Deep brain stimulation in the treatment of obesity

A review

View More View Less
  • 1 Departments of Neurosurgery,
  • 2 Neuroscience,
  • 3 Psychiatry, and
  • 4 Neurology; and
  • 5 Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Obesity is a growing global health problem frequently intractable to current treatment options. Recent evidence suggests that deep brain stimulation (DBS) may be effective and safe in the management of various, refractory neuropsychiatric disorders, including obesity. The authors review the literature implicating various neural regions in the pathophysiology of obesity, as well as the evidence supporting these regions as targets for DBS, in order to explore the therapeutic promise of DBS in obesity.

The lateral hypothalamus and ventromedial hypothalamus are the appetite and satiety centers in the brain, respectively. Substantial data support targeting these regions with DBS for the purpose of appetite suppression and weight loss. However, reward sensation associated with highly caloric food has been implicated in overconsumption as well as obesity, and may in part explain the failure rates of conservative management and bariatric surgery. Thus, regions of the brain's reward circuitry, such as the nucleus accumbens, are promising alternatives for DBS in obesity control.

The authors conclude that deep brain stimulation should be strongly considered as a promising therapeutic option for patients suffering from refractory obesity.

Abbreviations used in this paper: BMI = body mass index; DBS = deep brain stimulation; GABA = γ-aminobutyric acid; LH = lateral hypothalamus; MCH = melanin-concentrating hormone; NAc = nucleus accumbens; OCD = obsessive-compulsive disorder; PD = Parkinson disease; 6-OHDA = 6-hydroxydopamine; STN = subthalamic nucleus; VMH = ventromedial hypothalamus; VP = ventral pallidum.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Casey H. Halpern, M.D., Department of Neurosurgery, 3 Silverstein, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104. email: casey.halpern@uphs.upenn.edu.
  • 1

    Albin RL, , Young AB, & Penney JB: The functional anatomy of basal ganglia disorders. Trends Neurosci 12:366375, 1989

  • 2

    Allison DB, , Zannolli R, & Narayan KM: The direct health care costs of obesity in the United States. Am J Public Health 89:11941199, 1999

    • Search Google Scholar
    • Export Citation
  • 3

    Anand BK, & Brobeck JR: Localization of a “feeding center” in the hypothalamus of the rat. Proc Soc Exp Biol Med 77:323324, 1951

  • 4

    Anderson VC, , Burchiel KJ, , Hogarth P, , Favre J, & Hammerstad JP: Pallidal vs subthalamic nucleus deep brain stimulation in Parkinson disease. Arch Neurol 62:554560, 2005

    • Search Google Scholar
    • Export Citation
  • 5

    Andersson B: The effect and localization of electrical stimulation of certain parts of the brain stem in sheep and goats. Acta Physiol Scand 23:823, 1951

    • Search Google Scholar
    • Export Citation
  • 6

    Andy OJ, , Jurko MF, & Sias FR Jr: Subthalamotomy in treatment of parkinsonian tremor. J Neurosurg 20:860870, 1963

  • 7

    Aou S, , Oomura Y, , Nishino H, , Inokuchi A, & Mizuno Y: Influence of catecholamines on reward-related neuronal activity in monkey orbitofrontal cortex. Brain Res 267:165170, 1983

    • Search Google Scholar
    • Export Citation
  • 8

    Beaver JD, , Lawrence AD, , van Ditzhuijzen J, , Davis MH, , Woods A, & Calder AJ: Individual differences in reward drive predict neural responses to images of food. J Neurosci 26:51605166, 2006

    • Search Google Scholar
    • Export Citation
  • 9

    Benabid AL, , Pollak P, , Louveau A, , Henry S, & de Rougemont J: Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol 50:344346, 1987

    • Search Google Scholar
    • Export Citation
  • 10

    Bendotti C, , Berettera C, , Invernizzi R, & Samanin R: Selective involvement of dopamine in the nucleus accumbens in the feeding response elicited by muscimol injection in the nucleus raphe dorsalis of sated rats. Pharmacol Biochem Behav 24:11891193, 1986

    • Search Google Scholar
    • Export Citation
  • 11

    Bergman H, , Wichmann T, & DeLong MR: Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science 249:14361438, 1990

    • Search Google Scholar
    • Export Citation
  • 12

    Bernardis LL, & Bellinger LL: The lateral hypothalamic area revisited: ingestive behavior. Neurosci Biobehav Rev 20:189287, 1996

