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.
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:
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