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.
Keywords
neurosurgery - morbid obesity - deep brain stimulation (DBS) - nucleus accumbens -
hypothalamus