  • 13

    Berridge KC, & Valenstein ES: What psychological process mediates feeding evoked by electrical stimulation of the lateral hypothalamus?. Behav Neurosci 105:314, 1991

    • Search Google Scholar
    • Export Citation
  • 14

    Bewick GA, , Gardiner JV, , Dhillo WS, , Kent AS, , White NE, & Webster Z, : Post-embryonic ablation of AgRP neurons in mice leads to a lean, hypophagic phenotype. FASEB J 19:1680 1682, 2005

    • Search Google Scholar
    • Export Citation
  • 15

    Biron S, , Hould FS, , Lebel S, , Marceau S, , Lescelleur O, & Simard S, : Twenty years of biliopancreatic diversion: what is the goal of the surgery?. Obes Surg 14:160164, 2004

    • Search Google Scholar
    • Export Citation
  • 16

    Blundell JE, , Lawton CL, , Cotton JR, & Macdiarmid JI: Control of human appetite: implications for the intake of dietary fat. Annu Rev Nutr 16:285319, 1996

    • Search Google Scholar
    • Export Citation
  • 17

    Breiter HC, & Rauch SL: Functional MRI and the study of OCD: from symptom provocation to cognitive-behavioral probes of cortico-striatal systems and the amygdala. Neuroimage 4:S127S138, 1996

    • Search Google Scholar
    • Export Citation
  • 18

    Brobeck JR: Mechanism of the development of obesity in animals with hypothalamic lesions. Physiol Rev 26:541559, 1946

  • 19

    Broggi G, , Franzini A, , Marras C, , Romito L, & Albanese A: Surgery of Parkinson's disease: inclusion criteria and follow-up. Neurol Sci 24:1 Suppl S38S40, 2003

    • Search Google Scholar
    • Export Citation
  • 20

    Christou NV, , Look D, & Maclean LD: Weight gain after shortand long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg 244:734740, 2006

    • Search Google Scholar
    • Export Citation
  • 21

    Covalin A, , Feshali A, & Judy J: Deep brain stimulation for obesity control: analyzing stimulation parameters to modulate energy expenditure. Proceedings of the 2nd International IEEE EMBS, Conference on Neural Engineering Arlington, VA, IEEE EMBS, 2005. vviii

    • Search Google Scholar
    • Export Citation
  • 22

    Cox JE, & Powley TL: Intragastric pair feeding fails to prevent VMH obesity or hyperinsulinemia. Am J Physiol 240:E566 E572, 1981

  • 23

    de Lecea L, , Kilduff TS, , Peyron C, , Gao X, , Foye PE, & Danielson PE, : The hypocretins: hypothalamus-specific peptides with neuroexcitatory activity. Proc Natl Acad Sci USA 95:322327, 1998

    • Search Google Scholar
    • Export Citation
  • 24

    de Olmos JS, & Heimer L: The concepts of the ventral striatopallidal system and extended amygdala. Ann N Y Acad Sci 877:132, 1999

  • 25

    Deitel M: The International Obesity Task Force and “globesity”. Obes Surg 12:613614, 2002

  • 26

    Delgado JMR, & Anand BK: Increase of food intake induced by electrical stimulation of the lateral hypothalamus. Am J Physiol 172:162168, 1953

    • Search Google Scholar
    • Export Citation
  • 27

    Deogaonkar M, , Boulis N, , Machado A, , Azmi H, , Senatus P, & Rezai A: Surgical complications in 800 consecutive DBS implants. American Association of Neurological Surgeons 2007 Annual Meeting Proceedings Park Ridge, Ill, American Association of Neurosurgeons, 2007. Abstract No. 40777

    • Search Google Scholar
    • Export Citation
  • 28

    Deuschl G, , Herzog J, , Kleiner-Fisman G, , Kubu C, , Lozano AM, & Lyons KE, : Deep brain stimulation: postoperative issues. Mov Disord 21:14 Suppl S219S237, 2006

    • Search Google Scholar
    • Export Citation
  • 29

    Deutch AY, & Cameron DS: Pharmacological characterization of dopamine systems in the nucleus accumbens core and shell. Neuroscience 46:4956, 1992

    • Search Google Scholar
    • Export Citation
  • 30

    Elmquist JK, , Elias CF, & Saper CB: From lesions to leptin: hypothalamic control of food intake and body weight. Neuron 22:221232, 1999

