| language | English |
| last_indexed | 2024-12-11T15:58:57Z |
| publishDate | 2019-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neuroscience |
| spelling | doaj.art-7dc0042e30fb4e7998b920979f16bf812022-12-22T00:59:21ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2019-04-011310.3389/fnins.2019.00323431198Deep Brain Stimulation for Obesity: A Review and Future DirectionsDouglas A. Formolo0Douglas A. Formolo1Joana M. Gaspar2Joana M. Gaspar3Hiago M. Melo4Hiago M. Melo5Tuany Eichwald6Tuany Eichwald7Ramiro Javier Zepeda8Alexandra Latini9Alexandra Latini10Michael S. Okun11Roger Walz12Roger Walz13Roger Walz14Roger Walz15Roger Walz16Center for Applied Neuroscience, University Hospital, Federal University of Santa Catarina, Florianópolis, BrazilGraduate Program in Neuroscience, Federal University of Santa Catarina, Florianópolis, BrazilLaboratory of Bioenergetics and Oxidative Stress, Department of Biochemistry, Federal University of Santa Catarina, Florianópolis, BrazilGraduate Program in Biochemistry, Department of Biochemistry, Federal University of Santa Catarina, Florianópolis, BrazilCenter for Applied Neuroscience, University Hospital, Federal University of Santa Catarina, Florianópolis, BrazilGraduate Program in Neuroscience, Federal University of Santa Catarina, Florianópolis, BrazilLaboratory of Bioenergetics and Oxidative Stress, Department of Biochemistry, Federal University of Santa Catarina, Florianópolis, BrazilGraduate Program in Biochemistry, Department of Biochemistry, Federal University of Santa Catarina, Florianópolis, BrazilDepartment of Neuroscience, Faculty of Medicine, Chile University and Health Science Institute, O’Higgins University, Santiago, ChileLaboratory of Bioenergetics and Oxidative Stress, Department of Biochemistry, Federal University of Santa Catarina, Florianópolis, BrazilGraduate Program in Biochemistry, Department of Biochemistry, Federal University of Santa Catarina, Florianópolis, BrazilFixel Institute for Neurological Diseases, Department of Neurology, University of Florida, Gainesville, FL, United StatesCenter for Applied Neuroscience, University Hospital, Federal University of Santa Catarina, Florianópolis, BrazilGraduate Program in Neuroscience, Federal University of Santa Catarina, Florianópolis, BrazilFixel Institute for Neurological Diseases, Department of Neurology, University of Florida, Gainesville, FL, United StatesGraduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, BrazilDepartment of Internal Medicine, University Hospital, Federal University of Santa Catarina, Florianópolis, BrazilThe global prevalence of obesity has been steadily increasing. Although pharmacotherapy and bariatric surgeries can be useful adjuvants in the treatment of morbid obesity, they may lose long-term effectiveness. Obesity result largely from unbalanced energy homeostasis. Palatable and densely caloric foods may affect the brain overlapped circuits involved with homeostatic hypothalamus and hedonic feeding. Deep brain stimulation (DBS) consists of delivering electrical impulses to specific brain targets to modulate a disturbed neuronal network. In selected patients, DBS has been shown to be safe and effective for movement disorders. We review all the cases reports and series of patients treated with DBS for obesity using a PubMed search and will address the following obesity-related issues: (i) the hypothalamic regulation of homeostatic feeding; (ii) the reward mesolimbic circuit and hedonic feeding; (iii) basic concepts of DBS as well as the rationale for obesity treatment; (iv) perspectives and challenges in obesity DBS. The small number of cases provides preliminary evidence for the safety and the tolerability of a potential DBS approach. The ventromedial (n = 2) and lateral (n = 8) hypothalamic nuclei targets have shown mixed and disappointing outcomes. Although nucleus accumbens (n = 7) targets were more encouraging for the outcomes of body weight reduction and behavioral control for eating, there was one suicide reported after 27 months of follow-up. The authors did not attribute the suicide to DBS therapy. The identification of optimal brain targets, appropriate programming strategies and the development of novel technologies will be important as next steps to move DBS closer to a clinical application. The identification of electrical control signals may provide an opportunity for closed-loop adaptive DBS systems to address obesity. Metabolic and hormonal sensors such as glycemic levels, leptin, and ghrelin levels are candidate control signals for DBS. Focused excitation or alternatively inhibition of regions of the hypothalamus may provide better outcomes compared to non-selective DBS. Utilization of the NA delta oscillation or other physiological markers from one or multiple regions in obesity-related brain network is a promising approach. Experienced multidisciplinary team will be critical to improve the risk-benefit ratio for this approach.https://www.frontiersin.org/article/10.3389/fnins.2019.00323/fullobesitydeep brain stimulationhypothalamusnucleus accumbensmetabolic disordersneuroinflammation |
| spellingShingle | Douglas A. Formolo Douglas A. Formolo Joana M. Gaspar Joana M. Gaspar Hiago M. Melo Hiago M. Melo Tuany Eichwald Tuany Eichwald Ramiro Javier Zepeda Alexandra Latini Alexandra Latini Michael S. Okun Roger Walz Roger Walz Roger Walz Roger Walz Roger Walz Deep Brain Stimulation for Obesity: A Review and Future Directions Frontiers in Neuroscience obesity deep brain stimulation hypothalamus nucleus accumbens metabolic disorders neuroinflammation |
| title | Deep Brain Stimulation for Obesity: A Review and Future Directions |
| title_full | Deep Brain Stimulation for Obesity: A Review and Future Directions |
| title_fullStr | Deep Brain Stimulation for Obesity: A Review and Future Directions |
| title_full_unstemmed | Deep Brain Stimulation for Obesity: A Review and Future Directions |
| title_short | Deep Brain Stimulation for Obesity: A Review and Future Directions |
| title_sort | deep brain stimulation for obesity a review and future directions |
| topic | obesity deep brain stimulation hypothalamus nucleus accumbens metabolic disorders neuroinflammation |
| url | https://www.frontiersin.org/article/10.3389/fnins.2019.00323/full |
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