Correlation of antero-dorsal active contact location with weight gain after subthalamic nucleus deep brain stimulation: a case series

Abstract Background Weight gain is a frequently reported side effect of subthalamic deep brain stimulation; however, the underlying mechanisms remain unclear. The active contact locations influence the clinical outcomes of subthalamic deep brain stimulation, but it is unclear whether weight gain is directly associated with the active contact locations. We aimed to determine whether weight gain is associated with the subthalamic deep brain stimulation active contact locations.Methods We enrolled 14 patients with Parkinson’s disease who underwent bilateral subthalamic deep brain stimulation between 2013 and 2019. Bodyweight and body mass index were measured before and one year following surgery. The Lead-DBS Matlab toolbox was used to determine the active contact locations based on magnetic resonance imaging and computed tomography. Fluorodeoxyglucose-positron emission tomography data were also acquired before and one year following surgery, and statistical parametric mapping was used to evaluate changes in brain metabolism. The relationship between weight and active contact locations was evaluated with a Spearman rank test with a corrected p-value < 0.008. We examined which brain regions’ metabolism fluctuation significantly correlated with increased BMI scores and PET data.Results The body mass index increase was 2.03 kg/m2 1 year post-surgery. Weight gain was correlated with anterior and dorsal locations of the left-side active contacts, as well as with lateral locations of the right-side active contacts. Furthermore, weight gain was correlated with increased metabolism in the left-side limbic and associative regions, including the middle temporal gyrus, inferior frontal gyrus, and orbital gyrus.Conclusions Although the mechanisms underlying weight gain following subthalamic deep brain stimulation are possibly multifactorial, our findings suggest that anterior subthalamic deep brain stimulation alters the activities in the limbic and associative cortical regions, which may then lead to weight gain. Weight gain could be prevented by avoiding stimulation to the anterior part of the subthalamic nucleus.

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Subthalamic Nucleus Deep Brain Stimulation in Early Stage Parkinson’s Disease Is Not Associated with Increased Body Mass Index

Parkinson s Disease ◽

10.1155/2017/7163801 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Sarah H. Millan ◽

Mallory L. Hacker ◽

Maxim Turchan ◽

Anna L. Molinari ◽

Amanda D. Currie ◽

...

Keyword(s):

Parkinson’S Disease ◽

Body Mass Index ◽

Weight Gain ◽

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Body Mass ◽

Brain Stimulation ◽

Early Stage ◽

Stn Dbs ◽

Deep Brain

Previous studies suggest that deep brain stimulation of the subthalamic nucleus (STN-DBS) for Parkinson’s disease (PD) leads to weight gain. This study analyzes changes in body mass index (BMI) in 29 subjects from a prospective, single-blind trial of DBS in early stage PD (age 50–75, Hoehn & Yahr stage II off medication, treated with antiparkinsonian medications for ≥6 months but <4 years, and without a history of motor fluctuations, dyskinesias, or dementia). Subjects were randomized to DBS plus optimal drug therapy (DBS+ODT; n=15) or ODT (n=14) and followed for 24 months. Weight and height were recorded at baseline and each follow-up visit and used to calculate BMI. BMIs were compared within and between groups using nonparametric t-tests. Mean BMI at baseline was 29.7 in the ODT group and 32.3 in the DBS+ODT group (p>0.05). BMI change over two years was not different between the groups (p=0.62, ODT = −0.89; DBS+ODT = −0.17). This study suggests that STN-DBS is not associated with weight gain in subjects with early stage PD. This finding will be tested in an upcoming FDA-approved phase III multicenter, randomized, double-blind, placebo-controlled, pivotal clinical trial evaluating DBS in early stage PD (ClinicalTrials.gov identifier NCT00282152).

