Deep Brain Stimulation in Treatment-Refractory Addiction

Abstract

Surgical treatment for addiction has been proposed after the successful efficacy of deep brain stimulation (DBS) for the treatment of neurological movement disorders such as Parkinson's disease (PD). In the field of psychiatric diseases, DBS has been used firstly for obsessive compulsive disorder (OCD) and treatment-resistant depression. The role in addiction has been proposed only recently. The target areas for DBS in treatment-refractory addiction are nucleus accumbens (NAcc), lateral hypothalamus (LH), amigdala, lateral habenula (LHb), dorsal striatum, prefrontal cortex (PFC) and subthalamic nucleus (STN). A well-documented rationale for the choice of the target is required in order to investigate the effectiveness, safety and feasibility. NAcc appears to be the most effective and safe target for DBS followed by STN; PFC is another promising target but needs further exploration to establish its suitability for clinical purposes. DBS is not free of risks, so every patient has to be carefully evaluated and precise ethical standards must be defined in the form of inclusion and exclusion criteria.