title: Lateral hypothalamic area deep brain stimulation for refractory obesity: a pilot study with preliminary data on safety, body weight, and energy metabolism.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) of the lateral hypothalamic area (LHA) has been suggested as a potential treatment for intractable obesity. The authors present the 2-year safety results as well as early efficacy and metabolic effects in 3 patients undergoing bilateral LHA DBS in the first study of this approach in humans.
  
  
  METHODS
  Three patients meeting strict criteria for intractable obesity, including failed bariatric surgery, underwent bilateral implantation of LHA DBS electrodes as part of an institutional review board- and FDA-approved pilot study. The primary focus of the study was safety; however, the authors also received approval to collect data on early efficacy including weight change and energy metabolism.
  
  
  RESULTS
  No serious adverse effects, including detrimental psychological consequences, were observed with continuous LHA DBS after a mean follow-up of 35 months (range 30-39 months). Three-dimensional nonlinear transformation of postoperative imaging superimposed onto brain atlas anatomy was used to confirm and study DBS contact proximity to the LHA. No significant weight loss trends were seen when DBS was programmed using standard settings derived from movement disorder DBS surgery. However, promising weight loss trends have been observed when monopolar DBS stimulation has been applied via specific contacts found to increase the resting metabolic rate measured in a respiratory chamber.
  
  
  CONCLUSIONS
  Deep brain stimulation of the LHA may be applied safely to humans with intractable obesity. Early evidence for some weight loss under metabolically optimized settings provides the first "proof of principle" for this novel antiobesity strategy. A larger follow-up study focused on efficacy along with a more rigorous metabolic analysis is planned to further explore the benefits and therapeutic mechanism behind this investigational therapy.
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Whiting
authors.forename: Nestor D
authors.initials: ND
authors.lastname: Tomycz
authors.forename: Julian
authors.initials: J
authors.lastname: Bailes
authors.forename: Lilian
authors.initials: L
authors.lastname: de Jonge
authors.forename: Virgile
authors.initials: V
authors.lastname: Lecoultre
authors.forename: Bryan
authors.initials: B
authors.lastname: Wilent
authors.forename: Dunbar
authors.initials: D
authors.lastname: Alcindor
authors.forename: E Richard
authors.initials: ER
authors.lastname: Prostko
authors.forename: Boyle C
authors.initials: BC
authors.lastname: Cheng
authors.forename: Cynthia
authors.initials: C
authors.lastname: Angle
authors.forename: Diane
authors.initials: D
authors.lastname: Cantella
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Whiting
authors.forename: J Scott
authors.initials: JS
authors.lastname: Mizes
authors.forename: Kirk W
authors.initials: KW
authors.lastname: Finnis
authors.forename: Eric
authors.initials: E
authors.lastname: Ravussin
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Oh
mesh_terms: D050110:Bariatric Surgery; D001828:Body Image; D001835:Body Weight; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D004734:Energy Metabolism; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007026:Hypothalamic Area, Lateral / Q000502:physiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism / Q000523:psychology / Q000601:surgery* / Q000628:therapy*; D010865:Pilot Projects; D011581:Psychological Tests; D014213:Tretoquinol
chemical_list: D014213:Tretoquinol
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