  • 31

    Fang X, , Sugiyama K, , Akamine S, & Namba H: Improvements in motor behavioral tests during deep brain stimulation of the subthalamic nucleus in rats with different degrees of unilateral parkinsonism. Brain Res 1120:202210, 2006

    • Search Google Scholar
    • Export Citation
  • 32

    Field AE, , Coakley EH, , Must A, , Spadano JL, , Laird N, & Dietz WH, : Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 161:15811586, 2001

    • Search Google Scholar
    • Export Citation
  • 33

    Folkow B, & Rubinstein EH: Behavioral and autonomic patterns evoked by stimulation of the lateral hypothalamic area in the cat. Acta Physiol Scand 65:292299, 1965

    • Search Google Scholar
    • Export Citation
  • 34

    Fontaine KR, , Redden DT, , Wang C, , Westfall AO, & Allison DB: Years of life lost due to obesity. JAMA 289:187193, 2003

  • 35

    Garvey HL, & Melville KI: Cardiovascular effects of lateral hypothalamic stimulation in normal and coronary-ligated dogs. J Cardiovasc Surg (Torino) 10:377385, 1969

    • Search Google Scholar
    • Export Citation
  • 36

    Goldstein JM, & Siegel J: Suppression of attack behavior in cats by stimulation of ventral tegmental area and nucleus accumbens. Brain Res 183:181192, 1980

    • Search Google Scholar
    • Export Citation
  • 37

    Greenberg BD, , Malone DA, , Friehs GM, , Rezai AR, , Kubu CS, & Malloy PF, : Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology 31:23842393, 2006

    • Search Google Scholar
    • Export Citation
  • 38

    Groenewegen HJ, & Russchen FT: Organization of the efferent projections of the nucleus accumbens to pallidal, hypothalamic, and mesencephalic structures: a tracing and immunohistochemical study in the cat. J Comp Neurol 223:347367, 1984

    • Search Google Scholar
    • Export Citation
  • 39

    Halpern C, , Hurtig H, , Jaggi J, , Grossman M, , Won M, & Baltuch G: Deep brain stimulation in neurologic disorders. Parkinsonism Relat Disord 13:116, 2007

    • Search Google Scholar
    • Export Citation
  • 40

    Hano J, , Przewlocki R, , Smialowska M, , Chlapowska M, & Rokosz-Pelc A: The effect of electric stimulation of caudate nucleus and nucleus accumbens septi on serotonergic neurons in the rat brain. Pol J Pharmacol Pharm 30:475481, 1978

    • Search Google Scholar
    • Export Citation
  • 41

    Heimer L: Basal forebrain in the context of schizophrenia. Brain Res Brain Res Rev 31:205235, 2000

  • 42

    Herberg LJ, & Blundell JE: Lateral hypothalamus: hoarding behavior elicited by electrical stimulation. Science 155:349 350, 1967

  • 43

    Hetherington AW, & Ranson SW: The spontaneous activity and food intake in rats with hypothalamic lesions. Am J Physiol 36:609616, 1942

  • 44

    Hoebel BG: Brain neurotransmitters in food and drug reward. Am J Clin Nutr 42:11331150, 1985

  • 45

    Hoebel BG, Neuroscience and motivation: pathways and peptides that define motivational systems. Atkinson RC, , Herrnstein RJ, & Lindzey G, : Stevens' Handbook of Experimental Psychology New York, Wiley, 1988. 547625

    • Search Google Scholar
    • Export Citation
  • 46

    Hoebel BG, & Teitelbaum P: Hypothalamic control of feeding and self-stimulation. Science 135:375377, 1962

  • 47

    Huang XF, , Han M, , South T, & Storlien L: Altered levels of POMC, AgRP and MC4-R mRNA expression in the hypothalamus and other parts of the limbic system of mice prone or resistant to chronic high-energy diet-induced obesity. Brain Res 992:9 19, 2003

    • Search Google Scholar
    • Export Citation
  • 48

    Huang XF, , Xin X, , McLennan P, & Storlien L: Role of fat amount and type in ameliorating diet-induced obesity: insights at the level of hypothalamic arcuate nucleus leptin receptor, neuropeptide Y and pro-opiomelanocortin mRNA expression. Diabetes Obes Metab 6:3544, 2004

