Abstract
Purpose: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment method for advanced Parkinson's disease (PD) and isolated dystonia and provides marked improvement of major motor symptoms. In addition, non-motor effects have been reported including weight gain (WG) in patients with PD after STN-DBS. However, it is still unclear whether patients with isolated dystonia also experience WG.Methods: Data from 47 patients with isolated dystonia who underwent bilateral STN-DBS surgery between October 2012 and June 2019 were retrospectively collected. The severity of dystonia was assessed via the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Changes in the body mass index (BMI) and BFMDRS score were analyzed using paired Student's t-tests. Regression analysis was performed to identify factors that affected the BMI after surgery.Results: Postoperative WG was observed in 78.7% of patients. The percentage of overweight and obese patients increased from 25.5% (before STN-DBS) to 48.9% (at the last follow-up). The mean BMI and mean percentage change in BMI increased by 1.32 ± 1.83 kg/m2 (P < 0.001) and 6.28 ± 8.34%, respectively. BMI increased more in female than in male patients. At the last follow-up, BFMDRS movement and disability scores improved by 69.76 ± 33.23% and 65.66 ± 31.41%, respectively (both P < 0.001). The final regression model analysis revealed that sex and preoperative BMI alone were independently associated with BMI change (P < 0.05).Conclusions: STN-DBS is associated with postoperative WG with patients with isolated dystonia. WG is more prominent in female patients and is associated with preoperative weight but not with the efficacy of STN-DBS on motor symptoms.
Highlights
In recent decades, deep brain stimulation (DBS) has been applied to treat many disorders, such as advanced stages of Parkinson’s disease (PD), intractable essential tremor, complicated segmental and generalized dystonia, and neuropsychiatric diseases [1, 2]
Patients with isolated dystonia [with normal brain magnetic resonance imaging (MRI) scans] [10] who were treated with bilateral STN-DBS between August 2012 and May 2019 were included in the present study
There is evidence showing that female patients with PD gain disproportionate amounts of fat mass after STN-DBS, while weight gain (WG) in men was driven by both fat-free mass and fat mass [27, 28]
Summary
Deep brain stimulation (DBS) has been applied to treat many disorders, such as advanced stages of Parkinson’s disease (PD), intractable essential tremor, complicated segmental and generalized dystonia, and neuropsychiatric diseases [1, 2]. Many researchers have reported that weight gain (WG) is common in patients with PD after DBS of the subthalamic nucleus (STN-DBS) [9]. This is concerning because WG may lead to additional health complications such as obesity and diabetes [6]. Some potential mechanisms underlying WG in patients with PD after STN-DBS treatment have been suggested, including the improvement of resting tremor and dyskinesias, reduction in energy expenditure (EE), changes in eating behavior and food intake, perturbations of homeostatic control, changes in hormone and neurotransmitter systems, and improvement in motor function; the exact mechanism underlying WG remains unknown [9]
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