Stereotactic Cingulumotomy for Drug Addiction

Kanaka, T.S.; Balasubramaniam, V.

doi:10.1159/000102404

Cited by 31 publications

(33 citation statements)

References 7 publications

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“…In addicts, it is one of the structures, in which activity in response to stimuli paired with a variety of drugs, such as nicotine (Brody et al, 2002;Due et al, 2002;McClernon et al, 2005;McBride et al, 2006), cocaine (Maas et al, 1998;Childress et al, 1999;Garavan et al, 2000;Kilts et al, 2001;Wexler et al, 2001), and heroin (Daglish et al, 2001), is most frequently reported. Moreover, its importance for addiction is emphasized by the fact that surgical lesioning of the ACC can decrease drug consumption in addicts (Sharma, 1974;Kanaka and Balasubramaniam, 1978). Likewise, smokers treated with bupropion showed an attenuation of both, cueinduced cigarette craving and ACC activation (Brody et al, 2004).…”

Section: Neural Impact Of Begin-and End-stimuli In Nondeprived Smokersmentioning

confidence: 99%

Neural Responses to BEGIN- and END-Stimuli of the Smoking Ritual in Nonsmokers, Nondeprived Smokers, and Deprived Smokers

Stippekohl

Winkler

Mucha

et al. 2010

Neuropsychopharmacol

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Drug-associated stimuli (cues) have a prominent role in addiction research because they are able to provoke craving and relapses. Generally, drug cues are seen as conditioned excitatory stimuli, which elicit drug seeking and usage. However, newer data suggest differential effects for smoking stimuli depending on their stage in the smoking ritual. Specifically, stimuli associated with the terminal stage of smoke consumption (END-stimuli) may evoke reactivity opposite to the reactivity evoked by stimuli associated with the beginning of smoke consumption (BEGIN-stimuli). This fMRI study compared 20 nondeprived smokers with 20 nonsmokers to unravel the influence of smoking-related pictures displaying the beginning (BEGIN-stimuli) and termination (END-stimuli) of the smoking ritual on neural activity in the addiction network. In addition, 20 deprived smokers (12 h deprivation) were investigated to explore the effects of deprivation on the processing of these stimuli. In nondeprived smokers, BEGIN-stimuli reliably activated the addiction network (for example, the ventral striatum, orbitofrontal cortex, and anterior cingulate cortex (ACC)). In contrast, END-stimuli triggered a differential pattern of activations as well as deactivations; deactivations were found in the ventral striatum and the ACC. Deprivation had no clear effect on the responses triggered by BEGIN-stimuli, but affected the reactivity to END-stimuli. Our data clearly suggest that stimuli associated with different stages of the smoking ritual trigger differential neuronal responses. While BEGIN-stimuli generally seem to activate the addiction network, END-stimuli presumably have some inhibitory properties. This new finding might add to a more differentiated understanding of cue reactivity and addiction.

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Section: Neural Impact Of Begin-and End-stimuli In Nondeprived Smokersmentioning

confidence: 99%

Neural Responses to BEGIN- and END-Stimuli of the Smoking Ritual in Nonsmokers, Nondeprived Smokers, and Deprived Smokers

Stippekohl

Winkler

Mucha

et al. 2010

Neuropsychopharmacol

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“…It assesses patients' current symptoms within a specified and optimal point in time (i.e., the past 7 days) that may better evaluate mental health changes. Patients are instructed to rate mental health symptoms that have 'bothered' them within the past 7 days on a 5-point scale (1)(2)(3)(4)(5) ranging from 'not at all' (i.e., a '1' rating) to 'extremely' (i.e., a '5' rating). It includes global severity index and nine symptom dimensions that were based on factor analysis and that include diagnostic-specific and nonspecific symptoms.…”

Section: Psychological Assessmentsmentioning

confidence: 99%

“…Although there have been some clinical researches about stereotactic cingulotomy as a treatment for drug addiction in recent years [1][2][3][4] , the approach of ablating the nucleus accumbens (NAc), which has an intimate relationship with drug addiction, through stereotactic surgery as a new method for alleviating opiate psychological dependence has been shown to be particularly effective in animal experimental researches and clinical studies, particularly in changing drug-seeking behavior, eliminating abstinence symptoms and reducing the relapse rate [5][6][7] . However, being new therapy, more information regarding the physiological effectiveness and mechanism is needed; moreover, evidence indicated that ablating the target zones within the NAc may be associated with negative psychological sequelae such as cognitive dysfunction or change in personality characteristics [8,9] .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Short-Term Psychological Functions in Opiate Addicts after Ablating the Nucleus Accumbens via Stereotactic Surgery

