Published: April 12, 2009 02:07 am      

Deep brain stimulation

Goal: Help make people want to eat less

FAIRMONT — When Carol Poe saw an advertisement in the paper asking for participants in a study to help people lose weight through something called “deep brain stimulation,” she gave the idea some consideration, but decided not to look into it further.

“It said participants had to have had gastric bypass surgery and still have 40 percent body fat,” said the Morgantown resident. “I have both. But I didn’t do anything. I decided I just have to accept myself the way I am.”

Soon after, however, she went to see her doctor for a check-up. The doctor encouraged her to call the number at West Virginia University Hospitals’ Ruby Memorial Hospital and find out more about the study.

“I left the office and thought, ‘Maybe she’s got a point.’”

As a result, Poe, who weighed 287 pounds, was the second person to receive the surgery, which was designed to do what her gastric bypass surgery had not — make her want to eat less food.

So far, so good. On Feb 3, the 60-year-old Poe had the surgery, an event covered by the ABC News show “Nightline.” Weight loss was not expected to begin right away because the device used for the procedure, essentially a pacemaker for the brain that would stimulate the part of Poe’s brain that made her feel hungry, went through a period of weekly adjustments.

But by late March, she had lost nine pounds. More important, she had noticed big changes in the way she viewed her eating habits.

“I haven’t had a Pepsi all day,” she said. “And I only had 8 ounces yesterday. You don’t even think about it. The only reason I had 8 ounces yesterday was because I had a headache, and I’m so used to caffeine. But now my body is trying to get away from caffeine.”

Deep brain stimulation (DBS) is not new, but the idea to apply it to help make people want to eat less is. Dr. Don Whiting, co-director of the Division of Neuromodulation in the Department of Neurosurgery at WVU Hospitals who also practices at Allegheny General Hospital in Pittsburgh, took a treatment for neurological disorders such as essential tremors and Parkinson’s disease and decided to see if it could help people want to eat less.

In DBS, doctors basically implant wires in a specific part of the brain, depending on what the DBS is being used to treat, and a battery pack is implanted beneath the collarbone. The treatment was approved for essential tremors in 1997 and Parkinson’s disease in 2002. As the procedure was improved, physicians began to come up with different uses for it, including for the treatment of depression and other psychological disorders.

“After doing it for a few years for essential tremors, it was very safe and extremely effective and it’s non destructive,” Whiting said. “If you go and do it, and it does not have any benefit or if it gives them a side effect, you turn off the electricity and it goes back to normal.”

Whiting and his colleague, Dr. Michael Oh, decided to see if the procedure would work as a brain-centered approach to losing weight.

“It’s one of the biggest problems in the United States, and it’s a very unmet need,” Whiting said. “Mine and Dr. Oh’s rationale was that with a gastric bypass, you take a normally functioning organ and make it smaller. But if truly there is a weight, quote unquote, thermostat in the brain that controls intake, hunger and metabolism, why not go to the source and just readjust that thermostat rather than take a regularly functioning organ and make it different?”

As shown on the “Nightline” segment, Poe, the second patient to receive the surgery for weight loss, wore a metal ring screwed onto her head “that acts as a mini-GPS for the brain,” Whiting said. “So you put the coordinates into the computer and it gives us the direction to dial into that thing on her head within 1 millimeter of accuracy.

“We pick out the place in the brain, and the computer tells us how to get there.”

Poe was awake for the surgery, with the top of her head numbed, so she could react and tell the doctors how she felt as they adjusted the intensity of the electrodes in an effort to make Poe feel nauseous, not permanently but for the sake of making sure the electrodes were implanted in the correct location.

“We were just looking for any kind of effect in those areas,” Whiting said. “If she was getting nauseous, that meant we were in the right area. Then we can put it on a lower voltage and still stimulate and shut down that area and do at at sub-nausea levels.”

As she appeared in the “Nightline” segment, Poe seemed pretty nonplussed to have a large metal device screwed into her head and to have doctors performing surgery on her brain while awake.

While hearing about the procedure from Whiting, Poe asked him, “‘Do I have to be asleep?’ and he said, ‘No, you have to be awake.’ I said, ‘That makes it better because I like to know what’s going on.’ I was not afraid,” she said.

“When they explained that to me and gave me papers to read, I knew when I left that office that if I passed the test, I would do it. I felt confident with the doctors. I felt God is going to take care of me, and this is my last resort.”

Poe was a good candidate for the procedure because she already had gotten gastric bypass surgery and still had a body mass index of 40 percent or higher. In the future, if the procedure becomes an accepted treatment for obesity, that might not be the case. But for now, “This is a last resort,” Whiting said.

The risks are similar for DBS performed on Parkinson’s patients. That’s a 1 percent chance of bleeding, stroke, coma or death, Whiting said, which he noted is a smaller risk than death from being morbidly obese

A third patient has been scheduled for the procedure in a couple of months. After studying the results from the three patients for a period of time, Whiting and Oh can submit their results to the Food and Drug Administration (FDA) with the hope of getting approval for a larger study that would be performed at several hospitals across the country.

“We have to look at the data for at least a year to have anything meaningful to submit,” Whiting said. “If it is meaningful, we go back to the FDA with a bigger study with more people. This is just a pilot study with three patients.”

Poe and the other patient go to Ruby Memorial Hospital at WVU Hospitals once a week to be weighed in an effort to gauge the success of the procedure. “Success” would be defined as a weight loss of at least 60 pounds, Whiting said.

As for when the FDA might approve DBS for weight loss, “I’m just guessing, realistically, if we do this and go for a year, and go to the FDA to do a multi-center study, that’s another three or four years,” Whiting said. “Once the FDA gets those results, it’s another year or two. My guess is that this might be five to 10 years down the road.”

E-mail Mary Wade Burnside at mwburnside@timeswv.com.