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Ranjan M, Mahoney JJ, Rezai AR. Neurosurgical neuromodulation therapy for psychiatric disorders. Neurotherapeutics 2024; 21:e00366. [PMID: 38688105 PMCID: PMC11070709 DOI: 10.1016/j.neurot.2024.e00366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
Psychiatric disorders are among the leading contributors to global disease burden and disability. A significant portion of patients with psychiatric disorders remain treatment-refractory to best available therapy. With insights from the neurocircuitry of psychiatric disorders and extensive experience of neuromodulation with deep brain stimulation (DBS) in movement disorders, DBS is increasingly being considered to modulate the neural network in psychiatric disorders. Currently, obsessive-compulsive disorder (OCD) is the only U.S. FDA (United States Food and Drug Administration) approved DBS indication for psychiatric disorders. Medically refractory depression, addiction, and other psychiatric disorders are being explored for DBS neuromodulation. Studies evaluating DBS for psychiatric disorders are promising but lack larger, controlled studies. This paper presents a brief review and the current state of DBS and other neurosurgical neuromodulation therapies for OCD and other psychiatric disorders. We also present a brief review of MR-guided Focused Ultrasound (MRgFUS), a novel form of neurosurgical neuromodulation, which can target deep subcortical structures similar to DBS, but in a noninvasive fashion. Early experiences of neurosurgical neuromodulation therapies, including MRgFUS neuromodulation are encouraging in psychiatric disorders; however, they remain investigational. Currently, DBS and VNS are the only FDA approved neurosurgical neuromodulation options in properly selected cases of OCD and depression, respectively.
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Affiliation(s)
- Manish Ranjan
- Department of Neurosurgery, WVU Rockefeller Neuroscience Institute, Morgantown, WV, USA.
| | - James J Mahoney
- Department of Behavioral Medicine and Psychiatry, WVU Rockefeller Neuroscience Institute, Morgantown, WV, USA; Department of Neuroscience, WVU Rockefeller Neuroscience Institute, Morgantown, WV, USA
| | - Ali R Rezai
- Department of Neurosurgery, WVU Rockefeller Neuroscience Institute, Morgantown, WV, USA; Department of Neuroscience, WVU Rockefeller Neuroscience Institute, Morgantown, WV, USA
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Wang L, Hu F, Li W, Li Q, Li Y, Zhu J, Wei X, Yang J, Guo J, Qin Y, Shi H, Wang W, Wang Y. Relapse risk revealed by degree centrality and cluster analysis in heroin addicts undergoing methadone maintenance treatment. Psychol Med 2023; 53:2216-2228. [PMID: 34702384 DOI: 10.1017/s0033291721003937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Based on hubs of neural circuits associated with addiction and their degree centrality (DC), this study aimed to construct the addiction-related brain networks for patients diagnosed with heroin dependence undertaking stable methadone maintenance treatment (MMT) and further prospectively identify the ones at high risk for relapse with cluster analysis. METHODS Sixty-two male MMT patients and 30 matched healthy controls (HC) underwent brain resting-state functional MRI data acquisition. The patients received 26-month follow-up for the monthly illegal-drug-use information. Ten addiction-related hubs were chosen to construct a user-defined network for the patients. Then the networks were discriminated with K-means-clustering-algorithm into different groups and followed by comparative analysis to the groups and HC. Regression analysis was used to investigate the brain regions significantly contributed to relapse. RESULTS Sixty MMT patients were classified into two groups according to their brain-network patterns calculated by the best clustering-number-K. The two groups had no difference in the demographic, psychological indicators and clinical information except relapse rate and total heroin consumption. The group with high-relapse had a wider range of DC changes in the cortical-striatal-thalamic circuit relative to HC and a reduced DC in the mesocorticolimbic circuit relative to the low-relapse group. DC activity in NAc, vACC, hippocampus and amygdala were closely related with relapse. CONCLUSION MMT patients can be identified and classified into two subgroups with significantly different relapse rates by defining distinct brain-network patterns even if we are blind to their relapse outcomes in advance. This may provide a new strategy to optimize MMT.
