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Objective: To evaluate the potential role of exenatide for weight loss in overweight or obese adults without diabetes. Data Sources: PubMed (1946-August 2012) and EMBASE (1974-August 2012) were used to conduct a literature search utilizing the terms exenatide, weight loss, obesity, and overweight. Additional references were identified by bibliographic review of relevant articles. Study Selection and Data Extraction: Studies assessing the use of exenatide in adult subjects without type 2 diabetes or polycystic ovary syndrome and reporting effects on body weight were included. Data Synthesis: Five studies were identified that reported use of exenatide in nondiabetic adults and included weight change as an outcomes measure. In all 5 of these studies, subjects taking exenatide experienced statistically significant weight loss, which ranged from 2.0 ± 2.8 to 5.1 ± 0.5 kg. Two of the trials were randomized, placebo-control led studies; 1 trial was a randomized, open-label investigation; 1 study had a prospective, open-label cohort design; and the remaining study was a chart review. Adverse events experienced with exenatide were primarily gastrointestinal in nature, although each trial reported the drug to be well tolerated. Conclusions: Obesity continues to be a national epidemic, while choices for effective pharmacologic treatments are extremely limited. Exenatide appears to have promising effects on weight in overweight or obese adults without type 2 diabetes, Further investigations with large, placebo-controlled trials assessing long-term weight loss as a primary outcome are warranted.

To review the literature describing the efficacy and safety of deep brain stimulation (DBS) as an adjunct to pharmacotherapy and to determine the best treatment option for patients with Parkinson disease (PD).Literature was obtained through MEDLINE/PubMed (1948-September, week 2, 2011) and a bibliographic review of relevant articles. Key words included Parkinson disease, medication, pharmacotherapy, surgery, deep brain stimulation, and best medical therapy.Five English-language studies that compared the efficacy of DBS as an adjunct to pharmacologic treatment versus pharmacologic treatment alone in patients with PD met our inclusion criteria and were selected for this review.PD is a progressive neurodegenerative disease with limited treatment options, and levodopa is considered the pharmacologic gold standard. However, long-term levodopa use leads to decreased efficacy and increased incidence of adverse effects. Hence, DBS has been investigated as an adjunctive option for patients with PD both to overcome the adverse events of levodopa as well as to treat the disease. DBS, when used in conjunction with pharmacologic therapy, has resulted in improved motor function and quality of life in several trials compared with medication alone. Its benefit is limited by adverse events that are generally more frequent and severe than those with pharmacotherapy alone. Study limitations included small patient population and/or weak design.DBS may be an option as adjunct therapy in patients whose symptoms are no longer controlled with maximum pharmacologic therapy, but benefits of surgery must be weighed against the risks.