Lei Chen1, Nan Li1, Shunnan Ge1, Andres M Lozano2, Darrin J Lee2, Chen Yang1, Liang Li3, Qianrong Bai4, Hongbing Lu3, Jing Wang1, Xin Wang1, Jiaming Li1, Jiangpeng Jing1, Mingming Su1, Longxiao Wei4, Xuelian Wang5, Guodong Gao6. 1. Department of Neurosurgery, TangDu Hospital, Fourth Military Medical University, Xian, Shaanxi, 710038, China. 2. Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, M5T 2S8, Canada. 3. School of Biomedical Engineering, Fourth Military Medical University, Xian, Shaanxi, 710032, China. 4. Department of Nuclear Medicine, TangDu Hospital, Fourth Military Medical University, Xian, Shaanxi, 710038, China. 5. Department of Neurosurgery, TangDu Hospital, Fourth Military Medical University, Xian, Shaanxi, 710038, China. Electronic address: tdwxlian@126.com. 6. Department of Neurosurgery, TangDu Hospital, Fourth Military Medical University, Xian, Shaanxi, 710038, China. Electronic address: guodong_g@126.com.
Abstract
BACKGROUND: Deep brain stimulation (DBS) is currently used to treat addiction, with the nucleus accumbens (NAc) as one promising target. The anterior limb of the internal capsule (ALIC) is also a potential target, as it carries fiber tracts connecting the mesocorticolimbic circuits that are crucially involved in several psychiatric disorders, including addiction. Stimulating the NAc and ALIC simultaneously may have a synergistic effect against addiction. METHODS: Eight patients with a long history of heroin use and multiple relapses, despite optimal conventional treatments, were enrolled. Customized electrodes were implanted through the ALIC into the NAc, and deep brain stimulation (DBS) treatment began two weeks after surgery. The patients were followed for at least 24 months. The duration of drug-free time, severity of drug cravings, psychometric evaluations, and PET studies of glucose metabolism before and after DBS were conducted. All adverse events were recorded. RESULTS: With DBS, five patients were abstinent for more than three years, two relapsed after abstaining for six months, and one was lost of follow-up at three months. The degree of cravings for drug use after DBS was reduced if the patients remained abstinent (p < 0.001). Simultaneous DBS of the NAc and ALIC also improved the quality of life, alleviated psychiatric symptoms, and increased glucose metabolism in addiction-related brain regions. Moreover, stimulation-related adverse events were few and reversible. CONCLUSIONS: Simultaneous DBS of the NAc and ALIC appears to be safe, with few side effects, and may prevent long-term heroin relapse after detoxification in certain patients. (This trial was registered at ClinicalTrials.gov, NCT01274988).
BACKGROUND: Deep brain stimulation (DBS) is currently used to treat addiction, with the nucleus accumbens (NAc) as one promising target. The anterior limb of the internal capsule (ALIC) is also a potential target, as it carries fiber tracts connecting the mesocorticolimbic circuits that are crucially involved in several psychiatric disorders, including addiction. Stimulating the NAc and ALIC simultaneously may have a synergistic effect against addiction. METHODS: Eight patients with a long history of heroin use and multiple relapses, despite optimal conventional treatments, were enrolled. Customized electrodes were implanted through the ALIC into the NAc, and deep brain stimulation (DBS) treatment began two weeks after surgery. The patients were followed for at least 24 months. The duration of drug-free time, severity of drug cravings, psychometric evaluations, and PET studies of glucose metabolism before and after DBS were conducted. All adverse events were recorded. RESULTS: With DBS, five patients were abstinent for more than three years, two relapsed after abstaining for six months, and one was lost of follow-up at three months. The degree of cravings for drug use after DBS was reduced if the patients remained abstinent (p < 0.001). Simultaneous DBS of the NAc and ALIC also improved the quality of life, alleviated psychiatric symptoms, and increased glucose metabolism in addiction-related brain regions. Moreover, stimulation-related adverse events were few and reversible. CONCLUSIONS: Simultaneous DBS of the NAc and ALIC appears to be safe, with few side effects, and may prevent long-term heroin relapse after detoxification in certain patients. (This trial was registered at ClinicalTrials.gov, NCT01274988).
Authors: Jason Yuen; Abbas Z Kouzani; Michael Berk; Susannah J Tye; Aaron E Rusheen; Charles D Blaha; Kevin E Bennet; Kendall H Lee; Hojin Shin; Jee Hyun Kim; Yoonbae Oh Journal: Neurotherapeutics Date: 2022-04-11 Impact factor: 6.088
Authors: James J Mahoney; Marc W Haut; Sally L Hodder; Wanhong Zheng; Laura R Lander; James H Berry; Daniel L Farmer; Jennifer L Marton; Manish Ranjan; Nicholas J Brandmeir; Victor S Finomore; Jeremy L Hensley; Will M Aklin; Gene-Jack Wang; Dardo Tomasi; Ehsan Shokri-Kojori; Ali R Rezai Journal: Exp Clin Psychopharmacol Date: 2021-04 Impact factor: 3.157