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.

Ethical considerations in deep brain stimulation for psychiatric illness

2020 ◽  
pp. 247-251
Author(s):  
Ryan A. Grant ◽  
Casey H. Halpern ◽  
Gordon H. Baltuch ◽  
John P. O’Reardon ◽  
Arthur L. Caplan
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Psychiatric Illness ◽  
Ethical Considerations ◽  
Deep Brain

scholarly journals Deep Brain Stimulation at End of Life: Clinical and Ethical Considerations

2020 ◽  
Vol 23 (4) ◽  
pp. 582-585
Author(s):  
Lauren R. Sankary ◽  
Paul J. Ford ◽  
Andre G. Machado ◽  
Laura J. Hoeksema ◽  
Renato V. Samala ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
End Of Life ◽  
Brain Stimulation ◽  
Ethical Considerations ◽  
Deep Brain

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.

Pediatric Deep Brain Stimulation for Dystonia: Current State and Ethical Considerations

2020 ◽  
Vol 29 (4) ◽  
pp. 557-573
Author(s):  
KATRINA A. MUÑOZ ◽  
JENNIFER BLUMENTHAL-BARBY ◽  
ERIC A. STORCH ◽  
LAURA TORGERSON ◽  
GABRIEL LÁZARO-MUÑOZ
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
The United States ◽  
Childhood Onset ◽  
Ethical Considerations ◽  
Current State ◽  
Limited Effectiveness ◽  
Deep Brain

AbstractDystonia is a movement disorder that can have a debilitating impact on motor functions and quality of life. There are 250,000 cases in the United States, most with childhood onset. Due to the limited effectiveness and side effects of available treatments, pediatric deep brain stimulation (pDBS) has emerged as an intervention for refractory dystonia. However, there is limited clinical and neuroethics research in this area of clinical practice. This paper examines whether it is ethically justified to offer pDBS to children with refractory dystonia. Given the favorable risk-benefit profile, it is concluded that offering pDBS is ethically justified for certain etiologies of dystonia, but it is less clear for others. In addition, various ethical and policy concerns are discussed, which need to be addressed to optimize the practice of offering pDBS for dystonia. Strategies are proposed to help address these concerns as pDBS continues to expand.

scholarly journals Researcher Perspectives on Ethical Considerations in Adaptive Deep Brain Stimulation Trials

2020 ◽  
Vol 14 ◽  
Author(s):  
Katrina A. Muñoz ◽  
Kristin Kostick ◽  
Clarissa Sanchez ◽  
Lavina Kalwani ◽  
Laura Torgerson ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Ethical Considerations ◽  
Deep Brain

scholarly journals A Systematic Review of the Biological Processes Involved in Deep-Brain Stimulation for Parkinson's disease: A Focus on the Potential Disease-Modifying Effects

2021 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Francesco Sciancalepore ◽  
◽  
Giulia Remoli ◽  
Leonardo Tariciotti ◽  
Giulia Sarti ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Early Stage ◽  
Case Reports ◽  
Biological Processes ◽  
Inclusion Criteria ◽  
Disease Modifying ◽  
Deep Brain

Deep-Brain Stimulation (DBS) is an important treatment option for the management of Parkinson’s disease (PD) and is a common symptomatic treatment. However, an increasing number of studies have examined the biological processes to assess if DBS can also modify the natural history of PD by acting on its pathophysiological mechanisms. Relevant literature published up to November 2020 was systematically searched on databases such as PubMed, ISI Web of Knowledge, Academic Search Index, and Science Citation Index. The following predefined inclusion criteria were applied to the full-text versions of the selected articles: i) recruiting and monitoring of PD subjects that were previously treated with DBS and ii) investigating the electrophysiological, biochemical, epigenetic, or neuroimaging effects of DBS. Studies focusing exclusively on motor and clinical changes were excluded. Reviews, case reports, studies on animal models, and computational studies were also not considered. Out of 2,960 records screened, 43 studies met the inclusion criteria. Only three studies described a potential disease-modifying effect of DBS. However, a wide heterogeneity was observed in the investigated biomarkers, and the design and methodological issues of several studies limited their ability to find potential disease-modifying features. Specifically, 60.4% of the trials followed-up subjects for no more than 1 year from the surgical intervention, and 67.4% observed patients with PD only once after DBS. Moreover, 64.2% of the studies enrolled late-stage PD patients. Most of the studies (88.4%) reported that DBS only had a symptomatic effect, with several of them showing some limitations in the study design and recruitment of patients. Further studies using shared biomarkers are encouraged to assess if and how DBS might affect the progression of PD. Based on the existing preclinical literature, prospective clinical trials examining the course of PD in early-stage patients are needed.

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