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Affiliation(s)
- Lei Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, P.R. China
- Department of Nuclear Medicine, Tangdu Hospital, Air Force Military Medical University, Xi'an, P.R. China
| | - Feng Hu
- Department of Radiology, The Hospital of Shaanxi Provincial Geology and Mineral Resources Bureau, Xi'an, P.R. China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, P.R. China
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, P.R. China
| | - Yongbin Li
- Department of Radiology, The Second Hospital of Xi'an Medical University, Xi'an, P.R. China
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, P.R. China
| | - Xuan Wei
- Department of Radiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, P.R. China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, P.R. China
| | - Jianxin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, P.R. China
| | - Yue Qin
- Department of Radiology, Xi'an Daxing Hospital, Xi'an, P.R. China
| | - Hong Shi
- Department of Radiology, Xi'an No.1 Hospital, Xi'an, P.R. China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, P.R. China
| | - Yarong Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, P.R. China
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Yan H, Shlobin NA, Jung Y, Zhang KK, Warsi N, Kulkarni AV, Ibrahim GM. Nucleus accumbens: a systematic review of neural circuitry and clinical studies in healthy and pathological states. J Neurosurg 2023; 138:337-346. [PMID: 35901682 DOI: 10.3171/2022.5.jns212548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/17/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The nucleus accumbens (NAcc) of the ventral striatum is critically involved in goal- and reward-based behavior. Structural and functional abnormalities of the NAcc or its associated neural systems are involved in neurological and psychiatric disorders. Studies of neural circuitry have shed light on the subtleties of the structural and functional derangements of the NAcc across various diseases. In this systematic review, the authors sought to identify human studies involving the NAcc and provide a synthesis of the literature on the known circuity of the NAcc in healthy and diseased states, as well as the clinical outcomes following neuromodulation. METHODS A systematic review was conducted using the PubMed, Embase, and Scopus databases. Neuroimaging studies that reported on neural circuitry related to the human NAcc with sample sizes greater than 5 patients were included. Demographic data, aim, design and duration, participants, and clinical and neurocircuitry details and outcomes of the studies were extracted. RESULTS Of 3591 resultant articles, 123 were included. The NAcc and its corticolimbic connections to other brain regions, such as the prefrontal cortex, are largely involved in reward and pain processes, with distinct functional circuitry between the shell and core in healthy patients. There is heterogeneity between clinical studies with regard to the NAcc indirect targeting coordinates, methods for postoperative confirmation, and blinded trial design. Neuromodulation studies provided promising clinical results in the context of addiction and substance misuse, obsessive-compulsive disorder, and mood disorders. The most common complications were impaired memory or concentration, and a notable serious complication was hypomania. CONCLUSIONS The functional diversity of the NAcc highlights the importance of studying the NAcc in healthy and pathological states. The results of this review suggest that NAcc neuromodulation has been attempted in the management of diverse psychiatric indications. There is promising, emerging evidence that the NAcc may be an effective target for specific reward- or pain-based pathologies with a reasonable risk profile.