    • Search Google Scholar
    • Export Citation
  • 49

    Huang XF, , Zavitsanou K, , Huang X, , Yu Y, , Wang H, & Chen F, : Dopamine transporter and D2 receptor binding densities in mice prone or resistant to chronic high fat diet-induced obesity. Behav Brain Res 175:415419, 2006

    • Search Google Scholar
    • Export Citation
  • 50

    Jalali R, , Bergmann O, , Hosmann K, , Kupsch A, , Juckel D, & Morgenstern R, : High frequency stimulation of the subthalamic nucleus reduces quinpirole induced compulsive checking behavior in rats. Program No. 115.8. 2004 Abstract Viewer/Itinerary Planner Washington DC, Society for Neuroscience, 2004. 118

    • Search Google Scholar
    • Export Citation
  • 51

    Jeffery RW, , Kelly KM, , Rothman AJ, , Sherwood NE, & Boutelle KN: The weight loss experience: a descriptive analysis. Ann Behav Med 27:100106, 2004

    • Search Google Scholar
    • Export Citation
  • 52

    Kalarchian MA, , Marcus MD, , Wilson GT, , Labouvie EW, , Brolin RE, & LaMarca LB: Binge eating among gastric bypass patients at long-term follow-up. Obes Surg 12:270275, 2002

    • Search Google Scholar
    • Export Citation
  • 53

    Kelley AE, & Stinus L: Disappearance of hoarding behavior after 6-hydroxydopamine lesions of the mesolimbic dopamine neurons and its reinstatement with L-dopa. Behav Neurosci 99:531545, 1985

    • Search Google Scholar
    • Export Citation
  • 54

    Kennedy GC: The hypothalamic control of food intake in rats. Proc R Soc Lond B Biol Sci 137:535549, 1950

  • 55

    Kotz CM, , Teske JA, , Levine JA, & Wang C: Feeding and activity induced by orexin A in the lateral hypothalamus in rats. Regul Pept 104:2732, 2002

    • Search Google Scholar
    • Export Citation
  • 56

    Krack P, , Batir A, , Van Blercom N, , Chabardes S, , Fraix V, & Ardouin C, : Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 349:19251934, 2003

    • Search Google Scholar
    • Export Citation
  • 57

    Krasne FB: General disruption resulting from electrical stimulus of ventromedial hypothalamus. Science 138:822823, 1962

  • 58

    Lado FA, , Velisek L, & Moshe SL: The effect of electrical stimulation of the subthalamic nucleus on seizures is frequency dependent. Epilepsia 44:157164, 2003

    • Search Google Scholar
    • Export Citation
  • 59

    Lee KH, , Chang SY, , Roberts DW, & Kim U: Neurotransmitter release from high-frequency stimulation of the subthalamic nucleus. J Neurosurg 101:511517, 2004

    • Search Google Scholar
    • Export Citation
  • 60

    Lee KH, , Roberts DW, & Kim U: Effect of high-frequency stimulation of the subthalamic nucleus on subthalamic neurons: an intracellular study. Stereotact Funct Neurosurg 80:3236, 2003

    • Search Google Scholar
    • Export Citation
  • 61

    Leone M, , Franzini A, , Felisati G, , Mea E, , Curone M, & Tullo V, : Deep brain stimulation and cluster headache. Neurol Sci 26:2 Suppl S138S139, 2005

    • Search Google Scholar
    • Export Citation
  • 62

    Levin BE, , Hogan S, & Sullivan AC: Initiation and perpetuation of obesity and obesity resistance in rats. Am J Physiol 256:R766 R771, 1989

    • Search Google Scholar
    • Export Citation
  • 63

    Li Z, , Maglione M, , Tu W, , Mojica W, , Arterburn D, & Shugarman LR, : Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med 142:532546, 2005

    • Search Google Scholar
    • Export Citation
  • 64

    Ludwig DS, , Tritos NA, , Mastaitis JW, , Kulkarni R, , Kokkotou E, & Elmquist J, : Melanin-concentrating hormone overexpression in transgenic mice leads to obesity and insulin resistance. J Clin Invest 107:379386, 2001

    • Search Google Scholar
    • Export Citation
  • 65

    Maggard MA, , Shugarman LR, , Suttorp M, , Maglione M, , Sugerman HJ, & Livingston EH, : Meta-analysis: surgical treatment of obesity. Ann Intern Med 142:547559, 2005

