Nucleus accumbens as a stereotactic target for the treatment of addictions in humans: a literature review
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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.
Keywords: addictionalcohol dependenceanterior limb of the internal capsuledeep brain stimulation
References
- van den Bosch LMc, Verheul R. Patients with addiction and personality disorder: Treatment outcomes and clinical implications. Curr Opin Psychiatry. 2007; 20(1): 67–71.
- Di Chiara G, Bassareo V, Fenu S, et al. Dopamine and drug addiction: the nucleus accumbens shell connection. Neuropharmacology. 2004; 47 Suppl 1: 227–241.
- Greenberg BD, Gabriels LA, Malone DA, et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry. 2010; 15(1): 64–79.
- Nuttin B, Wu H, Mayberg H, et al. Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders. J Neurol Neurosurg Psychiatry. 2014; 85(9): 1003–1008.
- Zyss T, Zieba A, Hese RT, et al. [Deep brain stimulation--the newest physical method of treatment of depression]. Psychiatr Pol. 2010; 44(3): 301–317.
- Antosik-Wójcińska AZ, Święcicki Ł. The use of DBS stimulation in mental disorders - opportunities and risks. Psychiatr Pol. 2015; 49(4): 791–800.
- Beszłej JA, Wieczorek T, Kobyłko A, et al. Deep brain stimulation: new possibilities for the treatment of mental disorders. Psychiatr Pol. 2019; 53(4): 789–806.
- Adinoff B. Neurobiologic processes in drug reward and addiction. Harv Rev Psychiatry. 2004; 12(6): 305–320.
- Ikemoto S. Brain reward circuitry beyond the mesolimbic dopamine system: a neurobiological theory. Neurosci Biobehav Rev. 2010; 35(2): 129–150.
- Berridge KC, Kringelbach ML. Pleasure systems in the brain. Neuron. 2015; 86(3): 646–664.
- Olsen CM. Natural rewards, neuroplasticity, and non-drug addictions. Neuropharmacology. 2011; 61(7): 1109–1122.
- Blum K, Werner T, Carnes S, et al. Sex, drugs, and rock 'n' roll: hypothesizing common mesolimbic activation as a function of reward gene polymorphisms. J Psychoactive Drugs. 2012; 44(1): 38–55.
- Jung HHo, Kim CH, Chang JH, et al. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: Long-term follow-up results. Stereotact Funct Neurosurg. 2006; 84(4): 184–189.
- Pouratian N, Sharim J. Anterior cingulotomy for the treatment of chronic intractable pain: A systematic review. Pain Physician. 2016; 19(8): 537–550.
- Foltz EL, White LE. Pain "relief" by frontal cingulumotomy. J Neurosurg. 1962; 19: 89–100.
- Kanaka TS, Balasubramaniam V. Stereotactic cingulumotomy for drug addiction. Appl Neurophysiol. 1978; 41(1-4): 86–92.
- Medvedev SV, Anichkov AD, Polyakov II. Physiological mechanisms of the effectiveness of bilateral stereotactic cingulotomy against strong psychological dependence in drug addicts. Fiziol Cheloveka . 2003; 29(4): 117–123.
- Müller D, Roeder F, Orthner H. Further results of stereotaxis in the human hypothalamus in sexual deviations. First use of this operation in addiction to drugs. Neurochirurgia (Stuttg). 1973; 16(4): 113–126.
- Gao G, Wang X, He S, et al. Clinical study for alleviating opiate drug psychological dependence by a method of ablating the nucleus accumbens with stereotactic surgery. Stereotact Funct Neurosurg. 2003; 81(1-4): 96–104.
- Kuhn J, Lenartz D, Huff W, et al. Remission of alcohol dependency following deep brain stimulation of the nucleus accumbens: valuable therapeutic implications? J Neurol Neurosurg Psychiatry. 2007; 78(10): 1152–1153.
- Müller UJ, Sturm V, Voges J, et al. Successful treatment of chronic resistant alcoholism by deep brain stimulation of nucleus accumbens: first experience with three cases. Pharmacopsychiatry. 2009; 42(6): 288–291.
- Kuhn J, Gründler TOJ, Bauer R, et al. Successful deep brain stimulation of the nucleus accumbens in severe alcohol dependence is associated with changed performance monitoring. Addict Biol. 2011; 16(4): 620–623.
- Voges J, Müller U, Bogerts B, et al. Deep brain stimulation surgery for alcohol addiction. World Neurosurg. 2013; 80(3-4): S28.e21–S28.e31.
- Müller UJ, Sturm V, Voges J, et al. Nucleus accumbens deep brain stimulation for alcohol addiction - safety and clinical long-term results of a pilot trial. Pharmacopsychiatry. 2016; 49(4): 170–173.
- Zhou H, Xu J, Jiang J. Deep brain stimulation of nucleus accumbens on heroin-seeking behaviors: a case report. Biol Psychiatry. 2011; 69(11): e41–e42.
- Valencia-Alfonso CE, Luigjes J, Smolders R, et al. Effective deep brain stimulation in heroin addiction: a case report with complementary intracranial electroencephalogram. Biol Psychiatry. 2012; 71(8): e35–e37.
- Kuhn J, Möller M, Treppmann JF, et al. Deep brain stimulation of the nucleus accumbens and its usefulness in severe opioid addiction. Mol Psychiatry. 2014; 19(2): 145–146.
- Chen L, Li N, Ge S, et al. Long-term results after deep brain stimulation of nucleus accumbens and the anterior limb of the internal capsule for preventing heroin relapse: An open-label pilot study. Brain Stimul. 2019; 12(1): 175–183.
- Zhang C, Huang Y, Zheng F, et al. Death from opioid overdose after deep brain stimulation: A case report. Biol Psychiatry. 2018; 83(1): e9–ee10.
- Gonçalves-Ferreira A, do Couto FS, Rainha Campos A, et al. Deep brain stimulation for refractory cocaine dependence. Biol Psychiatry. 2016; 79(11): e87–e89.
- Zhang C, Wei H, Zhang Y, et al. Increased dopamine transporter levels following nucleus accumbens deep brain stimulation in methamphetamine use disorder: A case report. Brain Stimul. 2019; 12(4): 1055–1057.
- Ge S, Chen Y, Li N, et al. Deep brain stimulation of nucleus accumbens for methamphetamine addiction: Two case reports. World Neurosurg. 2019; 122: 512–517.
- Zhu R, Zhang Y, Wang T, et al. Deep brain stimulation of nucleus accumbens with anterior capsulotomy for drug addiction: A case report. Stereotact Funct Neurosurg. 2020; 98(5): 345–349.
- Zrinzo L, Foltynie T, Limousin P, et al. Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review. J Neurosurg. 2012; 116(1): 84–94.
- Fenoy AJ, Simpson RK. Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg. 2014; 120(1): 132–139.
- Luigjes J, van den Brink W, Feenstra M, et al. Deep brain stimulation in addiction: a review of potential brain targets. Mol Psychiatry. 2012; 17(6): 572–583.
- Luyten L, Hendrickx S, Raymaekers S, et al. Electrical stimulation in the bed nucleus of the stria terminalis alleviates severe obsessive-compulsive disorder. Mol Psychiatry. 2016; 21(9): 1272–1280.
- Greenberg BD, Gabriels LA, Malone DA, et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry. 2010; 15(1): 64–79.
- Naesström M, Hariz M, Strömsten L, et al. Deep brain stimulation in the bed nucleus of stria terminalis in obsessive-compulsive disorder-1-year follow-up. World Neurosurg. 2021; 149: e794–e802.
