Navigated repetitive transcranial magnetic stimulation to correct eating behavior in obesity (clinical cases)

Obesity is a pathological condition caused by overweight and requiring medical intervention. The clinical and scientific experience gained over the past decades has allowed researchers to consider this problem as an independent disease with its own pathophysiological features, prevalence, incidence, approaches to therapy and prevention. One of the most important factors in the pathogenesis of obesity is disordered eating behavior, the central regulation of which is carried out with the active participation of the prefrontal cortex. Impact on this area (for example, using non-invasive brain stimulation) may be one of the promising ways to modulate eating behavior. The article describes clinical cases of treatment of morbid obesity using navigated rhythmic transcranial magnetic stimulation (rTMS). Different patterns of dorsolateral prefrontal cortex (DLPFC) activation before and after rTMS are demonstrated. Possible mechanisms of the influence of DLPFC on the formation of eating behavior are also considered. These data underline the important role of DLPFC dysregulation in obesity, as well as show potentially effective neuromodulation techniques.

1. Seidell JC, Halberstadt J. The global burden of obesity and the challenges of prevention. Ann Nutr Metab. 2015;66 Suppl 2:7-12. DOI:10.1159/000375143

2. Zentenius E, Andersson-Assarsson JC, Carlsson LMS, et al. Self-Reported Weight-Loss Methods and Weight Change: Ten-Year Analysis in the Swedish Obese Subjects Study Control Group. Obesity (Silver Spring). 2018;26(7):1137-1143. DOI:10.1002/oby.22200

3. Ralston J, Brinsden H, Buse K, et al. Time for a new obesity narrative. Lancet. 2018;392(10156):1384-1386. DOI:10.1016/s0140-6736(18)32537-6

4. Логвинова О.В., Галиева М.О., Мазурина Н.В., Трошина Е.А. Место препаратов центрального действия в алгоритмах лечения экзогенно-конституционального ожирения. // Ожирение и метаболизм. — 2017. — Т. 14. — №2 — С. 18-23. [Logvinova OV, Galieva MO, Mazurina NV, Troshina EA. The place of central-acting drugs in the algorithms of treatment of primary obesity. Obesity and metabolism. 2017;14(2):18-23. (In Russ.)] DOI:10.14341/OMET2017218-23

5. Bray GA, Kim KK, Wilding JPH, World Obesity F. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017;18(7):715-723. DOI:10.1111/obr.12551

6. Schnabel RB, Yin X, Larson MG, et al. Multiple inflammatory biomarkers in relation to cardiovascular events and mortality in the community. Arterioscler Thromb Vasc Biol. 2013;33(7):1728-1733. DOI:10.1161/ATVBAHA.112.301174

7. Radmard AR, Merat S, Kooraki S, et al. Gallstone disease and obesity: a population‐based study on abdominal fat distribution and gender differences. Ann Hepatol. 2015;14(5):702-709.

8. Giel KE, Hartmann A, Zeeck A, et al. Decreased Emotional Perception in Obesity. Eur Eat Disord Rev. 2016;24(4):341-346. DOI:10.1002/erv.2444

9. Вахмистров А.В. Клинико-психологический анализ различных форм эмоциогенного пищевого поведения. // Альманах клинической медицины. — 2001. — №4. — С. 127-130. [Vakhmistrov AV. Kliniko-psikhologicheskiy analiz razlichnykh form emotsiogennogo pishchevogo povedeniya. Almanac of clinical medicine. 2001;(4):127-130. (In Russ.)]

10. van Strien T, Frijters JER, Bergers GPA, Defares PB. The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. Int J Eat Disord. 1986;5(2):295-315. DOI:10.1002/1098-108x(198602)5:2<295::aid-eat2260050209>3.0.co;2-t

11. Baothman OA, Zamzami MA, Taher I, et al. The role of Gut Microbiota in the development of obesity and Diabetes. Lipids Health Dis. 2016;15(1). DOI:10.1186/s12944-016-0278-4

12. Kallus SJ, Brandt LJ. The intestinal microbiota and obesity. J Clin Gastroenterol. 2012;46(1):16-24. DOI:10.1097/MCG.0b013e31823711fd

13. Opinto G, Natalicchio A, Marchetti P. Physiology of incretins and loss of incretin effect in type 2 diabetes and obesity. Arch Physiol Biochem. 2013;119(4):170-178. DOI:10.3109/13813455.2013.812664

14. Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342-362. DOI:10.1210/jc.2014-3415

15. Yanovski SZ, Yanovski JA. Long-term Drug Treatment for Obesity. Jama. 2014;311(1):74. DOI:10.1001/jama.2013.281361

16. Greenway FL, Caruso MK. Safety of obesity drugs. Expert Opin Drug Saf. 2005;4(6):1083-1095. DOI:10.1517/14740338.4.6.1083

17. Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. a systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253(3):484-487. DOI:10.1097/SLA.0b013e31820d98cb

18. Padwal R, Klarenbach S, Wiebe N, et al. Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Obes Rev. 2011;12(8):602-621. DOI:10.1111/j.1467-789X.2011.00866.x

19. Wadden TA, Sarwer DB. Behavioral assessment of candidates for bariatric surgery: a patient-oriented approach. Surg Obes Relat Dis. 2006;2(2):171-179. DOI:10.1016/j.soard.2006.03.011

20. Lowe CJ, Vincent C, Hall PA. Effects of Noninvasive Brain Stimulation on Food Cravings and Consumption: A Meta-Analytic Review. Psychosom Med. 2017;79(1):2-13. DOI:10.1097/PSY.0000000000000368

21. Di Lazzaro V, Ziemann U, Lemon RN. State of the art: Physiology of transcranial motor cortex stimulation. Brain Stimul. 2008;1(4):345-362. DOI:10.1016/j.brs.2008.07.004