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Affiliation(s)
- Han Yan
- 1Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.,2Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,4McMaster Medical School, Hamilton, Ontario, Canada
| | - Nathan A Shlobin
- 3Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Kristina K Zhang
- 5Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; and.,6Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Nebras Warsi
- 1Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.,5Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; and
| | - Abhaya V Kulkarni
- 1Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.,2Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - George M Ibrahim
- 1Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.,5Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; and.,6Institute of Medical Science, University of Toronto, Ontario, Canada
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Joutsa J, Moussawi K, Siddiqi SH, Abdolahi A, Drew W, Cohen AL, Ross TJ, Deshpande HU, Wang HZ, Bruss J, Stein EA, Volkow ND, Grafman JH, van Wijngaarden E, Boes AD, Fox MD. Brain lesions disrupting addiction map to a common human brain circuit. Nat Med 2022; 28:1249-1255. [PMID: 35697842 PMCID: PMC9205767 DOI: 10.1038/s41591-022-01834-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
Drug addiction is a public health crisis for which new treatments are urgently needed. In rare cases, regional brain damage can lead to addiction remission. These cases may be used to identify therapeutic targets for neuromodulation. We analyzed two cohorts of patients addicted to smoking at the time of focal brain damage (cohort 1 n = 67; cohort 2 n = 62). Lesion locations were mapped to a brain atlas and the brain network functionally connected to each lesion location was computed using human connectome data (n = 1,000). Associations with addiction remission were identified. Generalizability was assessed using an independent cohort of patients with focal brain damage and alcohol addiction risk scores (n = 186). Specificity was assessed through comparison to 37 other neuropsychological variables. Lesions disrupting smoking addiction occurred in many different brain locations but were characterized by a specific pattern of brain connectivity. This pattern involved positive connectivity to the dorsal cingulate, lateral prefrontal cortex, and insula and negative connectivity to the medial prefrontal and temporal cortex. This circuit was reproducible across independent lesion cohorts, associated with reduced alcohol addiction risk, and specific to addiction metrics. Hubs that best matched the connectivity profile for addiction remission were the paracingulate gyrus, left frontal operculum, and medial fronto-polar cortex. We conclude that brain lesions disrupting addiction map to a specific human brain circuit and that hubs in this circuit provide testable targets for therapeutic neuromodulation.
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Affiliation(s)
- Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, Finland. .,Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland. .,Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Khaled Moussawi
- National Institute on Drug Abuse-Intramural Research Program, Baltimore, MD, USA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shan H Siddiqi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Center for Brain Circuit Therapeutics, Departments of Neurology Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amir Abdolahi
- Clinical Affairs, Philips Healthcare, Cambridge, MA, USA
| | - William Drew
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Center for Brain Circuit Therapeutics, Departments of Neurology Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander L Cohen
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Center for Brain Circuit Therapeutics, Departments of Neurology Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas J Ross
- National Institute on Drug Abuse-Intramural Research Program, Baltimore, MD, USA
| | | | - Henry Z Wang
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Joel Bruss
- Departments of Pediatrics, Neurology & Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Elliot A Stein
- National Institute on Drug Abuse-Intramural Research Program, Baltimore, MD, USA
| | - Nora D Volkow
- Intramural Research Program, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Jordan H Grafman
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Northwestern University, Chicago, IL, USA.,Department of Psychiatry, Feinberg School of Medicine and Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Aaron D Boes
- Departments of Pediatrics, Neurology & Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Center for Brain Circuit Therapeutics, Departments of Neurology Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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De Salles A, Lucena L, Paranhos T, Ferragut MA, de Oliveira-Souza R, Gorgulho A. Modern neurosurgical techniques for psychiatric disorders. PROGRESS IN BRAIN RESEARCH 2022; 270:33-59. [PMID: 35396030 DOI: 10.1016/bs.pbr.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Psychosurgery refers to an ensemble of more or less invasive techniques designed to reduce the burden caused by psychiatric diseases in patients who have failed to respond to conventional therapy. While most surgeries are designed to correct apparent anatomical abnormalities, no discrete cerebral anatomical lesion is evident in most psychiatric diseases amenable to invasive interventions. Finding the optimal surgical targets in mental illness is troublesome. In general, contemporary psychosurgical procedures can be classified into one of two primary modalities: lesioning and stimulation procedures. The first group is divided into (a) thermocoagulation and (b) stereotactic radiosurgery or recently introduced transcranial magnetic resonance-guided focused ultrasound, whereas stimulation techniques mainly include deep brain stimulation (DBS), cortical stimulation, and the vagus nerve stimulation. The most studied psychiatric diseases amenable to psychosurgical interventions are severe treatment-resistant major depressive disorder, obsessive-compulsive disorder, Tourette syndrome, anorexia nervosa, schizophrenia, and substance use disorder. Furthermore, modern neuroimaging techniques spurred the interest of clinicians to identify cerebral regions amenable to be manipulated to control psychiatric symptoms. On this way, the concept of a multi-nodal network need to be embraced, enticing the collaboration of psychiatrists, psychologists, neurologists and neurosurgeons participating in multidisciplinary groups, conducting well-designed clinical trials.
