Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study

2010 ◽  
Vol 29 (2) ◽  
pp. E15 ◽  
Author(s):  
Jared M. Pisapia ◽  
Casey H. Halpern ◽  
Noel N. Williams ◽  
Thomas A. Wadden ◽  
Gordon H. Baltuch ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Sensitivity Analysis ◽  
Gastric Bypass ◽  
Deep Brain Stimulation ◽  
Decision Analysis ◽  
Success Rate ◽  
Brain Stimulation ◽  
Surgical Complications ◽  
Deep Brain

Object Roux-en-Y gastric bypass is the gold standard treatment for morbid obesity, although failure rates may be high, particularly in patients with a BMI > 50 kg/m2. With improved understanding of the neuropsychiatric basis of obesity, deep brain stimulation (DBS) offers a less invasive and reversible alternative to available surgical treatments. In this decision analysis, the authors determined the success rate at which DBS would be equivalent to the two most common bariatric surgeries. Methods Medline searches were performed for studies of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and DBS for movement disorders. Bariatric surgery was considered successful if postoperative excess weight loss exceeded 45% at 1-year follow-up. Using complication and success rates from the literature, the authors constructed a decision analysis model for treatment by LAGB, LRYGB, DBS, or no surgical treatment. A sensitivity analysis in which major parameters were systematically varied within their 95% CIs was used. Results Fifteen studies involving 3489 and 3306 cases of LAGB and LRYGB, respectively, and 45 studies involving 2937 cases treated with DBS were included. The operative successes were 0.30 (95% CI 0.247–0.358) for LAGB and 0.968 (95% CI 0.967–0.969) for LRYGB. Sensitivity analysis revealed utility of surgical complications in LRYGB, probability of surgical complications in DBS, and success rate of DBS as having the greatest influence on outcomes. At no values did LAGB result in superior outcomes compared with other treatments. Conclusions Deep brain stimulation must achieve a success rate of 83% to be equivalent to bariatric surgery. This high-threshold success rate is probably due to the reported success rate of LRYGB, despite its higher complication rate (33.4%) compared with DBS (19.4%). The results support further research into the role of DBS for the treatment of obesity.

scholarly journals Impact of an Interdisciplinary Deep Brain Stimulation Screening Model on Post-Surgical Complications in Essential Tremor Patients

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0145623 ◽  
Author(s):  
Masa-aki Higuchi ◽  
Dan D. Topiol ◽  
Bilal Ahmed ◽  
Hokuto Morita ◽  
Samuel Carbunaru ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Surgical Complications ◽  
Screening Model ◽  
Deep Brain

Early versus delayed bilateral subthalamic deep brain stimulation for parkinson's disease: A decision analysis

2010 ◽  
Vol 25 (10) ◽  
pp. 1456-1463 ◽  
Author(s):  
Alberto J. Espay ◽  
Jennifer E. Vaughan ◽  
Connie Marras ◽  
Rob Fowler ◽  
Mark H. Eckman
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Decision Analysis ◽  
Brain Stimulation ◽  
Deep Brain

Risks of common complications in deep brain stimulation surgery: management and avoidance

2014 ◽  
Vol 120 (1) ◽  
pp. 132-139 ◽  
Author(s):  
Albert J. Fenoy ◽  
Richard K. Simpson
Keyword(s):  
Deep Brain Stimulation ◽  
Adverse Events ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Surgical Complications ◽  
Large Population ◽  
Device Implantation ◽  
Additional Surgery ◽  
Deep Brain

Object Deep brain stimulation (DBS) surgery is increasingly prominent in the treatment of various disorders refractory to medication. Despite the procedure's efficacy, the community at large continues to be hesitant about presumed associated risks. The main object of this study was to assess the incidence of various surgical complications occurring both during and after DBS device implantation in a large population of patients with movement disorders in an effort to better quantify patient risk, define management plans, and develop methods for risk avoidance. A second aim was to corroborate the low procedural complication risk of DBS reported by others, which in light of the procedure's efficacy is needed to promote its widespread acceptance. Methods All patients who had undergone new DBS device implantation surgery between 2002 and 2010 by a single surgeon were entered into a database after being verified by cross-referencing manufacturer implantation records. All surgical records and charts were reviewed to identify intraoperative, perioperative, and long-term surgical complications, including any characteristics predictive of an adverse event. Results Seven hundred twenty-eight patients received 1333 new DBS electrodes and 1218 new internal pulse generators (IPGs) in a total of 1356 stereotactic procedures for the treatment of movement disorders. Seventy-eight percent of the patients had staged lead and IPG implantations. Of the 728 patients, 452 suffered from medically refractory Parkinson disease; in the other patients, essential tremor (144), dystonia (64), mixed disease (30), and other hyperkinetic movement disorders (38) were diagnosed. Severe intraoperative adverse events included vasovagal response in 6 patients (0.8%), hypotension in 2 (0.3%), and seizure in 2 (0.3%). Postoperative imaging confirmed asymptomatic intracerebral hemorrhage (ICH) in 4 patients (0.5%), asymptomatic intraventricular hemorrhage in 25 (3.4%), symptomatic ICH in 8 (1.1%), and ischemic infarction in 3 (0.4%), associated with hemiparesis and/or decreased consciousness in 13 (1.7%). Long-term complications of DBS device implantation not requiring additional surgery included hardware discomfort in 8 patients (1.1%) and loss of desired effect in 10 (1.4%). Hardware-related complications requiring surgical revision included wound infections in 13 patients (1.7%), lead malposition and/or migration in 13 (1.7%), component fracture in 10 (1.4%), component malfunction in 4 (0.5%), and loss of effect in 19 (2.6%). Conclusions The authors confirmed that the overall risk of both procedure- and hardware-related adverse events is acceptably low. They offer advice on how to avoid the most common complications.

