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Deep brain stimulation

Could deep brain stimulation treat obesity?

Research indicates obesity is associated with a relative imbalance of the reward circuitry
Study author, Alexander Taghva

Deep brain stimulation (DBS) is widely accepted as an effective treatment for neurological conditions such as Parkinson's disease, now researchers from the Ohio State University and University of Southern California, claim that the treatment could be used to treat obesity.

According to a review article in the journal Neurosurgery, Dr Alexander Taghva and colleagues claim recent understandings of the dysregulated reward circuitry of the brain may lead to developing in tackling obesity.

Drug treatments for obesity have targeted the homeostatic (self-regulating) mechanism regulating appetite and body weight. The homeostatic mechanism is thought to involve the feeding centre in the hypothalamus, which produces hormones (such as leptin and insulin) that affect feeding behaviour.

Initial experiments exploring DBS as a treatment for obesity have targeted the hypothalamus. However, as with drug options focusing on the homeostatic mechanisms, success has been limited

More recent studies have explored a different mechanism. Specifically, the dysregulated reward circuitry, of the brain. Research has suggested that obesity is associated with a relative imbalance of the reward circuitry and shows that obese subjects are more impulsive and less able to delay gratification. The reward circuitry is intimately interconnected with the homeostatic mechanisms.

The researchers have suggested that DBS could be used to deliver a mild electrical current to stimulate that area of the brain, with the goal of interrupting the feeding behaviour in obese patients.

They outline evidence implicating several different brain areas involved in the brain's reward circuitry, particularly the frontostriatal circuitry, which could be useful targets for DBS.

Previous reports in individual patients have suggested that DBS performed for other reasons, particularly severe obsessive-compulsive disorder, have unexpectedly had unpredicted beneficial effects on addictive behaviours like smoking and overeating.

Taghva and colleagues hope their review will open the way to further exploration of DBS, perhaps in combination with therapies targeting the homeostatic mechanism.

Clinical study

Ohio State University is currently conducting a study designed to investigate the safety and efficacy of deep brain stimulation (DBS) as a treatment option for obesity. The study will recruit five patients who are at least 24 months post Roux-en-Y gastric bypass surgery without evidence of a sustained improvement in BMI after surgery for at least six months. The primary outcome measure at the conclusion of the study will be percent of excess weight loss (EWL). The study is not expected to be completed until January 2015.

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