    • Search Google Scholar
    • Export Citation
  • 66

    Maldonado-Irizarry CS, & Kelley AE: Excitotoxic lesions of the core and shell subregions of the nucleus accumbens differentially disrupt body weight regulation and motor activity in rat. Brain Res Bull 38:551559, 1995

    • Search Google Scholar
    • Export Citation
  • 67

    Maldonado-Irizarry CS, , Swanson CJ, & Kelley AE: Glutamate receptors in the nucleus accumbens shell control feeding behavior via the lateral hypothalamus. J Neurosci 15:67796788, 1995

    • Search Google Scholar
    • Export Citation
  • 68

    Marsh DJ, , Hollopeter G, , Kafer KE, & Palmiter RD: Role of the Y5 neuropeptide Y receptor in feeding and obesity. Nat Med 4:718721, 1998

  • 69

    Martel P, & Fantino M: Influence of the amount of food ingested on mesolimbic dopaminergic system activity: a microdialysis study. Pharmacol Biochem Behav 55:297302, 1996

    • Search Google Scholar
    • Export Citation
  • 70

    Mathus-Vliegen EM: Long-term weight loss after bariatric surgery in patients visited at home outside the study environment. Obes Surg 16:15081519, 2006

    • Search Google Scholar
    • Export Citation
  • 71

    McBriar MD, , Guzik H, , Xu R, , Paruchova J, , Li S, & Palani A, : Discovery of bicycloalkyl urea melanin concentrating hormone receptor antagonists: orally efficacious antiobesity therapeutics. J Med Chem 48:22742277, 2005

    • Search Google Scholar
    • Export Citation
  • 72

    McCracken CB, & Grace AA: High-frequency deep brain stimulation of the nucleus accumbens region suppresses neuronal activity and selectively modulates afferent drive in rat orbitofrontal cortex in vivo. J Neurosci 27:1260112610, 2007

    • Search Google Scholar
    • Export Citation
  • 73

    McIntyre CC, , Savasta M, , Kerkerian-Le Goff L, & Vitek JL: Uncovering the mechanism(s) of action of deep brain stimulation: activation, inhibition, or both. Clin Neurophysiol 115:1239 1248, 2004

    • Search Google Scholar
    • Export Citation
  • 74

    Meguid MM, , Fetissov SO, , Varma M, , Sato T, , Zhang L, & Laviano A, : Hypothalamic dopamine and serotonin in the regulation of food intake. Nutrition 16:843857, 2000

    • Search Google Scholar
    • Export Citation
  • 75

    Mendelson J, & Chorover SL: Lateral hypothalamic stimulation in satiated rats: T-maze learning for food. Science 149:559 561, 1965

  • 76

    Mirski MA, & Ferrendelli JA: Interruption of the mammillothalamic tract prevents seizures in guinea pigs. Science 226:72 74, 1984

  • 77

    Morton GJ, , Cummings DE, , Baskin DG, , Barsh GS, & Schwartz MW: Central nervous system control of food intake and body weight. Nature 443:289295, 2006

    • Search Google Scholar
    • Export Citation
  • 78

    Moyer JT, , Wolf JA, & Finkel LH: Effects of dopaminergic modulation on the integrative properties of the ventral striatal medium spiny neuron. J Neurophysiol 98:37313748, 2007

    • Search Google Scholar
    • Export Citation
  • 79

    Mucha RF, & Iversen SD: Increased food intake after opioid microinjections into nucleus accumbens and ventral tegmental area of rat. Brain Res 397:214224, 1986

    • Search Google Scholar
    • Export Citation
  • 80

    Murer MG, & Pazo JH: Behavioral responses induced by electrical stimulation of the caudate nucleus in freely moving cats. Behav Brain Res 57:919, 1993

    • Search Google Scholar
    • Export Citation
  • 81

    Must A, , Spadano J, , Coakley EH, , Field AE, , Colditz G, & Dietz WH: The disease burden associated with overweight and obesity. JAMA 282:15231529, 1999

    • Search Google Scholar
    • Export Citation
  • 82

    Ocón Bretón J, , Pérez Naranjo S, , Gimeno Laborda S, , Benito Ruesca P, & García Hernández R: [Effectiveness and complications of bariatric surgery in the treatment of morbid obesity.]. Nutr Hosp 20:409414, 2005. (Span)

