Observations on Unaided Smoking Cessation after Deep Brain Stimulation of the Nucleus Accumbens

Abstract

Aims: We explore whether clinical research on deep brain stimulation (DBS) of the nucleus accumbens (NAc) to treat addiction is justified besides theoretical speculation. Methods: Since 2004, 10 patients who were also smokers were treated at the University of Cologne for Tourette’s syndrome (TS), obsessive-compulsive disorders (OCD) or anxiety disorders (AD) by DBS of the NAc. We assessed their smoking behavior after DBS and (in retrospection) before by the Fagerström Test for Nicotine Dependence (FTND) and additional items. Results: Three male patients were able to quit smoking after DBS. They were less dependent and higher motivated compared to the rest of the sample. They are stimulated with a higher voltage. During 1-year, 2-year, and 30-month follow-ups, we found a higher rate of successful smoking cessation (20, 30 and 30%) compared to unaided smoking cessation in the general population (13, 19 and 8.7%). Conclusions: Albeit the results of the study are severely limited by the method of retrospective self-assessment of psychiatric patients, further research of DBS of the NAc to treat addiction seems justified. In addition to biological mediators, psychosocial factors should be assessed in further prospective studies.

Deep brain stimulation in Parkinson disease—what went wrong?

“…Fortuitous observations of improvements in alcoholism [125], nicotine [126][127][128] or food addiction [128] have been reported for patients treated with NAcc DBS for anxiety, OCD or GTS. Three patients were treated with NAcc DBS specifically for alcohol addiction.…”

Deep brain stimulation: a mechanistic and clinical update

“…Of the latter 4, 2 attempted and were successful at smoking cessation after DBS. 100 Several preclinical studies in rats have investigated the effect of high-frequency DBS on ethanol consumption and cocaine/narcotic-seeking behavior. 15,79,92,165,193 These studies showed a significant reduction in drugseeking behaviors following DBS.…”

A Randomized Blinded Trial of Nucleus Accumbens Ablation to Treat Opiate Dependence in Humans: Location Correlates with Outcome

“…The mesolimbic dopamine system plays a central role in brain reward mechanisms with the nucleus accumbens (NAc) serving as a key structure in mediating these effects [7][8][9][10]. Based on this understanding, some functional neurosurgeons have used ablation or stimulation of the NAc to effectively treat severe refractory cases of obsessive-compulsive disorders and depression [11][12][13][14][15][16][17][18][19][20][21]. These patients incidentally noted decreases in chemical dependence [15][16].…”

“…Based on this understanding, some functional neurosurgeons have used ablation or stimulation of the NAc to effectively treat severe refractory cases of obsessive-compulsive disorders and depression [11][12][13][14][15][16][17][18][19][20][21]. These patients incidentally noted decreases in chemical dependence [15][16]. In parallel, a series of Chinese animal studies suggested the utility of NAc lesioning in treating drug dependence [22], which led to initial trials in humans in China with reasonable efficacy [11].…”