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Stapińska-Syniec A, Kupryjaniuk A, Sobstyl M. Deep Brain Stimulation for Morbid Obesity: An Underutilized Neuromodulatory Treatment for Severely Obese Patients? J Neurol Surg A Cent Eur Neurosurg 2022; 83:471-477. [DOI: 10.1055/s-0041-1740616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
| | - Anna Kupryjaniuk
- Department of Neurosurgery, Instytut Psychiatrii i Neurologii, Warsaw, Poland
| | - Michał Sobstyl
- Department of Neurosurgery, Instytut Psychiatrii i Neurologii, Warsaw, Poland
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Jia P, Cao X, Yang H, Dai S, He P, Huang G, Wu T, Wang Y. Green space access in the neighbourhood and childhood obesity. Obes Rev 2021; 22 Suppl 1:e13100. [PMID: 32666688 PMCID: PMC7988598 DOI: 10.1111/obr.13100] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022]
Abstract
Access to green space may influence individual physical activity (PA) and subsequently weight status, as increased exposure to green space could improve health by increasing opportunities and the actual levels of PA. However, whether such associations hold empirically remains inconclusive. This study reviewed articles that analysed the association between access to green space and weight-related behaviours/outcomes among children, published before 1 January 2019. The sample sizes ranged from 108 to 44 278. Four cohorts and 17 cross-sectional studies conducted in nine countries were identified. Overall, evidence showed a positive association between access to green space and PA and a negative association between access to green space and television-watching time, body mass index (BMI) and weight status among children. Distance to the nearest green space, measured by geographic information system (GIS) in 10 studies, was often used to represent access to the nearest green space. It still remains difficult to draw a clear conclusion on the association between access to green space and BMI. Longitudinal studies can directly estimate the strength of the association between exposure and disease, which is needed to determine the causal association between access to green space and weight status.
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Affiliation(s)
- Peng Jia
- Department of Land Surveying and Geo‐InformaticsThe Hong Kong Polytechnic UniversityHong KongChina
- Faculty of Geo‐Information Science and Earth ObservationUniversity of TwenteEnschedeThe Netherlands
- International Institute of Spatial Lifecourse Epidemiology (ISLE)Hong KongChina
| | - Xinxi Cao
- Department of Health Service Management, School of Public HealthTianjin Medical UniversityTianjinChina
| | - Hongxi Yang
- Department of Health Service Management, School of Public HealthTianjin Medical UniversityTianjinChina
| | - Shaoqing Dai
- Faculty of Geo‐Information Science and Earth ObservationUniversity of TwenteEnschedeThe Netherlands
- International Institute of Spatial Lifecourse Epidemiology (ISLE)Hong KongChina
| | - Pan He
- Department of Earth System ScienceTsinghua UniversityBeijingChina
| | - Ganlin Huang
- Center for Human‐Environment System Sustainability (CHESS), State Key Laboratory of Earth Surface Processes and Resource EcologyBeijing Normal UniversityBeijingChina
- School of Natural Resources, Faculty of Geographical ScienceBeijing Normal UniversityBeijingChina
| | - Tong Wu
- International Institute of Spatial Lifecourse Epidemiology (ISLE)Hong KongChina
- Research Center for Eco‐Environmental SciencesChinese Academy of SciencesBeijingChina
| | - Yaogang Wang
- Department of Health Service Management, School of Public HealthTianjin Medical UniversityTianjinChina
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Abstract
PURPOSE OF REVIEW Appetitive behaviors are mediated through homeostatic and reward signaling of brain circuits. There has been increasing interest in the use of neuromodulation techniques aimed at targeting brain regions such as the lateral prefrontal and subcortical regions associated with dysregulation of eating behaviors. RECENT FINDINGS Invasive brain stimulation techniques have demonstrated promising results in treating severe and enduring anorexia nervosa and morbid obesity. In addition, non-invasive techniques have been shown to successfully reduce food craving, hunger ratings, and calorie intake as well as binge/purge symptoms in eating disorders. Brain stimulation offers promising results for treating symptoms associated with eating disorders and modifying appetitive behaviors including craving and caloric consumption. Future research should focus on identifying optimal frequency and duration of stimulation and employ longitudinal studies to assess long-term effectiveness on clinical outcomes such as eating disorder symptomatology, weight loss, and sustained improvements in eating behaviors over time.
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Affiliation(s)
- Rebecca Dendy
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 North 16th Street, Room 541, Phoenix, AZ, 85016, USA
| | - Emma J Stinson
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, PA, USA
| | | | - Marci E Gluck
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 North 16th Street, Room 541, Phoenix, AZ, 85016, USA.
