Deep Brain Stimulation

Despite the better understanding of obesity pathophysiology, treating this disease remains a challenge. Thus, new therapeutic options are needed. Targeting the brain is a promising way considering both the brain abnormalities in obesity and the effect of bariatric surgery on the gut-brain axis. In this sense, deep brain stimulation can be discussed as an alternative treatment. This safe and reversible neurosurgical procedure, wherein electrodes are implanted in a brain area, modulates neural circuits for therapeutic purposes. It has already been approved for treating movement disorders and is under study for several neurologic and psychiatric diseases. Considering the physiology of eating and neuroimaging studies in obese people, two brain areas, namely the hypothalamus and the nucleus accumbens, involved in the reward system, appear as putative targets.
While stimulation of nucleus accumbens reduces the food intake, stimulation of hypothalamus could increase the resting energy expenditure. The clinical experience of deep brain stimulation in obesity remains limited to only six patients with mixed results, but clinical trials are ongoing. Thus, drawing clear conclusions about the effectiveness of this treatment is not yet possible, even if the results of preclinical studies are encouraging. Well-conducted clinical trials and preclinical studies are needed to further assess the efficacy and safety of deep brain stimulation for obesity