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Nucleus accumbens as a stereotactic target for the treatment of addictions in humans: a literature review
, 1, 2
Affiliations- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
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Abstract
Introduction: Deep brain stimulation (DBS) has achieved substantial success as a treatment for movement disorders such as Parkinson’s Disease (PD), essential tremor (ET), and dystonia. More recently, a limited number of basic and clinical studies have indicated that DBS of the nucleus accumbens (NAc) and other neighbouring structures of the reward circuit may be an effective intervention for patients with treatment-refractory addiction.
Material and methods: We performed a structured literature review of human studies of DBS for addiction outlining the clinical efficacy and adverse events. We found 14 human studies targeting mostly the NAc with neighbouring structures such as anterior limb of the internal capsule (ALIC). Five studies including 12 patients reported the outcomes for alcohol dependence. Nine studies including 18 patients reported the outcomes for addictions to various psychoactive substances. The most common indication was addiction to heroin, found in 13 patients, followed by methamphetamine, 3 patients, cocaine, one patient, and polysubstance drug abuse in one patient.
Conclusions: The limited clinical data available indicates that DBS may be a promising therapeutic modality for the treatment of intractable addiction. In general, the safety profile of DBS in patients with addiction is good. Based on the data published in the literature, the NAc is the most often targeted, and is probably the most effective, structure of the reward circuit in the treatment of addiction in humans. Given the ever-expanding understanding of the psychosurgery of addiction, DBS could in the future be a treatment option for patients suffering from intractable addictive disorders.
Abstract
Introduction: Deep brain stimulation (DBS) has achieved substantial success as a treatment for movement disorders such as Parkinson’s Disease (PD), essential tremor (ET), and dystonia. More recently, a limited number of basic and clinical studies have indicated that DBS of the nucleus accumbens (NAc) and other neighbouring structures of the reward circuit may be an effective intervention for patients with treatment-refractory addiction.
Material and methods: We performed a structured literature review of human studies of DBS for addiction outlining the clinical efficacy and adverse events. We found 14 human studies targeting mostly the NAc with neighbouring structures such as anterior limb of the internal capsule (ALIC). Five studies including 12 patients reported the outcomes for alcohol dependence. Nine studies including 18 patients reported the outcomes for addictions to various psychoactive substances. The most common indication was addiction to heroin, found in 13 patients, followed by methamphetamine, 3 patients, cocaine, one patient, and polysubstance drug abuse in one patient.
Conclusions: The limited clinical data available indicates that DBS may be a promising therapeutic modality for the treatment of intractable addiction. In general, the safety profile of DBS in patients with addiction is good. Based on the data published in the literature, the NAc is the most often targeted, and is probably the most effective, structure of the reward circuit in the treatment of addiction in humans. Given the ever-expanding understanding of the psychosurgery of addiction, DBS could in the future be a treatment option for patients suffering from intractable addictive disorders.
Keywords
addiction, alcohol dependence, anterior limb of the internal capsule, deep brain stimulation
About this articleTitle
Nucleus accumbens as a stereotactic target for the treatment of addictions in humans: a literature review
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Review Article
Pages
440-449
Published online
2021-10-11
Page views
7551
Article views/downloads
1302
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2021;55(5):440-449.
Keywords
addiction
alcohol dependence
anterior limb of the internal capsule
deep brain stimulation
Authors
Michał Sobstyl
Anna Kupryjaniuk
Paweł Mierzejewski
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