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Finding the balance between model complexity and performance: Using ventral striatal oscillations to classify feeding behavior in rats. PLoS Comput Biol 2019; 15:e1006838. [PMID: 31009448 PMCID: PMC6497302 DOI: 10.1371/journal.pcbi.1006838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 05/02/2019] [Accepted: 02/01/2019] [Indexed: 12/16/2022] Open
Abstract
The ventral striatum (VS) is a central node within a distributed network that controls appetitive behavior, and neuromodulation of the VS has demonstrated therapeutic potential for appetitive disorders. Local field potential (LFP) oscillations recorded from deep brain stimulation (DBS) electrodes within the VS are a pragmatic source of neural systems-level information about appetitive behavior that could be used in responsive neuromodulation systems. Here, we recorded LFPs from the bilateral nucleus accumbens core and shell (subregions of the VS) during limited access to palatable food across varying conditions of hunger and food palatability in male rats. We used standard statistical methods (logistic regression) as well as the machine learning algorithm lasso to predict aspects of feeding behavior using VS LFPs. We were able to predict the amount of food eaten, the increase in consumption following food deprivation, and the type of food eaten. Further, we were able to predict whether the initiation of feeding was imminent up to 42.5 seconds before feeding began and classify current behavior as either feeding or not-feeding. In classifying feeding behavior, we found an optimal balance between model complexity and performance with models using 3 LFP features primarily from the alpha and high gamma frequencies. As shown here, unbiased methods can identify systems-level neural activity linked to domains of mental illness with potential application to the development and personalization of novel treatments. As neuropsychiatry begins to leverage the power of computational methods to understand disease states and to develop better therapies, it is vital that we acknowledge the trade-offs between model complexity and performance. We show that computational methods can elucidate a neural signature of feeding behavior and we show how these methods could be used to discover neural patterns related to other behaviors and reveal new potential therapeutic targets. Further, our results help to contextualize both the limitations and potential of applying computational methods to neuropsychiatry by showing how changing the data being used to train predictive models (e.g., population vs. individual data) can have a large impact on how model performance generalizes across time, internal states, and individuals.
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Pelot NA, Grill WM. Effects of vagal neuromodulation on feeding behavior. Brain Res 2018; 1693:180-187. [PMID: 29425906 PMCID: PMC6003853 DOI: 10.1016/j.brainres.2018.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 02/06/2023]
Abstract
Implanted vagus nerve stimulation (VNS) for obesity was recently approved by the FDA. However, its efficacy and mechanisms of action remain unclear. Herein, we synthesize clinical and preclinical effects of VNS on feeding behavior and energy balance and discuss engineering considerations for understanding and improving the therapy. Clinical cervical VNS (≤30 Hz) to treat epilepsy or depression has produced mixed effects on weight loss as a side effect, albeit in uncontrolled, retrospective studies. Conversely, preclinical studies (cervical and subdiaphragmatic VNS) mostly report decreased food intake and either decreased weight gain or weight loss. More recent clinical studies report weight loss in response to kilohertz frequency VNS applied to the subdiaphragmatic vagi, albeit with a large placebo effect. Rather than eliciting neural activity, this therapy putatively blocks conduction in the vagus nerves. Overall, stimulation parameters lack systematic exploration, optimization, and justification based on target nerve fibers and therapeutic outcomes. The vagus nerve transduces, transmits, and integrates important neural (efferent and afferent), humoral, energetic, and inflammatory information between the gut and brain. Thus, improved understanding of the biophysics, electrophysiology, and (patho)physiology has the potential to advance VNS as an effective therapy for a wide range of diseases.
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Affiliation(s)
- Nicole A Pelot
- Department of Biomedical Engineering, Duke University, Room 1427, Fitzpatrick CIEMAS, 101 Science Drive, Campus Box 90281, Durham, NC, USA
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Room 1427, Fitzpatrick CIEMAS, 101 Science Drive, Campus Box 90281, Durham, NC, USA; Department of Electrical and Computer Engineering, Duke University, Room 130, Hudson Hall, Campus Box 90291, Durham, NC, USA; Department of Neurobiology, Duke University, Room 101B, Bryan Research Building, 311 Research Drive, Campus Box 3209, Durham, NC, USA; Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA.
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Roy HA, Green AL, Aziz TZ. State of the Art: Novel Applications for Deep Brain Stimulation. Neuromodulation 2017; 21:126-134. [DOI: 10.1111/ner.12604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/19/2017] [Accepted: 03/11/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Holly A. Roy
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
| | - Alexander L. Green
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
| | - Tipu Z. Aziz
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
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Basiago A, Binder DK. Effects of Deep Brain Stimulation on Autonomic Function. Brain Sci 2016; 6:brainsci6030033. [PMID: 27537920 PMCID: PMC5039462 DOI: 10.3390/brainsci6030033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 12/22/2022] Open
Abstract
Over the course of the development of deep brain stimulation (DBS) into a well-established therapy for Parkinson's disease, essential tremor, and dystonia, its utility as a potential treatment for autonomic dysfunction has emerged. Dysfunction of autonomic processes is common in neurological diseases. Depending on the specific target in the brain, DBS has been shown to raise or lower blood pressure, normalize the baroreflex, to alter the caliber of bronchioles, and eliminate hyperhidrosis, all through modulation of the sympathetic nervous system. It has also been shown to improve cortical control of the bladder, directly induce or inhibit the micturition reflex, and to improve deglutition and gastric emptying. In this review, we will attempt to summarize the relevant available studies describing these effects of DBS on autonomic function, which vary greatly in character and magnitude with respect to stimulation target.
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Affiliation(s)
- Adam Basiago
- School of Medicine, University of California, Riverside, CA 92521, USA.
| | - Devin K Binder
- Division of Biomedical Sciences, School of Medicine, University of California, 1247 Webber Hall, Riverside, CA 92521, USA.
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