title: Deep Brain Stimulation for Obesity.
abstract: Obesity is now the third leading cause of preventable death in the US, accounting for 216,000 deaths annually and nearly 100 billion dollars in health care costs. Despite advancements in bariatric surgery, substantial weight regain and recurrence of the associated metabolic syndrome still occurs in almost 20-35% of patients over the long-term, necessitating the development of novel therapies. Our continually expanding knowledge of the neuroanatomic and neuropsychiatric underpinnings of obesity has led to increased interest in neuromodulation as a new treatment for obesity refractory to current medical, behavioral, and surgical therapies. Recent clinical trials of deep brain stimulation (DBS) in chronic cluster headache, Alzheimer's disease, and depression and obsessive-compulsive disorder have demonstrated the safety and efficacy of targeting the hypothalamus and reward circuitry of the brain with electrical stimulation, and thus provide the basis for a neuromodulatory approach to treatment-refractory obesity. In this study, we review the literature implicating these targets for DBS in the neural circuitry of obesity. We will also briefly review ethical considerations for such an intervention, and discuss genetic secondary-obesity syndromes that may also benefit from DBS. In short, we hope to provide the scientific foundation to justify trials of DBS for the treatment of obesity targeting these specific regions of the brain.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine.
authors.forename: Allen L
authors.initials: AL
authors.lastname: Ho
authors.affiliation: Department of Neurosurgery, Stanford School of Medicine/Stanford University Medical Center.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Sussman
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine.
authors.forename: Michael
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Stanford University Medical Center.
authors.forename: Arjun V
authors.initials: AV
authors.lastname: Pendharkar
authors.affiliation: Department of Surgery, Stanford School of Medicine/Stanford University Medical Center.
authors.forename: Dan E
authors.initials: DE
authors.lastname: Azagury
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine.
authors.forename: Cara
authors.initials: C
authors.lastname: Bohon
authors.affiliation: Department of Neurosurgery, Stanford University Medical Center.
authors.forename: Casey H
authors.initials: CH
authors.lastname: Halpern
keywords: behavior; deep brain stimulation; food; hypothalamus; lateral hypothalamus; metabolism; neuromodulation; nucleus accumbens; obesity; reward pathway