Objective: To identify stimulation-dependent effects of deep brain stimulation (DBS) on body weight and energy metabolism depending on the electrode position within the subthalamic nucleus (STN).

Background: A remarkable body weight gain in combination with metabolic alterations has been observed after STN DBS in patients with Parkinson’s disease (PD), which potentially counteracts the positive effects of motor improvement.

Method: Fourteen PD patients who underwent STN DBS (PD-DBS) were assessed before, 6 and 12 months post-surgery. For control purposes, 18 PD patients under best medical treatment (PD-CON) and 25 healthy controls (H-CON) were enrolled. Wrist actigraphy, assessment of body composition, analysis of hormones, and energy expenditure measurements were applied. Electrode placement in the STN was localized using a state-of-the-art approach.

Results: STN DBS resulted in a mean improvement of motor function of 60.9±2.6% after 6 months of stimulation and remained stable over stimulation duration (DBS ON, Med ON). Body weight and fat mass increased by +2.9 kg and 2.7% in PD-DBS (all p≤0.01) after 6 months of stimulation. After 12 months of stimulation, body weight increased by +3.2 kg (p=0.011) and FM increased to 2.8% (p=0.001) compared to baseline. On a metabolic level, we found increased levels of insulin (p=0.05) as well as an increased HOMA index (insulin resistance measurement; p=0.04) in DBS-treated patients but not in the control groups after 6 months of DBS. Moreover, growth hormone levels decreased after 6 months of stimulation (p=0.03). Decreased levels of daily physical activity and decreased VO₂ levels during walking were exclusively found in PD-DBS group after 6 months of stimulation (all p≤0.01). Activity levels remained on a low level after 12 months of stimulation. DBS of the limbic proportion of the STN was associated with changes in body composition, glucose homeostasis and decreased energy output (all p≤0.04; all r≥0.56).

Conclusion: Our results highlight that physical activity is decreased after STN DBS in PD which contributes to weight gain and an unfavorable metabolic profile. We recommend measurements of the body weight on a regular basis and the use actigraphy devices to provide feedback on the daily activity. This approach could help the patient to achieve pre-defined activity goals, e.g. number of steps per day.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mechanisms-and-consequences-of-weight-gain-after-deep-brain-stimulation-of-the-subthalamic-nucleus-in-patients-with-parkinsons-disease/