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Expanding applications of deep brain stimulation: a potential therapeutic role in obesity and addiction management

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Abstract

Background

The indications for deep brain stimulation (DBS) are expanding, and the feasibility and efficacy of this surgical procedure in various neurologic and neuropsychiatric disorders continue to be tested. This review attempts to provide background and rationale for applying this therapeutic option to obesity and addiction. We review neural targets currently under clinical investigation for DBS—the hypothalamus and nucleus accumbens—in conditions such as cluster headache and obsessive-compulsive disorder. These brain regions have also been strongly implicated in obesity and addiction. These disorders are frequently refractory, with very high rates of weight regain or relapse, respectively, despite the best available treatments.

Methods

We performed a structured literature review of the animal studies of DBS, which revealed attenuation of food intake, increased metabolism, or decreased drug seeking. We also review the available radiologic evidence in humans, implicating the hypothalamus and nucleus in obesity and addiction.

Results

The available evidence of the promise of DBS in these conditions combined with significant medical need, support pursuing pilot studies and clinical trials of DBS in order to decrease the risk of dietary and drug relapse.

Conclusions

Well-designed pilot studies and clinical trials enrolling carefully selected patients with obesity or addiction should be initiated.

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Acknowledgements

We would like to thank Drs. Helen Mayberg, Charles O’Brien, and Anna Rose Childress for their invaluable discussion and comments that have greatly impacted the preparation of this manuscript. Thanks to Drs. Akiva Cohen, Jeffrey Keating and Hal Juul, and Mr. William Rodemer for their contributions to our preliminary work in a rodent model of binge eating.

Conflicts of interest

The authors have no financial disclosures or conflicts of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Center for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Washington Square West Building, 235 South 8th Street, Philadelphia, PA, 19106, USA

    Casey H. Halpern, John A. Wolf, James Stephen, Jurg L. Jaggi & Gordon H. Baltuch

  2. Department of Psychiatry, Center for Studies of Addiction, Hospital of the University of Pennsylvania, Philadelphia, PA, 19106, USA

    Kyle M. Kampman

  3. Department of Neurology, Hospital of the University of Pennsylvania, Neuroscience Graduate Group, Philadelphia, PA, 19106, USA

    Howard I. Hurtig & Marc A. Dichter

  4. Department of Medical Ethics, Hospital of the University of Pennsylvania, Philadelphia, PA, 19106, USA

    Arthur L. Caplan

  5. Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, 15301, USA

    Michael Y. Oh & Donald M. Whiting

  6. Département: DRT/DTBS/SBSC/DIR CEA-LETI, CEA-LETI, CLINATEC, Grenoble, France

    Napoleon Torres

  7. Department of Psychiatry, Center for Studies of Weight and Eating Disorders, Hospital of the University of Pennsylvania, Philadelphia, PA, 19106, USA

    Thomas A. Wadden

  8. Department of Surgery, Division of Bariatric Surgery, Center for Studies of Weight and Eating Disorders, Hospital of the University of Pennsylvania, Philadelphia, PA, 19106, USA

    Noel N. Williams & Marc A. Dichter

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  1. Casey H. Halpern
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  14. Gordon H. Baltuch
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Correspondence to Gordon H. Baltuch.

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Halpern, C.H., Torres, N., Hurtig, H.I. et al. Expanding applications of deep brain stimulation: a potential therapeutic role in obesity and addiction management. Acta Neurochir 153, 2293–2306 (2011). https://doi.org/10.1007/s00701-011-1166-3

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