open access

Ahead of print
Review Article
Published online: 2021-10-11
Submitted: 2021-05-30
Accepted: 2021-08-10
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Nucleus accumbens as a stereotactic target for the treatment of addictions in humans: a literature review

Michał Sobstyl1, Anna Kupryjaniuk1, Paweł Mierzejewski2
DOI: 10.5603/PJNNS.a2021.0065
·
Pubmed: 34633060
Affiliations
  1. Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
  2. Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland

open access

Ahead of print
Review articles
Published online: 2021-10-11
Submitted: 2021-05-30
Accepted: 2021-08-10

Abstract

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. 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. 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

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. 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. 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.

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Keywords

addiction, alcohol dependence, anterior limb of the internal capsule, deep brain stimulation

About this article
Title

Nucleus accumbens as a stereotactic target for the treatment of addictions in humans: a literature review

Journal

Neurologia i Neurochirurgia Polska

Issue

Ahead of print

Article type

Review Article

Published online

2021-10-11

DOI

10.5603/PJNNS.a2021.0065

Pubmed

34633060

Keywords

addiction
alcohol dependence
anterior limb of the internal capsule
deep brain stimulation

Authors

Michał Sobstyl
Anna Kupryjaniuk
Paweł Mierzejewski

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