Remission of alcohol dependency following deep brain stimulation of the nucleus accumbens: valuable therapeutic implications?

Abstract

Chronic consumption of alcohol represents one of the greatest health and socioeconomic problems worldwide. We report on a 54-year-old patient with a severe anxiety disorder and secondary depressive disorder in whom bilateral deep brain stimulation (DBS) of the nucleus accumbens was carried out. Despite the absence of desired improvement in his primary disorder, we observed a remarkable although not primarily intended alleviation of the patient's comorbid alcohol dependency. Our case report demonstrates the extremely effective treatment of alcohol dependency by means of DBS of the nucleus accumbens and may reveal new prospects in overcoming therapy resistance in dependencies in general.

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.…”

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

“…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].…”

“…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].…”

“…It has long been implicated in substance abuse and addiction, including ethanol, cocaine, and heroin [16][17][25][26][27][28][29][30][31][32][33].…”

Deep Brain Stimulation in Schizophrenia

“…Hence, DBS has become an approved treatment option in OCD under the humanitarian device exemption, and current discussions aim to extend its therapeutic scope even further (Kuhn et al, 2010). Besides others, current approaches address addiction due to psychotropic substances and Alzheimer's disease, both representing disorders of great socioeconomic relevance (Kuhn et al, submitted;Kuhn et al, 2007;Laxton et al, 2010). However, all studies comprised a not neglectable number of non-responders.…”