Studies raise possibility of new DBS approaches to treat obesity

Scientific advances in understanding the "addiction circuitry" of the brain may lead to effective treatment for obesity using deep brain stimulation (DBS), according to a review article in the August issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Electrical brain stimulation targeting the "dysregulated reward circuitry" could make DBS—already an accepted treatment for Parkinson's disease—a new option for the difficult-to-treat problem of obesity. Dr. Alexander Taghva of Ohio State University and University of Southern California was lead author of the new review.

New Insights into 'Reward Circuitry'
Obesity is a major public health problem that is notoriously difficult to treat. Although various approaches can promote weight loss, patients typically gain weight soon after the end of treatment. Drug options have shown limited success, with several products removed from the market because of serious adverse effects. Bariatric surgery is effective in many cases of obesity but has a significant failure rate and is associated with side effects.

Drug treatments for obesity have targeted the homeostatic (self-regulating) mechanism regulating appetite and body weight. The homeostatic mechanism is thought to involve the "feeding center" in the hypothalamus, which produces hormones (such as leptin and insulin) that affect feeding behavior.

Initial experiments exploring DBS as a treatment for obesity have targeted the hypothalamus. However—as with drug options focusing on the homeostatic mechanisms—success has been limited.

Possible Role of DBS for Obesity
More recent studies have explored a different mechanism: specifically, the "reward circuitry," of the brain. Research has suggested that obesity is associated with a "relative imbalance" of the reward circuitry. Studies show that obese subjects—like those with addictive behaviors—are more impulsive and less able to delay gratification. The reward circuitry is intimately interconnected with the homeostatic mechanisms.

Together, these studies raise the possibility of new DBS approaches to the treatment of obesity. In DBS, a small electrode is surgically placed in a precise location in the brain. A mild electrical current is delivered to stimulate that area of the brain, with the goal of interrupting abnormal activity. Deep brain stimulation has become a standard and effective treatment for movement disorders such as Parkinson's disease.

Just as stimulation of the brain areas responsible for abnormal movement helps "turn off" tremors in patients with Parkinson's disease, stimulation of the areas involved in dysregulated reward circuitry might be able to "turn off" abnormal feeding behaviors in obese patients. The authors outline evidence implicating several different brain areas involved in the brain's reward circuitry—particularly the "frontostriatal circuitry"—which could be useful targets for DBS.

Previous reports in individual patients have suggested that DBS performed for other reasons—particularly severe obsessive-compulsive disorder—have unexpectedly had unpredicted beneficial effects on addictive behaviors like smoking and overeating. Dr. Taghva and colleagues hope their review will open the way to further exploration of DBS as part of new and effective strategies for the treatment of obesity, perhaps in combination with therapies targeting the homeostatic mechanism.