J Neurol Surg A Cent Eur Neurosurg 2022; 83(05): 471-477
DOI: 10.1055/s-0041-1740616
Review Article

Deep Brain Stimulation for Morbid Obesity: An Underutilized Neuromodulatory Treatment for Severely Obese Patients?

1   Department of Neurosurgery, Instytut Psychiatrii i Neurologii, Warsaw, Poland
,
Anna Kupryjaniuk
1   Department of Neurosurgery, Instytut Psychiatrii i Neurologii, Warsaw, Poland
,
Michał Sobstyl
1   Department of Neurosurgery, Instytut Psychiatrii i Neurologii, Warsaw, Poland
› Author Affiliations

Abstract

Background Morbid obesity (MO) has been steadily increasing in the last few years. Pharmacotherapy and bariatric surgeries remain the main treatment modalities for MO, although in the long-term they may lose their effectiveness. Other treatment approaches are urgently needed and deep brain stimulation (DBS) is a promising therapy. Disturbed energy homeostasis caused by intake of highly palatable and caloric foods may induce hedonic eating. The brain nuclei responsible for energy homeostasis and hedonia are the hypothalamic nuclei and nucleus accumbens. These brain structures constitute the stereotactic targets approached with DBS to treat MO.

Material and Methods We have performed a literature search of all available clinical applications of DBS for MO in humans. We were able to identify three case series reports and additional six case reports involving 16 patients. The selected stereotactic targets included lateral hypothalamus in eight patients, ventromedial hypothalamus in two patients, and nucleus accumbens in six patients.

Results In general, the safety profile of DBS in refractory MO patients was good. Clinical improvement regarding the mean body mass index could be observed in obese patients.

Conclusions MO is a demanding condition. Since in some cases standardized treatment is ineffective, new therapies should be implemented. DBS is a promising therapy that might be used in patients suffering from MO, however, more studies incorporating more individuals and with a longer follow-up are needed to obtain more reliable results concerning its effectiveness and safety profile.



Publication History

Received: 20 April 2021

Accepted: 15 September 2021

Article published online:
29 May 2022

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