    • Search Google Scholar
    • Export Citation
  • 83

    Ogden CL, , Carroll MD, , Curtin LR, , McDowell MA, , Tabak CJ, & Flegal KM: Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:15491555, 2006

    • Search Google Scholar
    • Export Citation
  • 84

    Okun MS, , Mann G, , Foote KD, , Shapira NA, , Bowers D, & Springer U, : Deep brain stimulation in the internal capsule and nucleus accumbens region: responses observed during active and sham programming. J Neurol Neurosurg Psychiatry 78:310314, 2007

    • Search Google Scholar
    • Export Citation
  • 85

    Peyron C, , Tighe DK, , van den Pol AN, , de Lecea L, , Heller HC, & Sutcliffe JG, : Neurons containing hypocretin (orexin) project to multiple neuronal systems. J Neurosci 18:999610015, 1998

    • Search Google Scholar
    • Export Citation
  • 86

    Pories WJ, , Swanson MS, , MacDonald KG, , Long SB, , Morris PG, & Brown BM, : Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222:339352, 1995

    • Search Google Scholar
    • Export Citation
  • 87

    Poschel BPH: Comparison of reinforcing effects yielded by lateral versus medial hypothalamic stimulation. J Comp Physiol Psychol 61:346352, 1966

    • Search Google Scholar
    • Export Citation
  • 88

    Predy PA, & Kokkindis L: Sensitization to the effects of repeated amphetamine administration on intracranial self-stimulation: evidence for changes in reward processes. Behav Brain Res 13:251259, 1984

    • Search Google Scholar
    • Export Citation
  • 89

    Purves D, , Augustine GJ, , Fitzpatrick D, , Katz L, , LaMantia A, & McNamara JO, : Neuroscience ed 2 Sunderland, MA, Sinauer Associated, Inc., 2001

    • Search Google Scholar
    • Export Citation
  • 90

    Quaade F, , Vaernet K, & Larsson S: Stereotaxic stimulation and electrocoagulation of the lateral hypothalamus in obese humans. Acta Neurochir (Wien) 30:111117, 1974

    • Search Google Scholar
    • Export Citation
  • 91

    Rauch SL: Neuroimaging and neurocircuitry models pertaining to the neurosurgical treatment of psychiatric disorders. Neurosurg Clin N Am 14:213223, viiviii, 2003

    • Search Google Scholar
    • Export Citation
  • 92

    Roe DA, & Eickwort KR: Relationships between obesity and associated health factors with unemployment among low income women. J Am Med Womens Assoc 31:193194, 198199, 203194, 1976

    • Search Google Scholar
    • Export Citation
  • 93

    Rolls ET: The neurophysiology of feeding. Int J Obes 8:1 Suppl 139150, 1984

  • 94

    Ruffin M, & Nicolaidis S: Electrical stimulation of the ventromedial hypothalamus enhances both fat utilization and metabolic rate that precede and parallel the inhibition of feeding behavior. Brain Res 846:2329, 1999

    • Search Google Scholar
    • Export Citation
  • 95

    Saito M, , Minokoshi Y, & Shimazu T: Accelerated norepinephrine turnover in peripheral tissues after ventromedial hypothalamic stimulation in rats. Brain Res 481:298303, 1989

    • Search Google Scholar
    • Export Citation
  • 96

    Sakurai T, , Amemiya A, , Ishii M, , Matsuzaki I, , Chemelli RM, & Tanaka H, : Orexins and orexin receptors: a family of hypothalamic neuropeptides and G protein-coupled receptors that regulate feeding behavior. Cell 92:573585, 1998

    • Search Google Scholar
    • Export Citation
  • 97

    Sani S, , Jobe K, , Smith A, , Kordower JH, & Bakay RA: Deep brain stimulation for treatment of obesity in rats. J Neurosurg 107:809813, 2007

    • Search Google Scholar
    • Export Citation
  • 98

    Sani SB, , Jobe KW, , Kordower J, & Bakay RA: Deep brain stimulation for the treatment of obesity in the rat. 73rd Annual Meeting, American Association of Neurological Surgeons Rolling Meadows, IL, AANS, 2005. (Abstract #24653)

    • Search Google Scholar
    • Export Citation
  • 99

    Schaltenbrand G, & Warren W: Atlas for Stereotaxy of the Human Brain Stuttgart, Thieme, 1977

