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Post of the Week: Reason for the Weight Gain After DBS?


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#1 Dr. Okun

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Posted 23 January 2011 - 06:02 PM

Dear forum members,

The weight gain following DBS has been quite a mystery with many theories batted around by many experts,

This recent article addresses potential changes in hormone and neurotransmitter levels following DBS (melanocortin system) . This is potentially a plausible explanation for the weight gain, and will deserve a closer look. This also supports a role for DBS in affecting the hypothalamic circuits important to weight.

Here is the abstract:

Acta Neurol Scand. 2011 Jan 4. doi: 10.1111/j.1600-0404.2010.01469.x. [Epub ahead of print]
Change of the melanocortin system caused by bilateral subthalamic nucleus stimulation in Parkinson's disease.
Escamilla-Sevilla F, Pérez-Navarro MJ, Muñoz-Pasadas M, Sáez-Zea C, Jouma-Katati M, Piédrola-Maroto G, Ramírez-Navarro A, Mínguez-Castellanos A.

Departments of Neurology Neurosurgery Endocrinology Nuclear Medicine, 'Virgen de las Nieves' University Hospital, Granada, Spain.
Abstract
Escamilla-Sevilla F, Pérez-Navarro MJ, Muñoz-Pasadas M, Sáez-Zea C, Jouma-Katati M, Piédrola-Maroto G, Ramírez-Navarro A, Mínguez-Castellanos A. Change of the melanocortin system caused by bilateral subthalamic nucleus stimulation in Parkinson's disease. Acta Neurol Scand: DOI: 10.1111/j.1600-0404.2010.01469.x. © 2011 John Wiley & Sons A/S. Objectives -  Determine whether bilateral subthalamic nucleus stimulation (STN-DBS) in Parkinson's disease (PD) is associated with an increase in neuropeptide Y (NPY) and/or resistance to inhibition by leptin in relation to post-surgery weight gain. Materials and Methods -  This prospective study included 20 patients who underwent bilateral STN-DBS and 17 who refused surgery. Data were obtained at baseline, 3 and 6 months on neurological and nutritional status, including determination of body mass index (BMI) and serum NPY and leptin levels. Results -  NPY and leptin levels changed over time, with a distinct pattern. The BMI increase at 6 months was greater in the surgical group (5.5 ± 6.3% vs 0.5 ± 3.5%; P = 0.035). Medical group exhibited a reduction in leptin level (-2.0 ± 4.3 ng/ml) and a consequent increase in NPY level (72.4 ± 58.7 pmol/ml). However, STN-DBS patients showed an increase in leptin (3.1 ± 5.0 ng/ml; P = 0.001 vs medical group) and also in NPY (12.1 ± 53.6 pmol/ml; P = 0.022 vs medical group) levels, which suggests resistance to inhibition by leptin. Rise in NPY level correlated with higher stimulation voltages. Conclusions -  Bilateral STN-DBS causes disruption of the melanocortin system, probably related to diffusion of the electric current to the hypothalamus. This mechanism may in part explain the weight gain of patients with PD after surgery.

© 2011 John Wiley & Sons A/S.
PMID: 21198450 [PubMed - as supplied by publisher]

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Michael S. Okun, M.D.
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