Investigational Brain Stimulation Target: Nucleus Accumbens (NAcc)
|
| Goncalves-Ferreira (2016) |
Deep brain stimulation for refractory cocaine dependence |
Portugal
--
Implant equipment provided by Medtronic |
Cocaine |
Condition after Bilateral NAcc Stimulation
vs
Condition without Stimulation |
• 36-year-old-male
• Refractory cocaine dependence
• Excludes comorbid severe psychiatric disorder, acute suicidal ideation, organic brain disorder, or acquired immunodeficiency syndrome |
Longitudinal double-blind crossover randomized control
Approved by the Institutional Ethics Committee
Length: 30 months
|
• After 2.5 years, including a blind on/off period, DBS resulted in a significant decrease in the severity of the cocaine dependence in objective and subjective measurements
Major Adverse Events:
• None
|
Muller (2016)*
*Long-term follow-up; added 2 patients
|
Nucleus accumbens deep brain stimulation for alcohol addiction—Safety and clinical long-term results of a pilot trial |
Germany
--
none mentioned |
Condition after Bilateral NAcc Stimulation
vs
Condition before Implantation |
6 |
• Males aged 25-60 years old
• Inpatient detoxification followed by at least 2 weeks of abstinence
• History of alcoholism for > 10 years
• At least 2 long-term rehabilitation treatments totaling at least 6 months
• Unsuccessful therapy with anti-craving medication (acamprosate, naltrexone) or disulfiram |
Prospective Case Series
Approved by the Institutional Ethics Committee
Length: Up to 8 years
|
• Complete and persistent absence of craving for alcohol after initiation of NAcc DBS. However, DBS did not lead to complete abstinence in all patients treated
Major Adverse Events:
• None
|
| Kuhn (2013) |
Deep brain stimulation of the nucleus accumbens and its usefulness in severe opioid addiction |
Germany
--
German Research Foundation (DFG), Else Kroner-Fresenius-Stiftung and German Federal
Ministry of Education and Research (BMBF)
|
Condition after Bilateral NAcc Stimulation
vs
Condition without Stimulation |
2 |
• Longtime heroin addiction according to DSM-IV
• At least one detoxification without a prolonged phase of abstinence
• Longtime opiate replacement therapy with a constant dose of levomethadone |
Pilot phase (clinical trial) Approved by the Institutional Ethics Committee
Length: 12 - 24 months
|
• Improved patients’ depressive and anxious symptoms, as well as increased the subjectively perceived quality of life.
• Patients reported occasional consumption of other psychotropic substances arising out of boredom or coexisting private and occupational strains with at the same time lacking alternative behavioral patterns and compensatory social skills
Major Adverse Events:
• None
|
| Voges (2013) |
Deep Brain Stimulation Surgery for Alcohol Addiction |
Germany |
Alcohol
Condition after Bilateral NAcc Stimulation
vs
Condition before Implantation
|
5 |
• Age 25-60 years old
• Alcohol dependence > 10 years
• Inpatient detoxification after abstinence of at least 2 weeks
• Two or more inpatient therapies of at least 6 months
•Unsuccessful therapy with acamprosate or natrexone or disulfiram
• Excludes history of seizures, antisocial personality, brain damage visible on CT and MRI scans, alcohol-related personality deprivation, multiple substance abuse, additional psychiatric disorders, or IQ below 80 |
Prospective case series Approved by the Institutional Ethics Committee
Length: Average 38 months (range 32 - 48 months)
|
• All patients experienced significant and ongoing improvement of craving.
• Two patients remained abstinent for more than 4 years.
