Journal
NEUROSURGERY
Volume 87, Issue 6, Pages 1277-1288Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1093/neuros/nyaa300
Keywords
Responsive neurostimulation; DBS; Deep brain stimulation; Nucleus accumbens; Loss of control; Eating disorders; Binge; Obesity
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Funding
- NIH [UH3NS103446-01A1, K12NS080223]
- Brain & Behavior Research Foundation
- Neurosurgery Research and Education Foundation
- John A. Blume Foundation
- William Randolph Hearst Foundation
- European Society for Stereotactic and Functional Neurosurgery Research Grant
- Stanford Neuroscience Institute's Neurochoice Initiative
- Stanford's Department of Neurosurgery
- NeuroPace
- National Institute of Mental Health
- National Institute on Aging
- National Human Genome Research Institute
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BACKGROUND: Loss of control (LOC) is a pervasive feature of binge eating, which contributes significantly to the growing epidemic of obesity; approximately 80 million US adults are obese. Brain-responsive neurostimulation guided by the delta band was previously found to block binge-eating behavior in mice. Following novel preclinical work and a human case study demonstrating an association between the delta band and reward anticipation, the US Food and Drug Administration approved an Investigational Device Exemption for a first-in-human study. OBJECTIVE: To assess feasibility, safety, and nonfutility of brain-responsive neurostimulation for LOC eating in treatment-refractory obesity. METHODS: This is a single-site, early feasibility study with a randomized, single-blinded, staggered-onset design. Six subjects will undergo bilateral brain-responsive neurostimulation of the nucleus accumbens for LOC eating using the RNS (R) System (NeuroPace Inc). Eligible participants must have treatment-refractory obesity with body mass index >= 45 kg/m(2). Electrophysiological signals of LOC will be characterized using real-time recording capabilities coupled with synchronized video monitoring. Effects on other eating disorder pathology, mood, neuropsychological profile, metabolic syndrome, and nutrition will also be assessed. EXPECTED OUTCOMES: Safety/feasibility of brain-responsive neurostimulation of the nucleus accumbens will be examined. The primary success criterion is a decrease of >= 1 LOC eating episode/week based on a 28-d average in >= 50% of subjects after 6 mo of responsive neurostimulation. DISCUSSION: This study is the first to use brain-responsive neurostimulation for obesity; this approach represents a paradigm shift for intractable mental health disorders.
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