Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Shiraz University of Medical Sciences, Shiraz, Iran.
Neurosurg Rev. 2024 Sep 16;47(1):620. doi: 10.1007/s10143-024-02843-w.
Deep Brain Stimulation (DBS) is FDA-approved for several movement disorders; such as Parkinson's disease, dystonia, and neuropsychiatric disorders. There are various reports of Body mass index (BMI) changes following different DBS targets in various disorders.
A comprehensive systematic review and meta-analysis were conducted to investigate the impact of DBS on patients' Body Mass Index (BMI) and provide an in-depth overview of its underlying mechanisms.
We conducted research according to PRISMA guidelines. Our study assessed comprehensively electronic databases, including Pubmed, Scopus, Embase, web of science, and the Cochrane Library, up to May 2024. The random-effect model analysis was performed by the Comprehensive Meta-analysis software (CMA) version 3.0. As well, Cochran's Q test was used to determine the statistical heterogeneity of included studies.
This systematic review ultimately included 49 studies, 46 of which entered the meta-analysis. The total number of patients was 1478, consisting of Parkinson's disease (PD), dystonia, and the obsessive compulsive disorder (OCD) patients. The most common DBS target was subthalamic nucleus, followed by globus pallidus internus (GPi). Our meta-analysis depicted the BMI of participants significantly mount after DBS electrode implantation (SMD = -0.542, 95%CI: -0.678 to -0.406, and P-value < 0.001). However, moderate to high heterogeneity was detected among the studies (I = 67.566%). Additionally, the Daily energy intake (DEI) of patients significantly decreased after DBS (SMD: 0.457, 95%CI; 0.205 to 0.709, and P-value < 0.001).
STN and GPi DBS can lead to weight gain through distinct central pathways in various movement and neuropsychiatric disorders, posing a potential risk for obesity, insulin resistance, and metabolic syndrome.
深部脑刺激（DBS）已获得美国食品和药物管理局（FDA）批准，可用于治疗多种运动障碍，如帕金森病、肌张力障碍和神经精神障碍。针对不同疾病的不同 DBS 靶点，已有大量关于体重指数（BMI）变化的报告。
本研究进行了全面的系统评价和荟萃分析，以调查 DBS 对患者 BMI 的影响，并深入了解其潜在机制。
我们根据 PRISMA 指南进行了研究。我们的研究全面评估了电子数据库，包括 Pubmed、Scopus、Embase、Web of Science 和 Cochrane 图书馆，截至 2024 年 5 月。使用 Comprehensive Meta-analysis 软件（CMA）版本 3.0 进行随机效应模型分析。同时，使用 Cochran's Q 检验来确定纳入研究的统计学异质性。
本系统评价最终纳入 49 项研究，其中 46 项研究纳入荟萃分析。共有 1478 名患者，包括帕金森病（PD）、肌张力障碍和强迫症（OCD）患者。最常见的 DBS 靶点是丘脑底核，其次是苍白球内侧核。我们的荟萃分析显示，DBS 电极植入后参与者的 BMI 显著升高（SMD=-0.542，95%CI：-0.678 至-0.406，P 值<0.001）。然而，研究之间存在中度至高度异质性（I=67.566%）。此外，DBS 后患者的每日能量摄入量（DEI）显著下降（SMD：0.457，95%CI：0.205 至 0.709，P 值<0.001）。
STN 和 GPi DBS 可通过不同的中枢途径导致各种运动和神经精神障碍患者体重增加，从而增加肥胖、胰岛素抵抗和代谢综合征的风险。
