Could deep brain stimulation be a possible solution for acquired hypothalamic obesity?

Area of Science:

• Neuroscience
• Endocrinology
• Metabolic Disorders

Background:

• Hypothalamic dysfunction can lead to morbid obesity (HO) due to altered energy balance and satiety.
• Neurobehavioral dysfunction often co-occurs with hypothalamic dysfunction.
• Currently, no effective treatments exist for hypothalamic obesity.

Purpose of the Study:

• To investigate the potential of deep brain stimulation (DBS) as a treatment for hypothalamic obesity (HO).
• To evaluate the efficacy of DBS in addressing both HO and associated neurobehavioral dysfunction.

Main Methods:

• A systematic literature search was performed across major databases (PubMed, EMBASE, Cochrane Library) up to May 2022.
• Studies reporting on DBS for HO treatment were included.
• Data from six patients across three studies were analyzed.

Main Results:

• Deep brain stimulation (DBS) was applied to the lateral hypothalamic area (LHA) or nucleus accumbens (NAcc).
• Patients with Prader-Willi syndrome (PWS) receiving LHA-DBS showed a mean BMI increase (+5.8%), with no significant changes in hormonal or neuropsychological measures.
• A patient with HO post-craniopharyngioma (CP) treated with NAcc-DBS experienced a BMI decrease (-8.7%) and subjective improvements in mental health and energy.
• No severe adverse events were reported; mild events included hypomania and infection. Treatment was sustained for at least 6 months in most cases.

Conclusions:

• Evidence for deep brain stimulation (DBS) in treating hypothalamic obesity (HO) is currently limited.
• Effectiveness varied among the few reported cases, highlighting the need for more research.
• DBS may hold potential for severe, refractory HO, particularly in patients with craniopharyngioma, but requires further investigation into optimal targets and efficacy assessment.