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Brain Stimul. 2019 Jan - Feb;12(1):175-183. doi: 10.1016/j.brs.2018.09.006. Epub 2018 Sep 14.

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.

Author information

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).

KEYWORDS:

Addiction treatment; Anterior limb of internal capsule; Deep brain stimulation; Glucose metabolism; Nucleus accumbens

PMID:
30245163
DOI:
10.1016/j.brs.2018.09.006
[Indexed for MEDLINE]

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