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首页> 外文期刊>Journal of neurosurgery. >Lateral hypothalamic area deep brain stimulation for refractory obesity: A pilot study with preliminary data on safety, body weight, and energy metabolism: Clinical article
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Lateral hypothalamic area deep brain stimulation for refractory obesity: A pilot study with preliminary data on safety, body weight, and energy metabolism: Clinical article

机译：下丘脑外侧脑深部刺激治疗难治性肥胖症：初步研究，提供有关安全性，体重和能量代谢的初步数据：临床文章

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Object. Deep brain stimulation (DBS) of the lateral hypothalamic area (LHA) has been suggested as a potential treatment for intractable obesity. The authors present the 2-year safety results as well as early efficacy and metabolic effects in 3 patients undergoing bilateral LHA DBS in the first study of this approach in humans. Methods. Three patients meeting strict criteria for intractable obesity, including failed bariatric surgery, underwent bilateral implantation of LHA DBS electrodes as part of an institutional review board- and FDA-approved pilot study. The primary focus of the study was safety; however, the authors also received approval to collect data on early efficacy including weight change and energy metabolism. Results. No serious adverse effects, including detrimental psychological consequences, were observed with continuous LHA DBS after a mean follow-up of 35 months (range 30-39 months). Three-dimensional nonlinear transformation of postoperative imaging superimposed onto brain atlas anatomy was used to confirm and study DBS contact proximity to the LHA. No significant weight loss trends were seen when DBS was programmed using standard settings derived from movement disorder DBS surgery. However, promising weight loss trends have been observed when monopolar DBS stimulation has been applied via specific contacts found to increase the resting metabolic rate measured in a respiratory chamber. Conclusions. Deep brain stimulation of the LHA may be applied safely to humans with intractable obesity. Early evidence for some weight loss under metabolically optimized settings provides the first 'proof of principle' for this novel antiobesity strategy. A larger follow-up study focused on efficacy along with a more rigorous metabolic analysis is planned to further explore the benefits and therapeutic mechanism behind this investigational therapy.
机译：目的。下丘脑外侧区域（LHA）的深部脑刺激（DBS）已被建议作为顽固性肥胖症的一种潜在治疗方法。作者首次在人类中对该方法进行了研究，介绍了3名接受双侧LHA DBS的患者的2年安全性结果以及早期疗效和代谢作用。方法。作为机构审查委员会和FDA批准的先导研究的一部分，三名符合严格的肥胖症严格标准（包括减肥手术失败）的患者接受了LHA DBS电极的双边植入。研究的主要重点是安全性。然而，作者还获得了收集早期功效数据的批准，包括体重变化和能量代谢。结果。在平均随访35个月（30-39个月）后，连续LHA DBS未观察到严重的不良反应，包括有害的心理后果。术后影像的三维非线性变换叠加在脑图谱上，以确认和研究DBS与LHA的接触距离。当使用源自运动障碍DBS手术的标准设置对DBS进行编程时，没有发现明显的减肥趋势。但是，当通过特定接触施加单极DBS刺激可增加呼吸腔中测得的静息代谢率时，已观察到有希望的减肥趋势。结论。 LHA的深层脑刺激可以安全地应用于患有顽固性肥胖症的人。代谢优化设置下某些减肥的早期证据为这种新颖的抗肥胖策略提供了第一个“原理证明”。计划进行一项更大的针对功效的随访研究，并进行更严格的代谢分析，以进一步探索这种研究疗法背后的益处和治疗机制。

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