Deep Brain Stimulation of Nucleus Accumbens with Anterior Capsulotomy for Drug Addiction: A Case Report

Abstract

Background: Drug addiction is one of the most prevalent and costly health problems worldwide. Over the past decade, deep brain stimulation (DBS) has increasingly been used for the treatment of drug addiction. Simultaneous DBS of nucleus accumbens (NAc) and the anterior limb of the internal capsule (ALIC) has successfully been used for preventing heroin relapse. However, the excessive energy consumption speeds up battery depletion, which puts a burden on patients. By comparison, anterior capsulotomy is usually more convenient for patients and its clinical efficacy is similar to that of ALIC DBS. Accordingly, NAc DBS combined with anterior capsulotomy may also be an effective, yet more convenient, intervention for drug addiction and relapse prevention. Case Description: The patient was a 28-year-old man with a polysubstance use disorder (bucinnazine, morphine, and hypnotics) for 13 years. After bilateral NAc DBS combined with bilateral anterior capsulotomy, his craving for the three drugs decreased markedly, and he remained abstinent throughout the follow-up period of approximately 1-year. Moreover, psychiatric and neuropsychological assessments showed significant improvements in depression, anxiety, sleep, quality of life, and most aspects of cognitive functioning. His overall health status was also improved. Conclusions: NAc DBS combined with anterior capsulotomy is a promising surgical treatment for drug addiction.

Nucleus accumbens as a stereotactic target for the treatment of addictions in humans: a literature review

“…The surgery-related adverse events that have been reported have been transient, and did not result in any immediate neurological deficit or death related to a DBS procedure for addiction [20][21][22][23][24][25][26][27][28][29][30][31][32][33]. To date, only one patient treated by NAc DBS has experienced a clinically silent haemorrhagic complication located near the DBS electrode tip [28].…”

“…This discrepancy of clinical outcomes was attributed to misplaced DBS leads in the other patient [32]. A recently published case has featured multidrug addiction combining NAc DBS with anterior capsulotomy [33]. After placing radiofrequency lesions bilaterally in the anterior capsule, the DBS leads were implanted into the NAc.…”

“…According to these authors, the excellent results of combined simultaneous ablative and DBS lead implantations for drug addiction with comorbid psychiatric problems should prompt larger well-controlled clinical studies [33]. Table 1 sets out the clinical outcomes of DBS procedures in patients with various dependencies to psychoactive drugs.…”

“…The worldwide experience in DBS for addiction is limited, and there are no definitive guidelines on patient selection criteria. Some authors have formulated protocols for the use of DBS in addiction to alcohol or psychoactive substances [20,23,25,[30][31][32][33]. In all of the proposed studies, the main inclusion criterion is a primary diagnosis of addiction according to the Diagnostic and Statistical Manual of Mental Disorders, 5 th edition, and the International Classification of Diseases, 10 th edition.…”

“…Patients' cravings for alcohol or drugs have a profound influence on their health and severely affect the quality of their lives and the lives of their family members [23,25,[30][31][32][33]. The final important issue regarding the inclusion criteria is that the consequences of the procedure are understood by the patient and his or her family member in order for an informed choice without coercion to be made and written informed consent for the procedure to be given [23,28].…”