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Effectiveness of Deep Brain Stimulation in Reducing Body Mass Index and Weight: A Systematic Review

Stereotactic and Functional Neurosurgery ◽

10.1159/000519158 ◽

2021 ◽

pp. 1-11

Author(s):

William Omar Contreras López ◽

Paula Alejandra Navarro ◽

Santiago Crispín

Keyword(s):

Systematic Review ◽

Body Mass Index ◽

Deep Brain Stimulation ◽

Body Mass ◽

Brain Stimulation ◽

The Body ◽

Health Concern ◽

Prader Willi Syndrome ◽

Falling Asleep ◽

Deep Brain

Background: Obesity has become a major public health concern worldwide, with current behavioral, pharmacological, and surgical treatments offering varying rates of success and adverse effects. Neurosurgical approaches to treatment of refractory obesity include deep brain stimulation (DBS) on either specific hypothalamic or reward circuitry nuclei, which might contribute to weight reduction through different mechanisms. We aimed to determine the safety and clinical effect of DBS in medical refractory obesity. Summary: Adhering to PRISMA guidelines, we performed a systematic review to identify all original studies – observational and experimental – in which DBS was performed to treat refractory obesity. From database inception to April 2021, we conducted our search in PubMed, Scopus, and LILACS databases using the following MeSH terms: “Obesity” OR “Prader-Willi Syndrome” AND “Deep Brain Stimulation.” The main outcomes were safety and weight loss measured with the body mass index (BMI). The Grading of Recommendations Assessment, Development, and Evaluation methods were applied to evaluate the quality of evidence. This study protocol was registered with PROSPERO ID: CRD42019132929. Seven studies involving 12 patients met the inclusion criteria; the DBS target was the nucleus accumbens in four (57.1%), the lateral hypothalamic area in two (29.6%), and the ventral hypothalamus in one (14.3%). Further, 33% of participants had obesity secondary to Prader-Willi syndrome (PWS) and 66.6% had primary obesity. The global BMI average at baseline was 46.7 (SD: 9.6, range: 32.2–59.1), and after DBS, 42.8 (SD: 8.8, range: 25–53.9), with a mean difference of 3.9; however, the delta in PWS patients was −2.3 and 10 in those with primary obesity. The incidence of moderate side effects was 33% and included manic symptoms (N = 2), electrode fracture (N = 1), and seizure (N = 1); mild complications (41.6%) included skin infection (N = 2), difficulties falling asleep (N = 1), nausea (N = 1), and anxiety (N = 1). Key Messages: Despite available small case series and case reports reporting a benefit in the treatment of refractory obesity with DBS, this study emphasizes the need for prospective studies with longer follow-ups in order to further address the efficacy and indications.

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3.219 Body weight and body mass index changes after subthalamic nucleus deep brain stimulation in Parkinson's disease

Parkinsonism & Related Disorders ◽

10.1016/s1353-8020(08)70857-5 ◽

2007 ◽

Vol 13 ◽

pp. S166-S167

Author(s):

S.-R. Kim ◽

S.-J. Chung ◽

M.-J. Kim ◽

M.-S. Kim ◽

M.-C. Lee

Keyword(s):

Parkinson’S Disease ◽

Body Mass Index ◽

Parkinson's Disease ◽

Body Weight ◽

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Body Mass ◽

Brain Stimulation ◽

Index Changes ◽

Deep Brain

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Body mass index variations in patients with Parkinson's disease treated with levodopa-carbidopa intestinal gel infusion: A case control study versus standard of care and subthalamic nucleus deep brain stimulation

Revue Neurologique ◽

10.1016/j.neurol.2020.11.017 ◽

2021 ◽

Author(s):

B. Fernández-Rodríguez ◽

J. Dupouy ◽

E. Harroch ◽

M.-H. Fabre-Delcros ◽

C. Barthélémy ◽

...

Keyword(s):

Body Mass Index ◽

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Body Mass ◽

Brain Stimulation ◽

Case Control Study ◽

Standard Of Care ◽

Case Control ◽

Control Study ◽

Deep Brain

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Correlation of active contact location with weight gain after subthalamic nucleus deep brain stimulation: a case series

BMC Neurology ◽

10.1186/s12883-021-02383-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Katsuki Eguchi ◽

Shinichi Shirai ◽

Masaaki Matsushima ◽

Takahiro Kano ◽

Kazuyoshi Yamazaki ◽

...

