 | Raheleh Heidari Postdoc - University of Basel |
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02.03.2017-28.04.2017
Emerging Ethical Issues in the Use of Deep Brain Stimulation for the Treatment of Obesity
Obesity-DBS is a new clinical concept and to our knowledge there are not systematic reviews or retrospective studies on the current profile of DBS in treatment of obesity and its side-effects, therefore we aim to fill this gap in knowledge through the following:
Objective 1) Collect information on the clinical implication of DBS in obesity. Current bibliography suffers from a lack of information about the clinical status of obesity-DBS which restricts us to available information obtained from the DBS of neurodegenerative diseases, while brain targets are
different for obesity-DBS. We plan to clarify the actual clinical profile of obesity-DBS via the analysis of:- Main obesity-DBS methodology
- Brain areas targeted for the electrical stimulation
- Type of obesity and stage of the disease that qualify the patient for DBS therapy
Objective 2) Provide a systematic review of the psychological adverse-effects of obesity-DBS. DBS side effects tend to be highly heterogeneous even within a certain class of disease. These effects are still unknown with regard to obesity. We plan to investigate the following potential side-effects:
•Anhedonia and risk of addiction: a main target in obesity-DBS is pleasure circuitry that poses complications such as: i) DBS of subthalamic nucleus induces addictive behaviour and impulsivity in some cases and ii) DBS of nucleus accumbens alters the metabolic ratio of prefrontal cortex/amygdala and other areas of the brain highly involved in pleasure and sensory processing, thus inducing a pleasure seeking behaviour for external reward e.g. shopping, gambling and sex, while not enjoying it. Therefore we plan to collect information on anhedonia experience and addiction risk associated with obesity-DBS.
• Personality alteration and identity changes: A recent study, reports a negative impact of DBS on several personality traits e.g. temperament, perseverance and a higher level of impulsivity by impairing response inhibition associated with a reduced level of self-perception. We aim to review psychological assessment of these alterations, their impact on quality of life and on questions of personal identity.
Objective 3) Survey public perception of DBS as a novel therapy for obesity: while obesity-DBS is emerging as a novel treatment, the public needs to receive reliable information on clinical application of DBS, its risks and benefits. However, there is a lack of consistent access to resources that provide vital information on DBS. Survey of public databases and resources, and the information gained through questionnaires we aim to evaluate:- What resources are available to the public?
- Is the DBS image too optimistic or is it under-represented?
- Could DBS be transformed into an enhancement tool, as opposed to a therapeutic application?
I'm a neurobiologist by training. I have previously worked on the mechanisms of learning and memory in animal models, looking for potential links between sex-hormones and spatial memory and genetic components of habituation. My PhD thesis was on drug discovery and genetic screen in pre-clinical models of PolyQ class of neurodegenerative disorders.
Following my PhD I joined the department of biomedical ethics in the University of Basel to investigate the societal impact and regulatory framework of cutting-edge biotechnology such as CRISPR and emerging synthetic biology techniques.
Currently I’m following advanced studies in the clinical trial practice and management at the University-Hospital of Basel.
During my residency at Brocher foundation I will investigate the ethical and psychosocial consequences of Deep Brain Stimulation for the treatment of Obesity.
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