Deep brain stimulation for psychiatric disorders and behavioral/cognitive-related indications: Review of the literature and implications for treatment

Mahoney, James J.; Koch-Gallup, Nicolas; Scarisbrick, D; Berry, James H.; Rezai, Ali R.

doi:10.1016/j.jns.2022.120253

Cited by 11 publications

(8 citation statements)

References 148 publications

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“…[ 9 ] Since then, only 69 patients have undergone DBS for AN using different targets. [ 2 , 9 , 13 , 19 , 25 ]…”

Section: Discussionmentioning

confidence: 99%

“…The secondary goals were to analyze changes in body-mass index (BMI), anxiety, mood, obsessive symptoms, quality of life affective regulation, and AN-specific behaviors. According to the literature review, 41 cases[ 13 , 20 ] with NAc-DBS have been published worldwide. In relation to this series, our case is the surgical midlife patient with both the latest onset of the disease and the longest follow-up after NAc-DBS.…”

Section: Introductionmentioning

confidence: 99%

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Refractory anorexia nervosa in adulthood and nucleus accumbens deep brain stimulation

Lara-Almúnia

Aguirre-Orue

Roset-Ferrer

et al. 2023

Surgical Neurology International

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Background: Anorexia Nervosa is a life-threatening mental illness with numerous consequences. Some cases are chronic and refractory to multiple treatments. Consequently, there is great interest in therapeutic alternatives that may improve severe patients. We present an adult patient with anorexia nervosa that underwent to bilateral nucleus accumbens deep brain stimulation (NAc-DBS). Case description: The patient was a healthy 46-year-old woman with higher education and an adequate premorbid socio-labour situation. Her disease had a late onset (25 years). The patient never presented clinical remission or weight stability. In recent years, the patient’s body mass index (BMI) was 13.16 (32kg). The case was evaluated with multiple neuropsychological tests as well as the BMI before and after surgery. The clinical follow-up was 50 months. After bilateral NAc-DBS the patient experienced an important clinical benefit and significant improvement in neuropsychological tests and weight (BMI 17.28, 42 kg; 50th month) Programming: 4,5V, 130Hz, 210 µs. Conclusion: Despite the patient´s age and the long duration of the disease, our results suggest that bilateral nucleus accumbens stimulation may be a useful and effective therapeutic strategy for cases such as the one presented. Additionally, this case presents a surgical midlife patient with both the latest disease onset and the longest follow-up after treatment in the literature.

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“…[ 9 ] Since then, only 69 patients have undergone DBS for AN using different targets. [ 2 , 9 , 13 , 19 , 25 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Refractory anorexia nervosa in adulthood and nucleus accumbens deep brain stimulation

Lara-Almúnia

Aguirre-Orue

Roset-Ferrer

et al. 2023

Surgical Neurology International

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“…Deep brain stimulation (DBS) is a commonly used neuromodulation therapy for movement disorders and other conditions. 11 Case reports and a case series 12 investigating DBS for SUD suggest that DBS may reduce substance use and craving (see Fattahi et al 13 and Mahoney et al 14 ). Based on these findings, we initiated the first US clinical trial to rigorously assess the safety and feasibility of DBS among individuals with treatmentrefractory OUD who were at higher risk of death based on their substance use and overdose history.…”

mentioning

confidence: 99%

Safety and feasibility clinical trial of nucleus accumbens deep brain stimulation for treatment-refractory opioid use disorder