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Affiliation(s)
- Antonio De Salles
- University of California Los Angeles (UCLA), Los Angeles, CA, United States; NeuroSapiens®, Brazil; Hospital Rede D'Or, São Luiz, SP, Brazil.
| | - Luan Lucena
- NeuroSapiens®, Brazil; Hospital Rede D'Or, São Luiz, SP, Brazil
| | - Thiago Paranhos
- Hospital Rede D'Or, São Luiz, SP, Brazil; Federal University of Rio De Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Ricardo de Oliveira-Souza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Federal University of the State of Rio De Janeiro (UNIRIO), Rio de Janeiro, Brazil
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Muacevic A, Adler JR, Barahona KC, Caceros V, Cruz C, Arias J. Radioneuromodulation by Dual-Target Irradiation in Pain Crisis From Trigeminal Neuralgia. Cureus 2022; 14:e20971. [PMID: 35004092 PMCID: PMC8730795 DOI: 10.7759/cureus.20971] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 01/09/2023] Open
Abstract
Background Radioneuromodulation (RNM) can explain the immediate pain relief experienced by a subgroup of patients after stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). In this study, our main objective was to demonstrate that a minimum of a 50% reduction in TN pain can be achieved consistently in under 72 hours by targeting the affected nerve, the contralateral centromedian nucleus, and parafascicular complex in patients experimenting a prolonged refractory pain crisis. Methodology We treated eight patients experiencing severe TN pain crisis in whom percutaneous procedures had failed or were unwanted with SRS with an intention to procure pain relief in under 72 hours. The affected trigeminal nerve was targeted using a 4-mm collimator with an 80 to 90-Gy dose; an additional target was defined in the mesial portions of the thalamus and irradiated using the 4-mm collimator with a 120 to 140-Gy dose. Results The median duration of TN was 60 months, the median duration of pain crisis was 10.7 weeks despite the best medical treatment, and the mean presenting visual analogue score (VAS) was 10 at the time of treatment. The median follow-up was 135 days (range, 65-210). Twenty-four hours after treatment, two (25%) patients had no pain (VAS 0), three (37.5%) had mild pain (VAS 1 to 3), and three (37.5%) had moderate pain (VAS 4 to 7). Forty-eight hours after treatment, all patients reported pain relief, seven (87.5%) reported >50%, and one (12.5%) patients reported 30% relief. The three-month median VAS score was 3 (range, 0 to 5). At the last follow-up, there were no adverse events to report. Conclusions Dual irradiation to the affected trigeminal nerve and contralateral mesial structures of the thalamus may provide fast pain relief for patients experiencing a prolonged pain crisis from TN, which veers away from the concept that the SRS pain relief effect is generally delayed and holds no place in the management of such patients. Although this is a small series with a limited follow-up duration, no adverse effects were noted. RNM can be defined as the capacity to alter neuronal activity through targeted delivery of a stimulus of radiation at a duration too brief to be explained by the development of a focal lesion. The immediate pain relief and its habitual oscillatory nature of lesser pain recurrence in most patients until enough time elapses for pain stabilization clinically demonstrates that the pain circuitry is altered and remains functional, thus accomplishing a neuromodulation effect even at the face of an apparent doses suspected to be ablative. Further research is needed to understand if this clinical effect is achieved with a suspected sub-ablative dose.
