Deep brain stimulation in the treatment of obesity

A review

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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.

Article Information

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:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    A sagittal section depicting the lateral hypothalamus adjacent to the optic nerve. The fornix is not well visualized in this section. *lateral hypothalamus (L); #optic nerve (II); ^ nucleus accumbens ( From Schaltenbrand G, Warren W: Atlas for Stereotaxy of the Human Brain. Stuttgart: Thieme, 1977. Reprinted, with the addition of *, #, and ^, by permission.

  • View in gallery

    A sagittal section depicting the ventromedial hypothalamus bounded anteriorly by the optic nerve and posteriorly by the ipsilateral mammillary body. *ventromedial hypothalamus (Vm); #mammillary body (M.m); +optic chiasm (Ch. II); ^anterior commissure (Cm.a). From Schaltenbrand G, Warren W: Atlas for Stereotaxy of the Human Brain. Stuttgart: Thieme, 1977. Reprinted, with the addition of *, #, +, and ^, by permission.

  • View in gallery

    A coronal section depicting the nucleus accumbens located in the ventral striatum just inferior to the caudate nucleus and inferolateral to the lateral ventricle. *nucleus accumbens (; #caudate nucleus (Cd); + putamen (Put). From Schaltenbrand G, Warren W: Atlas for Stereotaxy of the Human Brain. Stuttgart: Thieme, 1977. Reprinted, with the addition of *, #, and ^, by permission.


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