Deep Brain Stimulation for Addiction?
With the expanding knowledge of the neuronal circuits responsible for the behavioral disorders associated with addiction, though, DBS could become a future treatment option for patients suffering from addiction and being part of an Addiction Recovery Therapy.
In people addicted to psychoactive substance it has been shown by Positron emission tomography studies that, when they take the psychoactive substance, dopamine is released in the nucleus accumbens, which causes “the high.”
They lack the decrease of the output neurons on this dopamine release. There is no brake on the “high” elicited by the drug and the subsequent dopamine release. This lack of inhibition causes activation of the reward system. The increased dopamine release is located in the nucleus accumbens. This reward circuit consists of dopaminergic neurons that project from the ventral tegmental area to the ventral striatum (including nucleus accumbens), the amygdala and septal nuclei, and prefrontal and cingulate cortices.
The feeling of well-being produced by activation of the reward system can be seen as positive reinforcement. Negative reinforcement involves escaping from or avoiding intensive outpatient treatment symptoms, which occur after cessation of the substance use. In addicted individuals both positive and negative reinforcement involve disruption of the reward system by repeated administration of the substance.
Other brain regions involved in addiction are:
- The amygdala. The amygdala couples the rewarding qualities of the substance and the environment in which the abuse takes place. This could explain why an environment with substance-
associated stimuli causes the craving reported by addicted individuals
- The prefrontal cortex and the anterior cingulate gyrus. Dysfunction of the dopaminergic transmission in these structures leads to impairment of inhibitory control and decision making. This may cause an inability to resist substance-abusing behavior in addicted individuals, even
though they are explicitly aware of the negative consequences.
A recent review described the different psychosurgical procedures used in an addiction treatment clinic as treatments. Moreover this review also discusses the first reports on the treatment of substance-related addictive disorders by using Deep Brain Stimulation.
They found three cases in two publications. Two patients with Parkinson’s disease and Dopamine dysregulation syndrome.
Dopaminergic medications, share some of the stimulant properties of commonly abused drugs such as amphetamine and cocaine. These have the potential to be compulsively used by a small group of susceptible individuals with Parkinson’s disease, causing harmful social, psychological, and physical effects. Patients with this condition, termed “dopamine dysregulation syndrome”, meet clinical criteria for substance dependence and addiction. They frequently also show behavioural compulsions, such as compulsive gambling, eating and hyper-sexuality.
In both cases there was a good effect of deep brain stimulation on motor disability, but also on Dopamine Dysregulation Syndrome and related behavior characteristics. They both underwent bilateral subthalamic nucleus deep brain stimulation. The other case report was about a man with severe agoraphobia with panic attacks, secondary depressive disorder, and alcohol dependency. After bilateral deep brain stimulation of the nucleus accumbens the substance abuse disappeared. The nucleus accumbens is part of the “addictive circuit” in the brain.
Psychosurgery for the Newport Beach Addiction Treatment has been done and published. Never in randomized controlled trials and the procedure is irreversible.
DBS is reversible and makes randomized placebo controlled trials for this indication feasible. Nevertheless, the evidence so far is circumstantial and limited
What do you think, should DBS be tried with addiction?
Bianca M. L. Stelten, Lieke H. M. Noblesse, Linda Ackermans, Yasin Temel, Veerle Visser-Vandewalle (2008). The neurosurgical treatment of addiction Neurosurgical FOCUS, 25 (1) DOI: 10.3171/FOC/2008/25/7/E5
September 27, 2008 @ 11:18 am
Its an very expensive invasive procedure to be trialling for such a common [though disabling] disorder. Before even thinking of this we should be further investigating treatments like Cranial Electrotherapy Stimulation which already has a positive research base for treating drug withdrawal and is both non-invasive and [relatively] inexpensive.
Cheers – Steve
September 27, 2008 @ 11:48 am
Cranial Electrotherapy Stimulation???? Will have to look into that.
Regards Dr Shock
September 27, 2008 @ 11:53 am
Can’t find anything in Pubmed with cranial electrotherapy and addiction. Chronic pain and fibromyalgia mostly.
“Positive research base for drug withdrawal”????
September 29, 2008 @ 1:57 pm
There was a case report about treating heroin addiction by Deep Brain Stimulation on nucleus accumbens bilaterally in China. The patient had abused drugs for five years, and relapsed after treatment repeatedly.After the implanted,the patient stopped taking drugs in 6 months follow-up. However, no paper about long-term outcome published.
Recently, a paper published in the Journal of Neuroscience showed deep brain stimulation on NAc could attenuate reinstatement of cocaine self administration in rat.
Since the ablation surgery showed some good outcome, the DBS may be a new solution for drug addiction,especially for refractory ones
September 29, 2008 @ 3:01 pm
@Nan Li, thanks for the additional information, regards Dr Shock
The Natural Number Encephalon « Neuroanthropology
October 13, 2008 @ 7:48 pm
[…] carnival, is now up over at Combining Cognits. Besides being anti-social and on alcohol, it’s deeply stimulating. So if you’re looking for a legal defense or empathy, or just a yank on your momentum chain, […]
October 21, 2008 @ 8:26 am
Maybe that’s the same one described in the poster below. To get this ball rolling, though, will take more than a case report here and a case report there.
— Paul Jaffe, MAADDSG@aol.com
International Neuromodulation Society
eighth world congress
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; email@example.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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Funada M et al: Blockade of morphine reward through the activation of kappa-opioid receptors in mice. Neuropharmacology 1993; 32 (12) 1315-1323.
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Gao G 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.
Sturm V et al: The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive and anxiety disorders. J Chem Neuroanat 2003; 26 (4) 293-299.
Papageorgiou C et al: Do obsessive-compulsive patients and abstinent heroin addicts share a common psychophysiological mechanism? Neuropsychobiology 2003; 47 (1) 1-11.
Medvedev SV, Anichkov AD, Poliakov IuI: [Physiological mechanisms of the effectiveness of bilateral stereotactic cingulotomy in treatment of strong psychological dependence in drug addiction]. Fiziol Cheloveka 2003; 29 (4) 117-123.
December 18, 2008 @ 3:27 pm
Very good post, thanks!
Deep Brain Stimulation for Treatment Resistant depression | Dr Shock MD PhD
March 13, 2009 @ 5:39 pm
[…] stimulation as a therapy for Obsessive compulsive disorder. In case reports DBS is also tried with addiction, Alzheimers disease, Tourette’s syndrom and even coma. This are all case reports, not […]
November 28, 2010 @ 1:07 pm
The Neural network analysis based on theories of neuropsychology (and / or neuroscience) should be the cognitive basis for the selection of tragets in DBS for addictions. I think the only surgical approach is too simple neofrenologic point of view and may be ethically challenged. I think, definitely, to treat behavioral disorders and addictions with DBS neurosurgeons need to learn some theory (neural network analysis based on cognitive psychology). It’s a question of transdisciplinarity.
January 20, 2012 @ 5:45 pm
It’s arduous to find educated folks on this topic, but you sound like you know what you’re speaking about! Thanks
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