Deep Brain Stimulation Studied as Last-Ditch Obesity Treatment

No major side effects seen in 3 patients over nearly 3 years

By Amy Norton

HealthDay Reporter

THURSDAY, June 13 (HealthDay News) -- For the first time, researchers have shown that implanting electrodes in the brain's "feeding center" can be safely done -- in a bid to develop a new treatment option for severely obese people who fail to shed pounds even after weight-loss surgery.

In a preliminary study with three patients, researchers found that they could safely use the therapy, known as deep brain stimulation (DBS). Over almost three years, none of the patients had any serious side effects, and two even lost some weight -- but it was temporary.

"The first thing we needed to do was to see if this is safe," said lead researcher Dr. Donald Whiting, vice chairman of neurosurgery at Allegheny General Hospital in Pittsburgh. "We're at the point now where it looks like it is."

The study, reported in the Journal of Neurosurgery and at a meeting this week of the International Neuromodulation Society in Berlin, Germany, was not meant to test effectiveness.

So the big remaining question is, can deep brain stimulation actually promote lasting weight loss?

"Nobody should get the idea that this has been shown to be effective," Whiting said. "This is not something you can go ask your doctor about."

Right now, deep brain stimulation is sometimes used for tough-to-treat cases of Parkinson's disease, a movement disorder that causes tremors, stiff muscles, and balance and coordination problems. A surgeon implants electrodes into specific movement-related areas of the brain, then attaches those electrodes to a neurostimulator placed under the skin near the collarbone.

The neurostimulator continually sends tiny electrical pulses to the brain, which in turn interferes with the abnormal activity that causes tremors and other symptoms.

What does that have to do with obesity? In theory, Whiting explained, deep brain stimulation might be able to "override" brain signaling involved in eating, metabolism or feelings of fullness. Research in animals has shown that electrical stimulation of a particular area of the brain -- the lateral hypothalamic area -- can spur weight loss even if calorie intake stays the same.

The new study marks the first time that deep brain stimulation has been tried in that brain region. And it's an important first step to show that not only could these three severely obese people get through the surgery, but they also seemed to have no serious effects from the brain stimulation, said Dr. Casey Halpern, a neurosurgeon at the University of Pennsylvania who was not involved in the research.

"That shows us this is a therapy that should be studied further in a larger trial," said Halpern, who has done animal research exploring the idea of using deep brain stimulation for obesity.

"Obesity is a major problem," Halpern said, "and current therapies, even gastric bypass surgery, don't always work. There is a medical need for new therapies."

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Nerve Stimulation Might Ease Fibromyalgia Pain

Small early study saw improvement in patients' quality of life

By Maureen Salamon

HealthDay Reporter

MONDAY, June 10 (HealthDay News) -- An implanted device that zaps the nerves at the nape of the neck -- shown effective in treating some people with migraines -- may also help ease the ache of fibromyalgia, an ailment that causes widespread body pain and tenderness.

A Belgian scientist treated small numbers of fibromyalgia patients with "occipital nerve stimulation," which rouses the occipital nerves just beneath the skin at the back of the neck using an implanted device. Dr. Mark Plazier found that pain scores dropped for 20 of 25 patients using this device over six months and their quality of life improved significantly.

"There are only a few treatment options [for fibromyalgia] right now and the response to treatment is far from 100 percent, which implies there are a lot of patients still looking for help to get a better life. This treatment might be an excellent option for them," said Plazier, a neurosurgeon at University Hospital Antwerp. But, "it is difficult to determine the impact of these findings on fibromyalgia patients, since larger trials ... are necessary."

Plazier is to present his research this week at a meeting of the International Neuromodulation Society, in Berlin. Neuromodulation is a group of therapies that use medical devices to relieve symptoms or restore abilities by altering nerve system function.

Research presented at scientific conferences has not typically been peer-reviewed or published and is considered preliminary.

Fibromyalgia is thought to affect about 5 million American adults -- most of them women -- according to the U.S. National Institutes of Health. The cause of the disorder, which can also involve sleep problems, anxiety and depression, is unknown and it can be difficult to treat.

Plazier also presented a separate study on six fibromyalgia patients using PET scan images to visualize brain changes from occipital nerve stimulation treatment. It suggested that the nerve stimulation changes activity in the limbic system, a brain region that helps determine pain perception.

"In fibromyalgia, we see that there is a hypervigilance to pain, so patients are more sensitive to pain and more aware of it," Plazier said. "They also have high scores on questionnaires concerning catastrophizing behavior, which implies the high impact of pain on their lives."

"During [occipital nerve] stimulation we see differences in brain activity on PET scans in regions involved in pain," he added. "This all might suggest that we are influencing a cerebral system and might even turn it back to 'normal' perception."

Study participants didn't find the nerve-zapping treatment to be painful, Plazier noted. The occipital nerve stimulation device is implanted during a brief surgery using general anesthesia, he said, and postoperative pain is normal but not extreme.

Dr. Patrick Wood, director of the fibromyalgia clinic at Madison River Oaks Medical Center in Canton, Miss., called the studied "interesting and promising" but said additional research is necessary before treatment with occipital nerve stimulation -- which may cost around $10,000 -- could become mainstream for fibromyalgia patients.

"It's mostly used in headaches, and even in the headache realm it's still considered experimental," Wood said. "It would be nice to have expanded data here that would indicate there's something worth banking on and putting our hopes on. It's promising, but more work needs to be done before the average patient can consider it."

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Scientists Pinpoint How Deep Brain Stimulation Eases OCD

By Amanda Gardner

HealthDay Reporter

SUNDAY, Feb. 24 (HealthDay News) -- Deep brain stimulation has helped people with severe obsessive-compulsive disorder, and new research begins to explain why.

A Dutch study appearing in the Feb. 24 online issue of the journal Nature Neuroscience found the procedure essentially restored normal function in a part of the brain called the nucleus accumbens.

The nucleus accumbens "is part of a greater brain network," explained study author Dr. Martijn Figee. "This network is involved in motivation and the processing of rewards, and its activity is disturbed in [obsessive-compulsive disorder], probably explaining why [patients] are stuck in pathological behaviors at the cost of healthy ones."

So, obsessive-compulsive disorder (OCD) is essentially the result of faulty wiring in the brain.

It's not so much a disorder of a specific part of the brain than it is a "disorder of neurocircuitry," explained Dr. Brian Snyder, director of functional and restorative neurosurgery at Winthrop University Hospital in Mineola, N.Y.

About 1 percent of U.S. adults suffer from the condition, which involves unwanted, intrusive thoughts or obsessions that then spur compulsive behavior.

While a person without OCD might momentarily worry that he or she has forgotten to lock the door, that thought is quickly balanced by the realization that, yes, the door has indeed been locked.

For a person with OCD, on the other hand, the thought that the door is unlocked will recur and fall into a repetitive pattern of thinking (obsession) and checking to make sure the door is locked (compulsion).

Dr. Wayne Goodman, professor and chair of psychiatry at Mount Sinai Hospital in New York City described OCD as a kind of "reverberating circuit."

Deep brain stimulation (DBS), which is widely used for severe Parkinson's and experimentally to treat major depression, has limited approval in the United States to treat OCD that hasn't responded to other treatments.

But experts haven't been sure why the procedure worked.

This study involved 16 patients with OCD and 13 healthy controls, all of whom had electrodes implanted in the nucleus accumbens area of the brain. They then underwent functional MRI brain scans while performing a task that involved the anticipation of reward (the type of activity that might trigger OCD).

OCD symptoms improved an average of 50 percent while brain activity -- not only in the nucleus accumbens but also in a larger brain network -- was normalized, said Figee, who is a psychiatrist with the DBS psychiatry department at Academic Medical Center in Amsterdam, the Netherlands.

"This may explain why patients with DBS experience very fast changes in a wide array of motivational and behavioral problems," he added. "This is clinically important because it indicates that DBS could also help for other disorders that have similar network disturbances, like addiction or eating disorders."

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Deep Brain Stimulation May Help in Early Stages of Parkinson's

Title: Deep Brain Stimulation May Help in Early Stages of Parkinson's
Category: Health News
Created: 2/13/2013 6:36:00 PM
Last Editorial Review: 2/14/2013 12:00:00 AM

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Electrical Brain Stimulation Plus Drug Fights Depression: Study

By Steven Reinberg

HealthDay Reporter

WEDNESDAY, Feb. 6 (HealthDay News) -- Treating major depression safely and affordably is a challenge. Now, Brazilian researchers have found that two techniques often used individually produce better results when used together.

The researchers paired the antidepressant Zoloft (sertraline) and a type of noninvasive brain stimulation called transcranial direct current stimulation (tDCS) to treat people with moderate to severe symptoms of major depression.

Transcranial direct current stimulation appears to be just as effective a treatment as Zoloft, but the two together are even more effective, said lead researcher Dr. Andre Russowsky Brunoni, from the Clinical Research Center at University Hospital of the University of Sao Paulo.

This painless treatment uses a low-intensity electrical current to stimulate specific parts of the brain. Previously, it has been tested for various conditions, such as stroke, anxiety, pain and Parkinson's disease, the researchers said.

Dr. Sarah Hollingsworth Lisanby, chair of the department of psychiatry and behavioral sciences at Duke University School of Medicine, is enthusiastic about the findings.

Lisanby said the advent of technologies such as noninvasive brain stimulation is "one of the exciting new developments" in treating depression.

Transcranial direct current stimulation is one of a family of approaches that uses electrical or magnetic fields to stimulate the brain to alter brain function, she said.

"These techniques offer great promise for people with depression, because we know, unfortunately, medications aren't always effective, and psychotherapy isn't always effective, so having effective alternatives is important," Lisanby said.

She noted the current study's two-pronged approach addresses both aspects of brain action. The drug affects the chemical aspects of brain function, while the electrical stimulation targets the brain's electrical activity.

"Because the brain is an electro/chemical organ, using both electrical and chemical approaches to treat it makes intuitive sense," she said.

For the report, published online Feb. 6 in JAMA Psychiatry, Brunoni's team divided 120 patients with major depression who had never taken antidepressants to take Zoloft or an inactive placebo every day with or without electrical brain stimulation, or with sham stimulation.

After six weeks of treatment, Brunoni's group found depression significantly improved among patients receiving Zoloft or electrical brain stimulation. However, the biggest gain was seen in those who received both therapies. To gauge improvement, the researchers used the Montgomery-Asberg depression rating scale.

Overall, the patients received 12 half-hour brain stimulation sessions over six weeks.

Side effects from brain stimulation usually are mild and include itching, scratching and redness on the stimulated area, Brunoni said.

However, the combination treatment was associated with more cases of mania after treatment, he said. "Although we could not rule out whether this association was spurious, other studies should investigate this issue," Brunoni said.

Brain stimulation alone could be useful for patients who can't take psychiatric drugs, he said. And the devices that deliver the treatment are relatively affordable, the authors noted.

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