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Affiliation(s)
| | | | - Kaory C Barahona
- Radiation Oncology, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Victor Caceros
- Radiation Oncology, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Claudia Cruz
- Pain Management, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Juan Arias
- Pain Management, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
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Lichterman BL, Schulder M, Liu B, Yang X, Taira T. A comparative history of psychosurgery. PROGRESS IN BRAIN RESEARCH 2022; 270:1-31. [DOI: 10.1016/bs.pbr.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moe FD, Moltu C, McKay JR, Nesvåg S, Bjornestad J. Is the relapse concept in studies of substance use disorders a 'one size fits all' concept? A systematic review of relapse operationalisations. Drug Alcohol Rev 2021; 41:743-758. [PMID: 34792839 DOI: 10.1111/dar.13401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
ISSUES Relapse is a theoretical construct and empirical object of inquiry. It is unclear how relapse is operationalised with regard to the various phases in substance use disorders (SUD). The aim was to investigate relapse operationalisations in SUDs studies after short- and long-term abstinence and remission, recovery and slip/lapse. APPROACH Systematic review using the following databases: Epistemonikos, Cochrane Central Register of Controlled Trials (CENTRAL and DARE), MEDLINE, EMBASE, Google Scholar, CINAHL, Web of Science and PsycINFO. Search returned 3426 articles, with 276 meeting the following inclusion criteria: empirical study published in English in a peer-reviewed journal; samples meet diagnostic criteria for dependence syndrome or moderate-severe drug use disorder or alcohol use disorder; reports relapse, abstinence, recovery, remission, slip or lapse. Review protocol registration: PROSPERO (CRD42020154062). KEY FINDINGS Thirty-two percent of the studies had no definition of 'relapse'. Most relapse operationalisations were defined according to measure (26%), time (17%), use (26%) and amount and frequency (27%). Of the 16 studies with a follow-up duration of up to 2 years, one (6%) contained a definition of 'long-term abstinence'. Of the 64 studies with a follow-up duration of more than 2 years, four (6%) contained a definition of 'long-term abstinence'. Of those, one (2%) mentioned 'early relapse' and one (2%) mentioned 'late relapse'. IMPLICATIONS Future research is needed to explore the possible difference between early and late relapse. Moreover, working to increase consensus on relapse operationalisations in SUD research is warranted. CONCLUSIONS We identified no consensus on relapse operationalisations nor agreement on the differentiation between early and late relapse. The clinical utility of current relapse operationalisations seems low and may compromise knowledge accumulation about relapse and implementation of research into treatment.
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Affiliation(s)
- Fredrik D Moe
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - James R McKay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Philadelphia VA Medical Center, Philadelphia, USA.,Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Sverre Nesvåg
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.,Department of Psychiatry, District General Hospital of Førde, Førde, Norway.,TIPS-Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
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Chen SC, Chen H, Yu SJ, Chen YH, Wang Y. Alleviation of Methamphetamine Sensitization by Partially Lesioning Dopaminergic Terminals with 6-Hydroxydopamine in Nucleus Accumbens. Cell Transplant 2021; 30:9636897211052300. [PMID: 34743572 PMCID: PMC8579363 DOI: 10.1177/09636897211052300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Amphetamine-type stimulants have become important and popular abused drugs worldwide. Methamphetamine (Meth) sensitization, characterized by a progressive increase in behavioral responses after repeated administration, has been reported in rodents and patients. This behavioral effect has been used as a laboratory model to study drug addiction and schizophrenia. The mesolimbic dopaminergic pathway plays a significant role in the development of Meth behavioral sensitization. Previous studies have reported that the ablation of nucleus accumbens (NAc) by electrolytic or thermal lesioning attenuates addictive behavior to opioids in animals. However, these studies were only conducted in opioid addictive rodents. Furthermore, these ablation procedures also damaged the non-dopaminergic neurons and fibers passing through the NAc. The purpose of this study was to examine the therapeutic effect of NAc lesioning by a selective dopaminergic toxin in Meth-sensitized animals. Adult mice received repeated administration of Meth for 7 days. Open-field locomotor activity and stereotype behavior were significantly increased after Meth treatment, suggesting behavior sensitization. A partial lesion of dopaminergic terminals was made through stereotaxic administration of dopaminergic toxin 6-hydroxydopamine (6-OHDA) to the NAc in the Meth -sensitized mice. Meth behavioral sensitization was significantly antagonized after the lesioning. Brain tissue was collected for qRT-PCR analysis. Repeated administration of Meth increased the expression of tyrosine hydroxylase (TH), BDNF, and Shati, a marker for Meth sensitization, in the NAc. Treatment with 6-OHDA significantly antagonized the upregulation of TH and Shati. Taken together, these data suggest that local administration of 6-OHDA mitigated Meth sensitization in chronic Meth-treated animals. Our data support a new surgical treatment strategy for Meth abuse.