  • 100

    Schlaepfer TE, , Cohen MX, , Frick C, , Kosel M, , Brodesser D, & Axmacher N, : Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology 33:368377, 2007

    • Search Google Scholar
    • Export Citation
  • 101

    Schwartzbaum JS: Electrophysiology of taste, feeding and reward in lateral hypothalamus of rabbit. Physiol Behav 44:507526, 1988

  • 102

    Shimizu H, , Shimomura Y, , Takahashi M, , Uehara Y, , Fukatsu A, & Sato N: Altered ambulatory activity and related brain monoamine metabolism in genetically obese Zucker rats. Exp Clin Endocrinol 97:3944, 1991

    • Search Google Scholar
    • Export Citation
  • 103

    Shumyatsky GP, , Tsvetkov E, , Malleret G, , Vronskaya S, , Hatton M, & Hampton L, : Identification of a signaling network in lateral nucleus of amygdala important for inhibiting memory specifically related to learned fear. Cell 111:905918, 2002

    • Search Google Scholar
    • Export Citation
  • 104

    Smith KS, & Berridge KC: Opioid limbic circuit for reward: interaction between hedonic hotspots of nucleus accumbens and ventral pallidum. J Neurosci 27:15941605, 2007

    • Search Google Scholar
    • Export Citation
  • 105

    Stanley BG, , Magdalin W, , Seirafi A, , Thomas WJ, & Leibowitz SF: The perifornical area: the major focus of (a) patchily distributed hypothalamic neuropeptide Y-sensitive feeding system(s). Brain Res 604:304317, 1993

    • Search Google Scholar
    • Export Citation
  • 106

    Stenger J, , Fournier T, & Bielajew C: The effects of chronic ventromedial hypothalamic stimulation on weight gain in rats. Physiol Behav 50:12091213, 1991

    • Search Google Scholar
    • Export Citation
  • 107

    Sturm R: Increases in morbid obesity in the USA: 2000–2005. Public Health 121:492496, 2007

  • 108

    Sturm V, , Lenartz D, , Koulousakis A, , Treuer H, , Herholz K, & Klein JC, : The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive- and anxiety-disorders. J Chem Neuroanat 26:293299, 2003

    • Search Google Scholar
    • Export Citation
  • 109

    Taha SA, & Fields HL: Encoding of palatability and appetitive behaviors by distinct neuronal populations in the nucleus accumbens. J Neurosci 25:11931202, 2005

    • Search Google Scholar
    • Export Citation
  • 110

    Teegarden SL, & Bale TL: Decreases in dietary preference produce increased emotionality and risk for dietary relapse. Biol Psychiatry 61:10211029, 2007

    • Search Google Scholar
    • Export Citation
  • 111

    Toleikis JR, , Toleikis SC, , Barborica A, , Verhagen L, , Sturaitis MK, & Bakay R: Analysis of human single unit activity acquired during deep brain stimulation. Proceedings of the American Association of Neurological Surgeons, Annual Meeting 2007 Park Ridge, IL, AANS, 2007

    • Search Google Scholar
    • Export Citation
  • 112

    Tremblay LK, , Naranjo CA, , Graham SJ, , Herrmann N, , Mayberg HS, & Hevenor S, : Functional neuroanatomical substrates of altered reward processing in major depressive disorder revealed by a dopaminergic probe. Arch Gen Psychiatry 62:12281236, 2005

    • Search Google Scholar
    • Export Citation
  • 113

    Valenstein ES, , Cox VC, & Kakolewski JW: Modification of motivated behavior elicited by electrical stimulation of the hypothalamus. Science 159:11191121, 1968

    • Search Google Scholar
    • Export Citation
  • 114

    van Kuyck K, , Demeulemeester H, , Feys H, , De Weerdt W, , Dewil M, & Tousseyn T, : Effects of electrical stimulation or lesion in nucleus accumbens on the behaviour of rats in a T-maze after administration of 8-OH-DPAT or vehicle. Behav Brain Res 140:165173, 2003

    • Search Google Scholar
    • Export Citation
  • 115

    van Kuyck K, , Gabriëls L, , Cosyns P, , Arckens L, , Sturm V, & Rasmussen S, : Behavioural and physiological effects of electrical stimulation in the nucleus accumbens: a review. Acta Neurochir Suppl 97 375391, 2007