Keyword(s):

Body Mass Index ◽

Deep Brain Stimulation ◽

Body Mass ◽

Brain Stimulation ◽

Emission Tomography ◽

Positron Emission ◽

Cortical Regions ◽

One Year ◽

Tomography Data ◽

Deep Brain

Abstract Background Weight gain (WG) is a frequently reported side effect of subthalamic deep brain stimulation; however, the underlying mechanisms remain unclear. The active contact locations influence the clinical outcomes of subthalamic deep brain stimulation, but it is unclear whether WG is directly associated with the active contact locations. We aimed to determine whether WG is associated with the subthalamic deep brain stimulation active contact locations. Methods We enrolled 14 patients with Parkinson’s disease who underwent bilateral subthalamic deep brain stimulation between 2013 and 2019. Bodyweight and body mass index were measured before and one year following the surgery. The Lead-DBS Matlab toolbox was used to determine the active contact locations based on magnetic resonance imaging and computed tomography. We also created sweet spot maps for WG using voxel-wise statistics, based on volume of tissue activation and the WG of each patient. Fluorodeoxyglucose-positron emission tomography data were also acquired before and one year following surgery, and statistical parametric mapping was used to evaluate changes in brain metabolism. We examined which brain regions’ metabolism fluctuation significantly correlated with increased body mass index scores and positron emission tomography data. Results One year after surgery, the body mass index increase was 2.03 kg/m2. The sweet spots for WG were bilateral, mainly located dorsally outside of the subthalamic nucleus (STN). Furthermore, WG was correlated with increased metabolism in the left limbic and associative regions, including the middle temporal gyrus, inferior frontal gyrus, and orbital gyrus. Conclusions Although the mechanisms underlying WG following subthalamic deep brain stimulation are possibly multifactorial, our findings suggest that dorsal stimulation outside of STN may lead to WG. The metabolic changes in limbic and associative cortical regions after STN-DBS may also be one of the mechanisms underlying WG. Further studies are warranted to confirm whether dorsal stimulation outside of STN changes the activities of these cortical regions.

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Electrode Location in a Microelectrode Recording-Based Model of the Subthalamic Nucleus Can Predict Motor Improvement After Deep Brain Stimulation for Parkinson’s Disease

Brain Sciences ◽

10.3390/brainsci9030051 ◽

2019 ◽

Vol 9 (3) ◽

pp. 51 ◽

Cited By ~ 2

Author(s):

Rens Verhagen ◽

Lo Bour ◽

Vincent Odekerken ◽

Pepijn van den Munckhof ◽

P. Schuurman ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Anatomical Variation ◽

Patient Specific ◽

One Year ◽

Motor Improvement ◽

Deep Brain

Motor improvement after deep brain stimulation (DBS) in the subthalamic nucleus (STN) may vary substantially between Parkinson’s disease (PD) patients. Research into the relation between improvement and active contact location requires a correction for anatomical variation. We studied the relation between active contact location relative to the neurophysiological STN, estimated by the intraoperative microelectrode recordings (MER-based STN), and contralateral motor improvement after one year. A generic STN shape was transformed to fit onto the stereotactically defined MER sites. The location of 43 electrodes (26 patients), derived from MRI-fused CT images, was expressed relative to this patient-specific MER-based STN. Using regression analyses, the relation between contact location and motor improvement was studied. The regression model that predicts motor improvement based on levodopa effect alone was significantly improved by adding the one-year active contact coordinates (R2 change = 0.176, p = 0.014). In the combined prediction model (adjusted R2 = 0.389, p < 0.001), the largest contribution was made by the mediolateral location of the active contact (standardized beta = 0.490, p = 0.002). With the MER-based STN as a reference, we were able to find a significant relation between active contact location and motor improvement. MER-based STN modeling can be used to complement imaging-based STN models in the application of DBS.

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