Rezai

Mahoney

Ranjan³

et al. 2024

Journal of Neurosurgery

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OBJECTIVE There were more than 107,000 drug overdose deaths in the US in 2021, the most ever recorded. Despite advances in behavioral and pharmacological treatments, over 50% of those receiving treatment for opioid use disorder (OUD) experience drug use recurrence (relapse). Given the prevalence of OUD and other substance use disorders (SUDs), the high rate of drug use recurrence, and the number of drug overdose deaths, novel treatment strategies are desperately needed. The objective of this study was to evaluate the safety and feasibility of deep brain stimulation (DBS) targeting the nucleus accumbens (NAc)/ventral capsule (VC) and potential impact on outcomes in individuals with treatment-refractory OUD. METHODS A prospective, open-label, single-arm study was conducted among participants with longstanding treatment-refractory OUD (along with other co-occurring SUDs) who underwent DBS in the NAc/VC. The primary study endpoint was safety; secondary/exploratory outcomes included opioid and other substance use, substance craving, and emotional symptoms throughout follow-up and 18FDG-PET neuroimaging. RESULTS Four male participants were enrolled and all tolerated DBS surgery well with no serious adverse events (AEs) and no device- or stimulation-related AEs. Two participants sustained complete substance abstinence for > 1150 and > 520 days, respectively, with significant post-DBS reductions in substance craving, anxiety, and depression. One participant experienced post-DBS drug use recurrences with reduced frequency and severity. The DBS system was explanted in one participant due to noncompliance with treatment requirements and the study protocol. 18FDG-PET neuroimaging revealed increased glucose metabolism in the frontal regions for the participants with sustained abstinence only. CONCLUSIONS DBS of the NAc/VC was safe, feasible, and can potentially reduce substance use, craving, and emotional symptoms in those with treatment-refractory OUD. A randomized, sham-controlled trial in a larger cohort of patients is being initiated.

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“…6 Because of its initial successes, DBS is being explored as a treatment option for depression, posttraumatic stress disorder, and SUDs. 7,8 Case reports of experimental DBS for refractory SUDs through stimulating the nucleus accumbens describe notable improvements: alleviation of cravings, reduction of self-reported depression and anxiety, and cessation or significant reduction of use. [9][10][11] Clinical trials are exploring the use of DBS for opioid use disorders (eg, NCT03950492, NCT04354077).…”

mentioning

confidence: 99%

“…DBS is broadly thought to disrupt brain networks whose overactivity or overconnection gives rise to symptoms 6 . Because of its initial successes, DBS is being explored as a treatment option for depression, posttraumatic stress disorder, and SUDs 7,8 …”

mentioning

confidence: 99%

Deep Brain Stimulation for Substance Use Disorders? An Exploratory Qualitative Study of Perspectives of People Currently in Treatment

Versalovic¹,

Klein²,

Goering³

et al. 2023

J Addict Med

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Objective: Although previous studies have discussed the promise of deep brain stimulation (DBS) as a possible treatment for substance use disorders (SUDs) and collected researcher perspectives on possible ethical issues surrounding it, none have consulted people with SUDs themselves. We addressed this gap by interviewing people with SUDs. Methods: Participants viewed a short video introducing DBS, followed by a 1.5-hour semistructured interview on their experiences with SUDs and their perspective on DBS as a possible treatment option. Interviews were analyzed by multiple coders who iteratively identified salient themes. Results: We interviewed 20 people in 12-step-based, inpatient treatment programs (10 [50%] White/Caucasian, 7 Black/African American [35%], 2 Asian [10%], 1 Hispanic/Latino [5%], and 1 [5%] Alaska Native/ American Indian; 9 women [45%], 11 men [55%]). Interviewees described a variety of barriers they currently faced through the course of their disease that mirrored barriers often associated with DBS (stigma, invasiveness, maintenance burdens, privacy risks) and thus made them more open to the possibility of DBS as a future treatment option. Conclusions: Individuals with SUDs gave relatively less weight to surgical risks and clinical burdens associated with DBS than previous surveys of provider attitudes anticipated. These differences derived largely from their experiences living with an often-fatal disease and encountering limitations of current treatment options. These findings support the study of DBS as a treatment option for SUDs, with extensive input from people with SUDs and advocates.

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Deep brain stimulation for psychiatric disorders and behavioral/cognitive-related indications: Review of the literature and implications for treatment

Cited by 11 publications

References 148 publications

Refractory anorexia nervosa in adulthood and nucleus accumbens deep brain stimulation

Refractory anorexia nervosa in adulthood and nucleus accumbens deep brain stimulation

Safety and feasibility clinical trial of nucleus accumbens deep brain stimulation for treatment-refractory opioid use disorder

Deep Brain Stimulation for Substance Use Disorders? An Exploratory Qualitative Study of Perspectives of People Currently in Treatment

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