He¹,

Guan

Zhao

et al. 2008

Stereotact Funct Neurosurg

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Objective: To investigate the short-term psychological function of opiate addicts who have undergone ablative stereotactic surgery targeting the nucleus accumbens (NAc) for alleviating opiate drug psychological dependence. Methods: The psychological functional status of 14 opiate addicts was assessed by standardized psychological tests both before and approximately 3 months after stereotactic surgery. Standardized tests included the Wechsler Adult Intelligence Scale-Revised Chinese (WAIS-RC), the Clinical Memory Scale of Chinese (CMS), the Eysenck Personality Questionnaire (EPQ) and the Symptom Checklist 90 (SCL-90). The evaluation of psychological dimensions included intelligence, memory, personality characteristics and mental health symptoms. Results: Compared with the preoperative state, there was no statistically significant difference in full-scale intelligence quotient (IQ) postoperatively, but without Bonferroni correction a significant decline by 13.55% (p < 0.05) was observed in the Digit Symbol-Substitution subtest of WAIS-RC. The memory quotient (MQ) of CMS demonstrated a significant decline of 10.65% (p < 0.05) postoperatively. Concerning the participants’ personality characteristics, a significant postoperative increase (p < 0.05) was detected in the Psychoticism (P) trait of EPQ. The mental healthy severity indexes of SCL-90 were decreased postoperatively. After Bonferroni correction, however, there was no statistical difference between pre- and postoperative results on all assessments. Conclusions: Although the patients’ intelligence measures were not changed significantly, their short-term memory and attention appeared to decline postoperatively. In addition, there was a trend towards change in some personality characteristics postoperatively. The postoperative mental health levels of the patients increased, indicating a trend towards improvement. Stereotactic ablation of the NAc in opiate addicts may be associated with short-term negative psychological functions. Advisement regarding the safety of the new surgical modality and recommendations for further investigation are necessary.

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“…Bilateral stereotactic cingulotomy has previously been shown to be a viable procedure to prevent relapse of drug addicts [14,15,16]. In a 15-month follow-up, Gao et al [17] first reported that ablation of the nucleus accumbens (NAc) can also effectively alleviate the opiate drug psychological dependence and lower the relapse rate.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Changes in the Personality and Psychopathological Profile of Opiate Addicts after Nucleus Accumbens Ablative Surgery Are Associated with Treatment Outcome

Chang

Adler

et al. 2012

Stereotact Funct Neurosurg

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Objective: To investigate the long-term outcome and changes of the personality and psychopathological profile of opiate addicts after bilateral stereotactic nucleus accumbens (NAc) ablative surgery. Methods: 60 patients were followed up for 5 years and abstinent status and adverse events were evaluated. NAc lesion volumes and locations were obtained by postoperative MRI scans. The Chinese version of the Eysenck Personality Questionnaire (EPQ-RSC), the Symptom Checklist-90-Revised (SCL-90-R), the Beck Depression Inventory (BDI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the World Health Organization’s Quality of Life Questionnaire – Brief Version (WHOQOL-BREF) were administered to the patients before and 5 years after the stereotactic surgery. Results: The total abstinence rate of all patients in their 5th postoperative year was 47.4%. The abstinent patients had a significantly larger lesion volume than the relapsed ones, but a larger lesion volume also increased the risk of adverse events. 5 years after surgery, the abstinent patients showed significant decreases on the Psychoticism (EPQ-P) and Neuroticism (EPQ-N) scores by EPQ-RSC, a significant decline on the Global Severity Index and the subscores in all 10 dimensions by SCL-90-R, significant decreases on the BDI and Y-BOCS scores, and significant improvements on the scores of all domains by WHOQOL-BREF, while for the relapsed patients, only the subscores of obsessive-compulsive by SCL-90-R and the Y-BOCS scores significantly decreased. Postoperative analysis revealed that the abstinent patients had a significantly better score than the relapsed ones by various instruments, and NAc lesion volumes and locations did not correlate with the outcome of any of these instruments. Conclusion: The bilateral ablation of NAc by stereotactic neurosurgery was a feasible method for alleviating psychological dependence on opiate drugs and preventing a relapse. Long-term follow-up suggested that surgery can improve the personality and psychopathological profile of opiate addicts with a trend towards normal levels, provided persistent abstinence can be maintained; relapse, on the other hand, may ruin this effect.

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Stereotactic Cingulumotomy for Drug Addiction

Cited by 31 publications

References 7 publications

Neural Responses to BEGIN- and END-Stimuli of the Smoking Ritual in Nonsmokers, Nondeprived Smokers, and Deprived Smokers

Neural Responses to BEGIN- and END-Stimuli of the Smoking Ritual in Nonsmokers, Nondeprived Smokers, and Deprived Smokers

Evaluation of Short-Term Psychological Functions in Opiate Addicts after Ablating the Nucleus Accumbens via Stereotactic Surgery

Long-Term Changes in the Personality and Psychopathological Profile of Opiate Addicts after Nucleus Accumbens Ablative Surgery Are Associated with Treatment Outcome

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