— Paul Jaffe, MAADDSG@aol.com

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International Neuromodulation Society
eighth world congress
Acapulco, Mexico
December 9, 2007

THERAPEUTIC EFFECT OF DEEP BRAIN STIMULATION OF THE NUCLEUS ACCUMBENS ON REFRACTORY DRUG ADDICTION: A CASE REPORT

Jiwen Xu, MD, PhD; Department of Neurosurgery, Shanghai Renji Hospital, Medical College of Shanghai, Jiaotong University, Shanghai, PRC; xujiwen88@vip.sina.com

Wang Guisong, MD

INTRODUCTION: The mesolimbic dopaminergic (DAergic) pathway projecting from the ventral tegmental area (VTA) to the nucleus accumbens (NAC) may play a critical role in the initiation of psychological dependence on morphine. Bilateral ablating the nucleus accumbens has been demonstrated to be an effective treatment for drug addiction. But there are many concerns about the effects of producing irreversible lesions in neural centers such as food intake, sexual behaviour and probably a myriad other more mundane daily pleasures. In order to avoid these complications, DBS may be the best choice to prevent permanent damage of nucleus accumbens.

MATERIALS AND METHODS: We report the bilateral nucleus accumbens DBS in a 24-year-old young man who has started intravenous heroin injections for five years. Treatment included UROD first, three days later, bilateral nucleus accumbens were implanted two electrodes for DBS. In UROD program. The patient was treated with naloxone (0.2mg/kg) under anesthesia. In DBS program the nucleus accumbens target coordinates were as follows: 7.5mm in front of the anterior commissural, 6mm below the midcommissural point, and 6.5mmlateral to the midline. the final stimulator settings: amplitude 2.5 volts; pulse width 90 sec; rate 145 Hz;electrodes monopolar C +, 1-, 3-.

RESULTS: The patient has been followed-up for over two years, irregular randomly selected examination of urine samples and naloxone tests show that he has completely abandoned his drug usage without any ancillary treatment . He has even returned to full-time work for more than one year. One month ago, the stimulator was turned off and the patient’s condition was satisfactory. The temporary postoperative complications were clouding of consciousness, somniloquy and urine incontinence, they were recovered within 2-3 days. While the insomnia recovered after about 4-5 months latter. WMS, WEIS-RC and MMPI before and after the DBS assessed by psychologist revealed that the patient’s intelligence remembrance and personality were intact.

CONCLUSION: Our preliminary study demonstrate that deep brain stimulation of the nucleus accumbens has therapeutic effort on refractory drug addiction.

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Cheers – Steve