22. Hoogendam JM, Ramakers GM, Di Lazzaro V. Physiology of repetitive transcranial magnetic stimulation of the human brain. Brain Stimul. 2010;3(2):95-118. DOI:10.1016/j.brs.2009.10.005

23. Chervyakov AV, Chernyavsky AY, Sinitsyn DO, Piradov MA. Possible Mechanisms Underlying the Therapeutic Effects of Transcranial Magnetic Stimulation. Front Hum Neurosci. 2015;9:303. DOI:10.3389/fnhum.2015.00303

24. Червяков А.В., Пойдашева А.Г., Коржова Ю.Е., и др. Ритмическая транскраниальная магнитная стимуляция в неврологии и психиатрии. // Журнал неврологии и психиатрии им. C.C. Корсакова. 2015. — Т. 115. — №12. — С. 7-18. [Chervyakov AV, Poydasheva AG, Korzhova JE, et al. Repetitive transcranial magnetic stimulation in neurology and psychiatry. Zh Nevrol Psikhiatr Im S S Korsakova. 2015;115(12):7-18. (In Russ.)] DOI:10.17116/jnevro20151151127-18

25. Bliss TV, Cooke SF. Long-term potentiation and long-term depression: a clinical perspective. Clinics (Sao Paulo). 2011;66 Suppl 1:3-17. DOI:10.1590/s1807-59322011001300002

26. Duffau H. Brain plasticity: from pathophysiological mechanisms to therapeutic applications. J Clin Neurosci. 2006;13(9):885-897. DOI:10.1016/j.jocn.2005.11.045

27. Val-Laillet D, Aarts E, Weber B, et al. Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity. Neuroimage Clin. 2015;8:1-31. DOI:10.1016/j.nicl.2015.03.016

28. Hall PA, Vincent CM, Burhan AM. Non-invasive brain stimulation for food cravings, consumption, and disorders of eating: A review of methods, findings and controversies. Appetite. 2018;124:78-88. DOI:10.1016/j.appet.2017.03.006

29. Uher R, Yoganathan D, Mogg A, et al. Effect of left prefrontal repetitive transcranial magnetic stimulation on food craving. Biol Psychiatry. 2005;58(10):840-842. DOI:10.1016/j.biopsych.2005.05.043

30. Van den Eynde F, Claudino AM, Mogg A, et al. Repetitive transcranial magnetic stimulation reduces cue-induced food craving in bulimic disorders. Biol Psychiatry. 2010;67(8):793-795. DOI:10.1016/j.biopsych.2009.11.023

31. Kim SH, Chung JH, Kim TH, et al. The effects of repetitive transcranial magnetic stimulation on eating behaviors and body weight in obesity: A randomized controlled study. Brain Stimul. 2018;11(3):528-535. DOI:10.1016/j.brs.2017.11.020

32. Логвинова О.В., Пойдашева А.Г., Бакулин И.С., и др. Cовременные представления о патогенезе ожирения и новых подходах к его коррекции. // Ожирение и метаболизм. — 2018. — Т. 15. — №2. — С. 11-16. [Logvinova OV, Poydasheva AG, Bakulin IS, et al. Modern concepts of the pathogenesis of obesity and new approaches to its correction. Obesity and metabolism. 2018;15(2):11-16. (In Russ.)] DOI:10.14341/OMET9491

33. Heinitz S, Reinhardt M, Piaggi P, et al. Neuromodulation directed at the prefrontal cortex of subjects with obesity reduces snack food intake and hunger in a randomized trial. Am J Clin Nutr. 2017;106(6):1347-1357. DOI:10.3945/ajcn.117.158089

34. Ruohonen J, Karhu J. Navigated transcranial magnetic stimulation. Neurophysiol Clin. 2010;40(1):7-17. DOI:10.1016/j.neucli.2010.01.006

35. Ahdab R, Ayache SS, Brugieres P, et al. Comparison of «standard» and «navigated» procedures of TMS coil positioning over motor, premotor and prefrontal targets in patients with chronic pain and depression. Neurophysiol Clin. 2010;40(1):27-36. DOI:10.1016/j.neucli.2010.01.001

36. Willis LH, Slentz CA, Bateman LA, et al. Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. J Appl Physiol (1985). 2012;113(12):1831-1837. DOI:10.1152/japplphysiol.01370.2011

37. Poirier P, Després J-P. Exercise in Weight Management of Obesity. Cardiol Clin. 2001;19(3):459-470. DOI:10.1016/s0733-8651(05)70229-0

38. Rossi S, Hallett M, Rossini PM, et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120(12):2008-2039. DOI:10.1016/j.clinph.2009.08.016

39. Gluck ME, Viswanath P, Stinson EJ. Obesity, Appetite, and the Prefrontal Cortex. Curr Obes Rep. 2017;6(4):380-388. DOI:10.1007/s13679-017-0289-0

40. Keller KL. Brain stimulation for treatment of obesity: will stimulating the prefrontal cortex reduce overeating? Am J Clin Nutr. 2017;106(6):1331-1332. DOI:10.3945/ajcn.117.169631

41. Кремнева Е.И., Суслин А.С., Говорин А.Н., и др. ФМРТ-картирование алиментарных функциональных зон головного мозга. // Анналы клинической и экспериментальной неврологии. — 2015. — Т. 9. — №1. — С. 32-36. [Kremneva EI, Suslin AS, Govorin AN, et al. Mapping of the brain regions responsible for eating behavior regulation with functional MRI. Annaly klinicheskoy i eksperimental’noy nevrologii. 2015;9(1):32-36. (In Russ.)]