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Deep brain stimulation for obesity—from theoretical foundations to designing the first human pilot study

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Abstract

Obesity is perhaps an evolutionary consequence of a species reared with intermittent caloric reward. Humans are hardwired to enjoy food, and our bodies voraciously extract and store energy from food as if each meal was the last. As an amalgam of behavioral and metabolic disturbance, obesity is an attractive target for deep brain stimulation (DBS) since neuromodulation may be able to influence both eating behavior and metabolism. The current pandemic proportions of obesity combined with the failures and morbidity of modern treatments remain the impetus behind the application of DBS to this complex disease. We review the rationale and scientific foundations for obesity DBS and explain how this preclinical evidence has helped sculpt the design of the first human pilot study.

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Acknowledgments

We would like to thank Kurt W. Finnis Ph.D. of Medtronic for his help with Figure 1.

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Authors and Affiliations

  1. Department of Neurological Surgery, Allegheny General Hospital, 420 East North Avenue, Suite 302, Pittsburgh, PA, 15212, USA

    Nestor D. Tomycz, Donald M. Whiting & Michael Y. Oh

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  1. Nestor D. Tomycz
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  2. Donald M. Whiting
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Correspondence to Nestor D. Tomycz.

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Hans-Joachim Freund, Hannover, Germany

In my opinion, this proposal is well founded on the knowledge of hypothalamic mechanisms involved in energy administration and considers all the safety aspects and possible risks of the neurosurgical approach. Certainly, other parts of the hypothalamus participate in the regulation of food intake, energy metabolism and reward. None of these nuclei have only one function as we define it from behaviour, but animal experiments and human pathology indicate: this is a sensitive trial.

Johannes Sarnthein, Zurich, Switzerland

After deep brain stimulation (DBS) has proven its effectiveness for patients with movement disorders, several researchers began to search for other patient groups that might benefit equally from the technique. However, DBS is an invasive therapy and, since it targets the brain, DBS is associated with the risk of serious morbidity and mortality. Therefore, safety and efficacy of DBS in the respective patient group have to be addressed with special attention. In the case of obese patients, also ethical questions are often raised.

In their publication, Tomycz et al. describe their rationale for conducting a first human pilot study in patients suffering from severe obesity. The main goal of the study is to monitor the safety of the three patients implanted with DBS stimulators. Metabolic chamber measurements are proposed to overcome the inherent difficulties in testing the efficacy of DBS for obesity.

Given the high prevalence of obesity and its serious implications, there is a general interest in potential treatments. I therefore welcome the description of the rationale for the ongoing study at this time, and I am looking forward to learn about the results of this pioneering study in the near future.

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Tomycz, N.D., Whiting, D.M. & Oh, M.Y. Deep brain stimulation for obesity—from theoretical foundations to designing the first human pilot study. Neurosurg Rev 35, 37–43 (2012). https://doi.org/10.1007/s10143-011-0359-9

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