• 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 NAcc in processing alcohol-related cues
Major Adverse Events:
• None
|
| Heldmann (2012) |
Deep Brain Stimulation of Nucleus Accumbens Region in Alcoholism Affects Reward Processing |
Germany
--
German Research Foundation (DFG |
Alcohol
Condition after Bilateral NAcc Stimulation
vs
Condition without Stimulation
|
1 |
• 38-year-old
• DSM-IV criteria for alcohol dependence
•Unsuccessful detoxification and prolonged withdrawal therapies as well as anti-craving therapy with acamprosate
• No abstinence longer than 3 months |
Case report
Approved by the Institutional Ethics Committee
Length: 18 months
|
• PET (positron emission tomography) was used to investigate the stimulation effects. Active DBS was associated with slower and less risky choices, implying a more impulsive, riskier and less controlled behavior when neural activity was not modulated by DBS
Major Adverse Events:
• None |
Valencia-Alfanso
(2012) |
Effective deep brain stimulation in heroin addiction: a case report with complementary intracranial electroencephalogram |
Netherlands
_
Netherlands Organization for Health Research and Development |
Heroin
Condition after Bilateral NAcc Stimulation
vs
Condition before Implantation
|
1 |
• 47-year-old male
•Treatment-refractory heroin dependence for >22 years |
Prospective Case Report
Approved by the Institutional Ethics Committee
Length:
10 months
|
• Decreased use, and cessation of drug abuse for all 10 months
• 1 episode 14-day relapse after cessation
Major Adverse Events:
• None
|
Zhou
(2011) |
Deep Brain Stimulation of Nucleus Accumbens on Heroin-Seeking Behaviors: A Case Report
|
China
---
none mentioned |
Heroin
Condition after Bilateral NAcc Stimulation
vs
Condition without Stimulation
|
1 |
• 24-year-old male
• Heroin dependence for ≥ 5 years
|
Prospective Case Report
Approved by the Institutional Ethics Committee
Length:
6 years
|
• Complete cessation of drug use for 6 years (last follow-up)
• Significant improvement of memory and IQ
• Improvements in Depression and Anxiety
Major Adverse Events:
• None
 |
Kuhn
(2011) |
Successful deep brain stimulation of the nucleus accumbens in severe alcohol dependence is associated with changed performance monitoring
|
Germany
__
none mentioned |
Alcohol
Condition after Bilateral NAcc Stimulation
vs
Condition without Stimulation
|
1 |
• 69-year-old male
• Alcohol dependence >30 years |
Prospective Case Report
Approved by the Institutional Ethics Committee
Length:
12 months
|
• Decreased alcohol use, cravings, and malnutrition at 12 months
Major Adverse Events:
• None |
Muller
(2009) |
Successful treatment of chronic resistant alcoholism by deep brain stimulation of nucleus accumbens: first experience with three cases
|
Germany
---
none mentioned |
Alcohol
Condition after Bilateral NAcc Stimulation
vs
Condition without Stimulation
|
3 |
• Males ages 25-60
• Alcoholism for ≥10 years
• ≥ 2 inpatient therapy sessions for ≥ 6 months
• No response to anticraving medications
• Sober for at least 2 weeks
• Educational level of at least 9 years
• No personality disorder
• No visible brain damage on imaging
|
Prospective Case Series
Approved by the Institutional Ethics Committee
Length:
12 months |
• Significant improvement in urge for acohol at 12 months (average of 81% improvement)
• 2 Patients were abstinent and 1 significantly decreased amount of drinking days
Major Adverse Events:
• None |
| Heize (2009) |
Counteracting incentive sensitization in severe alcohol dependence using deep brain stimulation of the nucleus accumbens: clinical and basic science aspects
|
Germany
--
The Federal Ministry of Education and Research (BMBF) and German Research Foundation (DFG)
|
Alcohol
Condition after Bilateral NAcc Stimulation
vs
Condition before Implantation
|
3 |
• Males aged 25–60 years old
• Finished detoxification; abstinence of at least 2 weeks
• Two or more treatment failures of inpatient programs lasting at least 6 months
• Failure of anti-craving substances (e.g. acamprosate, naltrexone)
• Failure of community and self-help programs
• At least 10 years of schooling and completion of an apprenticeship or higher education |
Prospective case series
Approved by the Institutional Ethics Committee
Length:
14 months (at least)
|
After the operation, craving was greatly reduced and all three patients were able to abstain from drinking for extended periods of time. LFPs in the action monitoring task provided evidence for a role of the NAcc in goal-directed behaviors
Major Adverse Events:
• None: |
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