Deep Brain Stimulation in Addiction

Table Summarizing Clinical Research Studies

First Author (Year), Study Title	Study Size, Country, Funder(s)	Addiction, Intervention Tested, Trial Type	Inclusion Criteria, Patient Demographics	Findings +/-
Investigational Brain Stimulation Target: Nucleus Accumbens (NAcc)
Goncalves-Ferreira (2016) -- Deep brain stimulation for refractory cocaine dependence	1 -- Portugal -- Implant equipment provided by Medtronic	Cocaine, Condition after Bilateral NAcc Stimulation vs Condition without Stimulation -- Longitudinal double-blind crossover randomized control Approved by the Institutional Ethics Committee Length: 30 months	• 36-year-old-male • Refractory cocaine dependence • Excludes comorbid severe psychiatric disorder, acute suicidal ideation, organic brain disorder, or acquired immunodeficiency syndrome	• 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	6 -- Germany -- none mentioned	Condition after Bilateral NAcc Stimulation vs Condition before Implantation -- Prospective Case Series Approved by the Institutional Ethics Committee Length: Up to 8 years	• 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	• 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	2 -- 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 -- Pilot phase (clinical trial) Approved by the Institutional Ethics Committee Length: 12 - 24 months	• 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	• 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	5 -- Germany	Alcohol Condition after Bilateral NAcc Stimulation vs Condition before Implantation -- Prospective case series Approved by the Institutional Ethics Committee Length: Average 38 months (range 32 - 48 months)	• 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	• 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	1 -- Germany -- German Research Foundation (DFG	Alcohol Condition after Bilateral NAcc Stimulation vs Condition without Stimulation -- Case report Approved by the Institutional Ethics Committee Length: 18 months	• 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	• 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	1 -- Netherlands _ Netherlands Organization for Health Research and Development	Heroin Condition after Bilateral NAcc Stimulation vs Condition before Implantation -- Prospective Case Report Approved by the Institutional Ethics Committee Length: 10 months	• 47-year-old male •Treatment-refractory heroin dependence for >22 years	• 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	1 -- China --- none mentioned	Heroin Condition after Bilateral NAcc Stimulation vs Condition without Stimulation -- Prospective Case Report Approved by the Institutional Ethics Committee Length: 6 years	• 24-year-old male • Heroin dependence for ≥ 5 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	1 -- Germany __ none mentioned	Alcohol Condition after Bilateral NAcc Stimulation vs Condition without Stimulation -- Prospective Case Report Approved by the Institutional Ethics Committee Length: 12 months	• 69-year-old male • Alcohol dependence >30 years	• 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	3 -- Germany --- none mentioned	Alcohol Condition after Bilateral NAcc Stimulation vs Condition without Stimulation -- Prospective Case Series Approved by the Institutional Ethics Committee Length: 12 months	• 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	• 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	3 -- Germany -- The Federal Ministry of Education and Research (BMBF) and German Research Foundation (DFG)	Alcohol Condition after Bilateral NAcc Stimulation vs Condition before Implantation -- Prospective case series Approved by the Institutional Ethics Committee Length: 14 months (at least)	• 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	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:

Updated in 2018 by International Neuromodulation Society member Leonardo Almeida Frizon, MD, Neurosurgeon (Stereotactic and Functional Neurosurgery), Cajuru University Hospital, Department of Neurosurgery Curitiba-PR, Brazil. (Originally compiled during 2012-2013 by INS member Chengyuan Wu, MD, MSBmE, Thomas Jefferson University Hospital, Department of Neurosurgery and second-year medical student Lekhaj Daggubati, Drexel University School of Medicine.)

Please note: This information should not be used as a substitute for medical treatment and advice. Always consult a medical professional about any health-related questions or concerns.

Last Updated on Tuesday, December 21, 2021 02:05 PM

Deep Brain Stimulation in Addiction

Table Summarizing Clinical Research Studies

Investigational Brain Stimulation Target: Nucleus Accumbens (NAcc)