Deep Brain Stimulation Surgery for Alcohol Addiction

被引:93
作者
Voges, Juergen [1 ]
Mueller, Ulf
Bogerts, Bernhard
Muente, Thomas
Heinze, Hans-Jochen
机构
[1] Univ Magdeburg, Dept Stereotact Neurosurg, Dept Neurol & Psychiat, D-39106 Magdeburg, Germany
关键词
Addiction; Craving; Deep brain stimulation; Nucleus accumbens; Reward system; Stereotaxy; NUCLEUS-ACCUMBENS; DRUG-ADDICTION; STEREOTACTIC SURGERY; PARKINSON-DISEASE; PREFRONTAL CORTEX; DOPAMINE; STRIATUM; SEEKING; HEROIN; ABUSE;
D O I
10.1016/j.wneu.2012.07.011
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: The consequences of chronic alcohol dependence cause important health and economic burdens worldwide. Relapse rates after standard treatment (medication and psychotherapy) are high. There is evidence from in vivo investigations and from studies in patients that the brain's reward system is critically involved in the development and maintenance of addictive behavior, suggesting that modification of this system could significantly improve the prognosis of addictive patients. Motivated by an accidental observation, we used the nucleus accumbens (NAc), which has a central position in the dopaminergic reward system for deep brain stimulation (DBS) of alcohol addiction. METHODS: We report our first experiences with NAc DBS for alcohol dependence and review the literature addressing the mechanisms leading to addiction. RESULTS: Five patients were treated off-label with bilateral NAc DBS for severe alcohol addiction (average follow-up 38 months). All patients experienced significant and ongoing improvement of craving. Two patients remained completely abstinent for more than 4 years. NAc stimulation was tolerated without permanent side effects. Simultaneous recording of local field potentials from the target area and surface electroencephalography while patients performed neuropsychological tasks gave a hint on the pivotal role of the NAc in processing alcohol-related cues. CONCLUSIONS: To our knowledge, the data presented here reflect the first attempt to treat alcohol-addicted patients with NAc DBS. Electrical NAc stimulation probably counterbalances the effect of drug-related stimuli triggering involuntarily drug-seeking behavior. Meanwhile, two prospective clinical studies using randomized, double-blind, and crossover stimulation protocols for DBS are underway to corroborate these preliminary results.
引用
收藏
页码:S28.e21 / S28.e31
页数:11
相关论文
共 67 条
[1]  
Allen J, 1998, ALCOHOL CLIN EXP RES, V22, P1300
[2]   The disease of addiction: Origins, treatment, and recovery [J].
Angres, Daniel H. ;
Bettinardi-Angres, Kathy .
DM DISEASE-A-MONTH, 2008, 54 (10) :696-721
[3]  
[Anonymous], 1993, Alcohol Clin Exp Res, V17, P1130
[4]  
[Anonymous], 2004, GLOB STAT REP ALC 20
[5]  
[Anonymous], 2002, ALC DEV SOC PUBL HLT
[6]  
BENABID AL, 1987, APPL NEUROPHYSIOL, V50, P344
[7]   Parsing reward [J].
Berridge, KC ;
Robinson, TE .
TRENDS IN NEUROSCIENCES, 2003, 26 (09) :507-513
[8]   Nucleus Accumbens Deep Brain Stimulation Decreases Ratings of Depression and Anxiety in Treatment-Resistant Depression [J].
Bewernick, Bettina H. ;
Hurlemann, Rene ;
Matusch, Andreas ;
Kayser, Sarah ;
Grubert, Christiane ;
Hadrysiewicz, Barbara ;
Axmacher, Nikolai ;
Lemke, Matthias ;
Cooper-Mahkorn, Deirdre ;
Cohen, Michael X. ;
Brockmann, Holger ;
Lenartz, Doris ;
Sturm, Volker ;
Schlaepfer, Thomas E. .
BIOLOGICAL PSYCHIATRY, 2010, 67 (02) :110-116
[9]   Acamprosate for the treatment of alcohol dependence [J].
Boothby, LA ;
Doering, PL .
CLINICAL THERAPEUTICS, 2005, 27 (06) :695-714
[10]   A randomized trial of deep-brain stimulation for Parkinson's disease [J].
Deuschl, Guenther ;
Schade-Brittinger, Carmen ;
Krack, Paul ;
Volkmann, Jens ;
Schaefer, Helmut ;
Boetzel, Kai ;
Daniels, Christine ;
Deutschlaender, Angela ;
Dillmann, Ulrich ;
Eisner, Wilhelm ;
Gruber, Doreen ;
Hamel, Wolfgang ;
Herzog, Jan ;
Hilker, Ruediger ;
Klebe, Stephan ;
Kloss, Manja ;
Koy, Jan ;
Krause, Martin ;
Kupsch, Andreas ;
Lorenz, Delia ;
Lorenzl, Stefan ;
Mehdorn, H. Maximilian ;
Moringlane, Jean Richard ;
Oertel, Wolfgang ;
Pinsker, Marcus O. ;
Reichmann, Heinz ;
Reuss, Alexander ;
Schneider, Gerd-Helge ;
Schnitzler, Alfons ;
Steude, Ulrich ;
Sturm, Volker ;
Timmermann, Lars ;
Tronnier, Volker ;
Trottenberg, Thomas ;
Wojtecki, Lars ;
Wolf, Elisabeth ;
Poewe, Werner ;
Voges, Juergen .
NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (09) :896-908