title: Deep brain stimulation for obesity: rationale and approach to trial design.
abstract: Obesity is one of the most serious public health concerns in the US. While bariatric surgery has been shown to be successful for treatment of morbid obesity for those who have undergone unsuccessful behavioral modification, its associated risks and rates of relapse are not insignificant. There exists a neurological basis for the binge-like feeding behavior observed in morbid obesity that is believed to be due to dysregulation of the reward circuitry. The authors present a review of the evidence of the neuroanatomical basis for obesity, the potential neural targets for deep brain stimulation (DBS), as well as a rationale for DBS and future trial design. Identification of an appropriate patient population that would most likely benefit from this type of therapy is essential. There are also significant cost and ethical considerations for such a neuromodulatory intervention designed to alter maladaptive behavior. Finally, the authors present a consolidated set of inclusion criteria and study end points that should serve as the basis for any trial of DBS for obesity.
authors.affiliation: 1Departments of Neurosurgery.
authors.forename: Allen L
authors.initials: AL
authors.lastname: Ho
authors.affiliation: 1Departments of Neurosurgery.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Sussman
authors.affiliation: 1Departments of Neurosurgery.
authors.forename: Arjun V
authors.initials: AV
authors.lastname: Pendharkar
authors.affiliation: 2General Surgery, and.
authors.forename: Dan E
authors.initials: DE
authors.lastname: Azagury
authors.affiliation: 3Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
authors.forename: Cara
authors.initials: C
authors.lastname: Bohon
authors.affiliation: 1Departments of Neurosurgery.|3Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
authors.forename: Casey H
authors.initials: CH
authors.lastname: Halpern
mesh_terms: D002986:Clinical Trials as Topic / Q000379:methods; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D009765:Obesity / Q000473:pathology / Q000628:therapy*; D012107:Research Design
keywords: BMI = body mass index; DBS = deep brain stimulation; DSM = Diagnostic and Statistical Manual of Mental Disorders; LH = lateral hypothalamus; NAc = nucleus accumbens; OCD = obsessive-compulsive disorder; PD = Parkinson’s disease; PWS = Prader-Willi syndrome; Prader-Willi syndrome; QALY = quality-adjusted life year; VMH = ventromedial hypothalamus; YFAS = Yale Food Addiction Scale; deep brain stimulation; lateral hypothalamus; nucleus accumbens; obesity