Lateral hypothalamic area deep brain stimulation for refractory obesity: a pilot study with preliminary data on safety, body weight, and energy metabolism

Clinical article

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Object

Deep brain stimulation (DBS) of the lateral hypothalamic area (LHA) has been suggested as a potential treatment for intractable obesity. The authors present the 2-year safety results as well as early efficacy and metabolic effects in 3 patients undergoing bilateral LHA DBS in the first study of this approach in humans.

Methods

Three patients meeting strict criteria for intractable obesity, including failed bariatric surgery, underwent bilateral implantation of LHA DBS electrodes as part of an institutional review board– and FDA-approved pilot study. The primary focus of the study was safety; however, the authors also received approval to collect data on early efficacy including weight change and energy metabolism.

Results

No serious adverse effects, including detrimental psychological consequences, were observed with continuous LHA DBS after a mean follow-up of 35 months (range 30–39 months). Three-dimensional nonlinear transformation of postoperative imaging superimposed onto brain atlas anatomy was used to confirm and study DBS contact proximity to the LHA. No significant weight loss trends were seen when DBS was programmed using standard settings derived from movement disorder DBS surgery. However, promising weight loss trends have been observed when monopolar DBS stimulation has been applied via specific contacts found to increase the resting metabolic rate measured in a respiratory chamber.

Conclusions

Deep brain stimulation of the LHA may be applied safely to humans with intractable obesity. Early evidence for some weight loss under metabolically optimized settings provides the first “proof of principle” for this novel antiobesity strategy. A larger follow-up study focused on efficacy along with a more rigorous metabolic analysis is planned to further explore the benefits and therapeutic mechanism behind this investigational therapy.

Abbreviations used in this paper:AC = anterior commissure; DBS = deep brain stimulation; LHA = lateral hypothalamic area; PC = posterior commissure; RMR = resting metabolic rate; VMH = ventromedial nucleus of the hypothalamus.

Article Information

Address correspondence to: Nestor D. Tomycz, M.D., Allegheny General Hospital, 420 East North Avenue, Suite 302, Pittsburgh, Pennsylvania 15212. email: ndtomycz@gmail.com.

Please include this information when citing this paper: published online April 5, 2013; DOI: 10.3171/2013.2.JNS12903.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Three-dimensional modeling of electrode contact location in 3 patients (Case 1 [A], Case 2 [B], and Case 3 [C]) undergoing bilateral LHA DBS. Yellow indicates the lateral hypothalamic area; rust, the fornices; light blue and light green, the medial hypothalamic nuclei. The numbers denote the contacts.

References

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