Surgical Complications of Deep Brain Stimulation

2008 ◽  
Vol 86 (6) ◽  
pp. 367-372 ◽  
Author(s):  
Sanjay Bhatia ◽  
Michael Oh ◽  
Taylor Whiting ◽  
Matthew Quigley ◽  
Donald Whiting
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Surgical Complications ◽  
Deep Brain

scholarly journals Deep brain stimulation for obesity: rationale and approach to trial design

2015 ◽  
Vol 38 (6) ◽  
pp. E8 ◽  
Author(s):  
Allen L. Ho ◽  
Eric S. Sussman ◽  
Arjun V. Pendharkar ◽  
Dan E. Azagury ◽  
Cara Bohon ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Trial Design ◽  
Maladaptive Behavior ◽  
Inclusion Criteria ◽  
Ethical Considerations ◽  
Reward Circuitry ◽  
The Us ◽  
Deep Brain

Obesity is one of the most serious public health concerns in the US. While bariatric surgery has been shown to be successful for treatment of morbid obesity for those who have undergone unsuccessful behavioral modification, its associated risks and rates of relapse are not insignificant. There exists a neurological basis for the binge-like feeding behavior observed in morbid obesity that is believed to be due to dysregulation of the reward circuitry. The authors present a review of the evidence of the neuroanatomical basis for obesity, the potential neural targets for deep brain stimulation (DBS), as well as a rationale for DBS and future trial design. Identification of an appropriate patient population that would most likely benefit from this type of therapy is essential. There are also significant cost and ethical considerations for such a neuromodulatory intervention designed to alter maladaptive behavior. Finally, the authors present a consolidated set of inclusion criteria and study end points that should serve as the basis for any trial of DBS for obesity.

scholarly journals Surgical management of adverse events associated with deep brain stimulation: A single-center experience

2020 ◽  
Vol 8 ◽  
pp. 205031212091345
Author(s):  
Masani Nonaka ◽  
Takashi Morishita ◽  
Kazumichi Yamada ◽  
Shinsuke Fujioka ◽  
Masa-aki Higuchi ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Adverse Events ◽  
Surgical Management ◽  
Brain Stimulation ◽  
Surgical Complications ◽  
Pulse Generator ◽  
Implantable Pulse Generator ◽  
Surgical Methods ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Objectives: Deep brain stimulation is widely used to treat movement disorders and selected neuropsychiatric disorders. Despite the fact, the surgical methods vary among centers. In this study, we aimed to evaluate our own surgical complications and how we performed surgical troubleshooting. Methods: A retrospective chart review was performed to evaluate the clinical data of patients who underwent deep brain stimulation surgery and deep brain stimulation–related procedures at our center between October 2014 and September 2019. We reviewed surgical complications and how surgical troubleshooting was performed, regardless of where the patient underwent the initial surgery. Results: A total of 92 deep brain stimulation lead implantation and 43 implantable pulse generator replacement procedures were performed. Among the 92 lead implantation procedures, there were two intracranial lead replacement surgeries and one deep brain stimulation lead implantation into the globus pallidus to add to existing deep brain stimulation leads in the bilateral subthalamic nuclei. Wound revision for superficial infection of the implantable pulse generator site was performed in four patients. There was neither intracerebral hemorrhage nor severe hardware infection in our series of procedures. An adaptor (extension cable) replacement was performed due to lead fracture resulting from a head trauma in two cases. Conclusion: We report our experience of surgical management of adverse events associated with deep brain stimulation therapy with clinical vignettes. Deep brain stimulation surgery is a safe and effective procedure when performed by a trained neurosurgeon. It is important for clinicians to be aware that there are troubles that are potentially manageable with optimal surgical treatment.

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