    • Search Google Scholar
    • Export Citation
  • 116

    Van Rijckevorsel K, , Basel A, , de Tourtchaninoff M, , Gwenaelle M, , Ivanoiu A, & Grandin C, : Safety and tolerability of deep brain stimulation of mammillary bodies and mammillothalamic area in patients with chronic refractory epilepsy. Epilepsia 45:164, 2004

    • Search Google Scholar
    • Export Citation
  • 117

    Velley L, & Cardo B: Long-term improvement of learning after early electrical stimulation of some central nervous structures: is the effect structure and age-dependent?. Brain Res Bull 4:459466, 1979

    • Search Google Scholar
    • Export Citation
  • 118

    Voges J, , Waerzeggers Y, , Maarouf M, , Lehrke R, , Koulousakis A, & Lenartz D, : Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery–experiences from a single centre. J Neurol Neurosurg Psychiatry 77:868 872, 2006

    • Search Google Scholar
    • Export Citation
  • 119

    Volkow ND, & O'Brien CP: Issues for DSM-V: should obesity be included as a brain disorder?. Am J Psychiatry 164:708 710, 2007

  • 120

    Wang GJ, , Volkow ND, , Thanos PK, & Fowler JS: Similarity between obesity and drug addiction as assessed by neurofunctional imaging: a concept review. J Addict Dis 23:3953, 2004

    • Search Google Scholar
    • Export Citation
  • 121

    Weber M, , Muller MK, , Bucher T, , Wildi S, , Dindo D, & Horber F, : Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg 240:975983, 2004

    • Search Google Scholar
    • Export Citation
  • 122

    Will MJ, , Pratt WE, & Kelley AE: Pharmacological characterization of high-fat feeding induced by opioid stimulation of the ventral striatum. Physiol Behav 89:226234, 2006

    • Search Google Scholar
    • Export Citation
  • 123

    Wise RA, & Rompre PP: Brain dopamine and reward. Annu Rev Psychol 40:191225, 1989

  • 124

    Wolf JA, , Moyer JT, , Lazarewicz MT, , Contreras D, , Benoit-Marand M, & O'Donnell P, : NMDA/AMPA ratio impacts state transitions and entrainment to oscillations in a computational model of the nucleus accumbens medium spiny projection neuron. J Neurosci 25:90809095, 2005

    • Search Google Scholar
    • Export Citation
  • 125

    Wortley KE, , Chang GQ, , Davydova Z, & Leibowitz SF: Peptides that regulate food intake: orexin gene expression is increased during states of hypertriglyceridemia. Am J Physiol Regul Integr Comp Physiol 284:R1454R1465, 2003

    • Search Google Scholar
    • Export Citation
  • 126

    Wright J, , Kelly DF, , Mitchell-Heggs N, & Frankel R, Respiratory changes induced by intracranial stimulation: anatomical localizing value and related functional effects in rhesus monkeys. Sweet WH, , Obrador S, & Martin-Rodriguez JG: Neurosurgical Treatment in Psychiatry, Pain, and Epilepsy Baltimore, University Park Press, 1977. 751756

    • Search Google Scholar
    • Export Citation
  • 127

    Wyrwicka W, & Dobrzecka C: Relationship between feeding and satiation centers of the hypothalamus. Science 132:805806, 1960

  • 128

    Zaborszky L, , Alheid GF, , Beinfeld MC, , Eiden LE, , Heimer L, & Palkovits M: Cholecystokinin innervation of the ventral striatum: a morphological and radioimmunological study. Neuroscience 14:427453, 1985

    • Search Google Scholar
    • Export Citation
  • 129

    Zahm DS: An integrative neuroanatomical perspective on some subcortical substrates of adaptive responding with emphasis on the nucleus accumbens. Neurosci Biobehav Rev 24:85 105, 2000

    • Search Google Scholar
    • Export Citation
  • 130

    Zahm DS, & Brog JS: On the significance of subterritories in the “accumbens” part of the rat ventral striatum. Neuroscience 50:751767, 1992

    • Search Google Scholar
    • Export Citation
  • 131

    Zhang M, , Gosnell BA, & Kelley AE: Intake of high-fat food is selectively enhanced by mu opioid receptor stimulation within the nucleus accumbens. J Pharmacol Exp Ther 285:908914, 1998

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1283 576 50
Full Text Views 263 35 3
PDF Downloads 166 16 0
EPUB Downloads 0 0 0