title: Expanding applications of deep brain stimulation: a potential therapeutic role in obesity and addiction management.
abstract: BACKGROUND
  The indications for deep brain stimulation (DBS) are expanding, and the feasibility and efficacy of this surgical procedure in various neurologic and neuropsychiatric disorders continue to be tested. This review attempts to provide background and rationale for applying this therapeutic option to obesity and addiction. We review neural targets currently under clinical investigation for DBS—the hypothalamus and nucleus accumbens—in conditions such as cluster headache and obsessive-compulsive disorder. These brain regions have also been strongly implicated in obesity and addiction. These disorders are frequently refractory, with very high rates of weight regain or relapse, respectively, despite the best available treatments.
  
  
  METHODS
  We performed a structured literature review of the animal studies of DBS, which revealed attenuation of food intake, increased metabolism, or decreased drug seeking. We also review the available radiologic evidence in humans, implicating the hypothalamus and nucleus in obesity and addiction.
  
  
  RESULTS
  The available evidence of the promise of DBS in these conditions combined with significant medical need, support pursuing pilot studies and clinical trials of DBS in order to decrease the risk of dietary and drug relapse.
  
  
  CONCLUSIONS
  Well-designed pilot studies and clinical trials enrolling carefully selected patients with obesity or addiction should be initiated.
authors: Department of Neurosurgery, Center for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Washington Square West Building, 235 South 8th Street, Philadelphia, PA 19106, USA.
authors: Casey H
authors: CH
authors: Halpern
authors: Napoleon
authors: N
authors: Torres
authors: Howard I
authors: HI
authors: Hurtig
authors: John A
authors: JA
authors: Wolf
authors: James
authors: J
authors: Stephen
authors: Michael Y
authors: MY
authors: Oh
authors: Noel N
authors: NN
authors: Williams
authors: Marc A
authors: MA
authors: Dichter
authors: Jurg L
authors: JL
authors: Jaggi
authors: Arthur L
authors: AL
authors: Caplan
authors: Kyle M
authors: KM
authors: Kampman
authors: Thomas A
authors: TA
authors: Wadden
authors: Donald M
authors: DM
authors: Whiting
authors: Gordon H
authors: GH
authors: Baltuch
mesh_terms: D000818:Animals; D046690:Deep Brain Stimulation / Q000379:methods* / Q000639:trends*; D004195:Disease Models, Animal; D006801:Humans; D007031:Hypothalamus / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery*; D009714:Nucleus Accumbens / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery*; D009765:Obesity / Q000503:physiopathology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome