Assessment of Safety and Outcome of Lateral Hypothalamic Deep Brain Stimulation for Obesity in a Small Series of Patients With Prader-Willi Syndrome

Imagem de Miniatura
Arquivos
art_FRANCO_Assessment_of_Safety_and_Outcome_of_Lateral_Hypothalamic_2018.PDF (1.03 MB)
Citações na Scopus
31
Tipo de produção
article
Data de publicação
2018
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
AMER MEDICAL ASSOC
Autores
Citação
JAMA NETWORK OPEN, v.1, n.7, article ID e185275, 9p, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
IMPORTANCE Deep brain stimulation (DBS) has been investigated for treatment of morbid obesity with variable results. Patients with Prader-Willi syndrome (PWS) present with obesity that is often difficult to treat. OBJECTIVE To test the safety and study the outcome of DBS in patients with PWS. DESIGN, SETTING, AND PARTICIPANTS This case series was conducted in the Hospital das Clinicas, University of Sao Paulo, Brazil. Four patients with genetically confirmed PWS presenting with severe obesity were included. EXPOSURE Deep brain stimulation electrodes were bilaterally implanted in the lateral hypothalamic area. After DBS implantation, the treatment included the following phases: titration (1-2 months), stimulation off (2 months), low-frequency DBS (40 Hz; 1 month), washout (15 days), high-frequency DBS (130 Hz; 1 month), and long-term follow-up (6 months). MAIN OUTCOMES AND MEASURES Primary outcome measures were adverse events recorded during stimulation and long-term DBS treatment. Secondary outcomes consisted of changes in anthropometric measures (weight, body mass index [calculated as weight in kilograms divided by height in meters squared], and abdominal and neck circumference), bioimpedanciometry, and calorimetry after 6 months of treatment compared with baseline. The following evaluations and measurements were conducted before and after DBS: clinical, neurological, psychiatric, neuropsychological, anthropometry, calorimetry, blood workup, hormonal levels, and sleep studies. Adverse effects were monitored during all follow-up visits. RESULTS Four patients with PWS were included (2 male and 2 female; ages 18-28 years). Baseline mean (SD) body mass index was 39.6 (11.1). Two patients had previous bariatric surgery, and all presented with psychiatric comorbidity, which was well controlled with the use of medications. At 6 months after long-term DBS, patients had a mean 9.6% increase in weight, 5.8% increase in body mass index, 8.4% increase in abdominal circumference, 4.2% increase in neck circumference, 5.3% increase in the percentage of body fat, and 0% change in calorimetry compared with baseline. Also unchanged were hormonal levels and results of blood workup, sleep studies, and neuropsychological evaluations. Two patients developed stimulation-induced manic symptoms. Discontinuation of DBS controlled this symptom in 1 patient. The other required adjustments in medication dosage. Two infections were documented, 1 associated with skin picking. CONCLUSIONS AND RELEVANCE Safety of lateral hypothalamic area stimulation was in the range of that demonstrated in patients with similar psychiatric conditions receiving DBS. In the small cohort of patients with PWS treated in our study, DBS was largely ineffective.
Palavras-chave
URI
https://observatorio.fm.usp.br/handle/OPI/29953
Referências
  1. BIELAJEW C, 1994, BEHAV BRAIN RES, V62, P143, DOI 10.1016/0166-4328(94)90021-3
  2. BROWN FD, 1984, J NEUROSURG, V60, P1253, DOI 10.3171/jns.1984.60.6.1253
  3. Calandrella D, 2017, J NEUROL SCI, V373, P342, DOI 10.1016/j.jns.2017.01.034
  4. Cassidy SB, 2012, GENET MED, V14, P10, DOI 10.1038/gim.0b013e31822bead0
  5. Chang CY, 2017, MEDICINE, V96, DOI 10.1097/MD.0000000000006128
  6. Chang CH, 2010, J NEUROSURG, V112, P1299, DOI 10.3171/2009.10.JNS09918
  7. DELGADO JMR, 1953, AM J PHYSIOL, V172, P162
  8. Doucette WT, 2015, TRANSL PSYCHIAT, V5, DOI 10.1038/tp.2015.197
  9. Ettrup KS, 2012, STEREOT FUNCT NEUROS, V90, P281, DOI 10.1159/000338087
  10. Franco R, 2016, BRAIN SCI, V6, DOI 10.3390/brainsci6030021
  11. Fronczek R, 2005, J CLIN ENDOCR METAB, V90, P5466, DOI 10.1210/jc.2005-0296
  12. Halpern CH, 2013, J NEUROSCI, V33, P7122, DOI 10.1523/JNEUROSCI.3237-12.2013
  13. Hamani C, 2008, ANN NEUROL, V63, P119, DOI 10.1002/ana.21295
  14. Harat M, 2016, NEUROL NEUROCHIR POL, V50, P207, DOI 10.1016/j.pjnns.2016.01.014
  15. KRASNE FB, 1962, SCIENCE, V138, P822, DOI 10.1126/science.138.3542.822
  16. Lacan G, 2008, J NEUROSURG, V108, P336, DOI 10.3171/JNS/2008/108/2/0336
  17. Alho EJL, 2018, BRAIN STRUCT FUNCT, V223, P1121, DOI 10.1007/s00429-017-1548-2
  18. Soto-Montenegro ML, 2014, MOL IMAGING BIOL, V16, P830, DOI 10.1007/s11307-014-0753-0
  19. Manzardo AM, 2016, AM J MED GENET A, V170, P2097, DOI 10.1002/ajmg.a.37749
  20. Melega WP, 2012, PLOS ONE, V7, DOI 10.1371/journal.pone.0030672
  21. MENDELSON J, 1967, SCIENCE, V157, P1077, DOI 10.1126/science.157.3792.1077
  22. MENDELSON J, 1965, SCIENCE, V149, P559, DOI 10.1126/science.149.3683.559
  23. Miller JL, 2007, J NEUROL NEUROSUR PS, V78, P615, DOI 10.1136/jnnp.2006.099044
  24. Rezai AR, 2018, NEUROSURGERY, V82, pE136, DOI 10.1093/neuros/nyx630
  25. Ruffin MP, 1999, BRAIN RES, V846, P23, DOI 10.1016/S0006-8993(99)01922-8
  26. Sani S, 2007, J NEUROSURG, V107, P809, DOI 10.3171/JNS-07/10/0809
  27. STENGER J, 1991, PHYSIOL BEHAV, V50, P1209, DOI 10.1016/0031-9384(91)90584-B
  28. Stuber GD, 2016, NAT NEUROSCI, V19, P198, DOI 10.1038/nn.4220
  29. Talakoub O, 2017, ANN CLIN TRANSL NEUR, V4, P897, DOI 10.1002/acn3.466
  30. Torres N, 2012, INT J OBESITY, V36, P1537, DOI 10.1038/ijo.2011.271
  31. Whiting DM, 2013, J NEUROSURG, V119, P56, DOI 10.3171/2013.2.JNS12903
  32. Widge AS, 2016, J NEUROPSYCH CLIN N, V28, P38, DOI 10.1176/appi.neuropsych.15040089
  33. Zhang C, 2015, NEUROSCI LETT, V589, P1, DOI 10.1016/j.neulet.2015.01.019

Coleções
Artigos e Materiais de Revistas Científicas - FM/MNE
Artigos e Materiais de Revistas Científicas - FM/MPS
Artigos e Materiais de Revistas Científicas - HC/ICr
Artigos e Materiais de Revistas Científicas - HC/IPq
Artigos e Materiais de Revistas Científicas - LIM/21
Artigos e Materiais de Revistas Científicas - LIM/26
Carregar mais