Obesity, Obesity, Morbid
Conditions
Keywords
Deep Brain Stimulation, Functional Neurosurgery, Neuromodulation, Bariatrics, Weight Loss, Addiction
Brief summary
This is an open-label, phase I pilot trial designed to evaluate the safety and feasibility of deep brain stimulation (DBS) for the treatment of refractory morbid obesity. Patients with diagnoses of morbid obesity will be recruited and enrolled. All patients will receive DBS targeting two brains areas involved in the pathophysiology of obesity and will be followed post-operatively for 12 months.
Detailed description
This study will establish 1)the safety of deep brain stimulation (DBS) in a patient population with treatment refractory morbid obesity. DBS has been used safely and effectively in thousands of patients for numerous disorders. Recent evidence (outlined above) has shown that DBS can also be used to manage refractory psychiatric conditions, such as depression and obsessive-compulsive disorder, as well as in eating disorders such as anorexia nervosa. Such studies indicate that a targeted therapy informed by the neuroanatomic and circuitry literature can be effective in altering pathological mood and behaviour. 2) evaluate the effectiveness of the procedure, which will be evaluated by the actual weight loss and resolution of the core symptoms of morbid obesity, including BMI, as well of, depression, self-esteem, and binge eating scores surrounding with loss or weight gain.
Interventions
DEVICEDeep Brain Stimulation
All patients will undergo surgical implantation of a deep brain stimulation (DBS) system, which involves placement of stimulating electrodes in the brain. These electrodes will be used to deliver electrical current to target two brain structures involved in the pathophysiology of obesity.
Sponsors
University Health Network, Toronto
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
1. Female or Male patients between age 20-60 2. Diagnosis of Morbid Obesity (defined as a BMI\>40kg/m2 or BMI\>35 with 1 obesity related comorbidity) OR a diagnosis of Binge Eating Disorder not responsive to recommended treatments (as defined by the DSM-5) 3. Failure or non eligibility of bariatric surgery with \<50% of excess weight loss, with or without BMI\>35 kg/m2, at 18 months or more after the operation; OR diagnosis of binge eating disorder for over 18 months 4. Diagnosis of food dependence via Yale Food Addiction Scale (YFAS) criteria 5. Normal neurological exam 6. Normal head CT scan and cerebral MRI 7. Patient informed and able to give written consent 8. Able to comply with all testing, follow-ups and study appointments and protocols
Exclusion criteria
1. Active neurologic disease such as epilepsy 2. Alcohol or substance dependence or abuse in the last 6 months, excluding caffeine and nicotine 3. Any contraindication to magnetic resonance imaging (MRI) or positron emission tomography (PET) scanning 4. Likely to relocate or move during the study's one year duration 5. Presence of cardiac arrhythmias, or other cardiac, respiratory, renal or endocrine conditions as a result of morbid obesity, that will result in significant risk from a surgical procedure. 6. Presence of epilepsy, stroke or degenerative disorder of the nervous system 7. Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Treatment-Emergent Adverse Events | 12 months | Patients will be closely monitored for adverse events following DBS surgery with regular check-ups. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 'Quality of Life Scale' Questionnaire | 12 months | Patients will regularly complete the 16-item Quality of Life Scale questionnaire (worst score = 16, best score = 112) to assess psychosocial function. |
| 'Generalized Anxiety Disorder 7-item (GAD-7)' Questionnaire | 12 months | Patients will regularly complete the 7-item GAD-7 questionnaire (worst score = 21, best score = 0) to assess anxiety symptoms. |
| 'Behavioral Inhibition System/Behavioral Activation System Scales (BIS/BAS Scales)' Questionnaire | 12 months | Patients will regularly complete the 24-item BIS/BAS Scales questionnaire to assess psychosocial behaviour. This questionnaire has 3 sub-scales: 'BAS drive' (highest score = 16, lowest score = 4), 'BAS fun seeking' (highest score = 20, lowest score = 5), 'BAS reward responsiveness' (highest score = 20, lowest score = 5), and 'BIS' (highest score = 28, lowest score = 7). |
| 'Patient Health Questionnaire (PHQ-9)' Questionnaire | 12 months | Patients will regularly complete the 9-item PHQ-9 questionnaire (worst score = 27, best score = 0) to assess mood and depression symptoms. |
| 'Difficulties in Emotion Regulation Scale (DERS)' Questionnaire | 12 months | Patients will regularly complete the 36-item DERS questionnaire (worst score = 180, best score = 36) to assess emotional dysregulation. |
| 'Yale-Brown Obsessive Compulsive Scale (Y-BOCS)' Questionnaire | 12 months | Patients will regularly complete the 10-item Y-BOCS questionnaire (worst score = 40, best score = 0) to assess severity of obsessive and compulsive symptoms |
| Weight | 12 months | Weight (in kilograms) will be frequently assessed prior to and following DBS surgery. |
| 'Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS)' Questionnaire | 12 months | Patients will regularly complete the 19-item YBC-EDS questionnaire (worst score = 32, best score = 0) to assess eating-related preoccupations and rituals |
| 'Emotional Eating Scale (EES)' Questionnaire | 12 months | Patients will regularly complete the 25-item EES questionnaire (worst score = 100, best score = 0) to assess their emotional relationship with food. |
| 'Power of Food (POF)' Questionnaire | 12 months | Patients will regularly complete the 15-item POF questionnaire (worst score = 75, best score = 15) to assess the degree of influence food exerts on their day-to-day life. |
| 'Eating Disorder Examination Questionnaire (EDE-Q)' | 12 months | Patients will regularly complete the 28-item EDE-Q (worst score = 6, best score = 0) to assess aspects of eating behaviour including restraint, eating concern, shape concern, and weight concern. |
| 'Yale Food Addiction Scale (YFAS)' Questionnaire | 12 months | Patients will regularly complete the 25-item YFAS (higher numbers = more severe symptoms) to assess the severity of food addiction. |
| 'Binge Eating Scale (BES)' Questionnaire | 12 months | Patients will regularly complete the 16-item BES questionnaire (worst score = 43, best score = 0) to assess binge eating symptoms |
Countries
Canada
Outcome results
None listed