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Affiliation(s)
- Shu-Chun Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan.,Graduate Institute of Applied Science and Engineering, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Hsi Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Seong-Jin Yu
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Yun-Hsiang Chen
- Department of Life Science, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Yun Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
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Maatoug R, Bihan K, Duriez P, Podevin P, Silveira-Reis-Brito L, Benyamina A, Valero-Cabré A, Millet B. Non-invasive and invasive brain stimulation in alcohol use disorders: A critical review of selected human evidence and methodological considerations to guide future research. Compr Psychiatry 2021; 109:152257. [PMID: 34246194 DOI: 10.1016/j.comppsych.2021.152257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) ranks among the leading causes of decrements in disability-adjusted life-years. Long-term exposure to alcohol leads to an imbalance of activity between frontal cortical systems and the striatum, thereby enhancing impulsive behaviours and weakening inhibitory control. Alternative therapeutic approaches such as non-invasive and invasive brain stimulation have gained some momentum in the field of addictology by capitalizing on their ability to target specific anatomical structures and correct abnormalities in dysfunctional brain circuits. MATERIALS AND METHODS The current review, covers original peer-reviewed published research on the use of brain stimulation methods for the rehabilitation of AUD. A broad and systematic search was carried out on four electronic databases: NCBI PubMed, Web of Science, Handbooks and the Cochrane Library. Any original article in English or French language, without restrictions of patient age or gender, article type and publication outlet, were included in the final pool of selected studies. RESULTS The outcomes of this systematic review suggest that the dorsolateral prefrontral cortex (DLPFC) is a promising target for treating AUD with high frequency repetitive transcranial magnetic stimulation. Such effect would reduce feelings of craving by enhancing cognitive control and modulating striatal function. Existing literature also supports the notion that changes of DLPFC activity driven by transcranial direct current stimulation, could decrease alcohol craving and consumption. However, to date, no major differences have been found between the efficacy of these two non-invasive brain-stimulation approaches, which require further confirmation. In contrast, beneficial stronger evidence supports an impact of deep brain stimulation reducing craving and improving quality of life in AUD, effects that would be mediated by an impact on the nucleus accumbens, a central structure of the brain's reward circuitry. Overall, neurostimulation shows promise contributing to the treatment of AUD. Nonetheless, progress has been limited by a number of factors such as the low number of controlled randomized trials, small sample sizes, variety of stimulation parameters precluding comparability and incomplete or questionable sham-conditions. Additionally, a lack of data concerning clinical impact on the severity of AUD or craving and the short follow up periods precluding and accurate estimation of effect duration after discontinuing the treatment, has also limited the clinical relevance of final outcomes. CONCLUSION Brain stimulation remains a promising approach to contribute to AUD therapy, co-adjuvant of more conventional procedures. However, a stronger therapeutic rational based on solid physio-pathological evidence and accurate estimates of efficacy, are still required to achieve further therapeutic success and expand clinical use.
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Affiliation(s)
- R Maatoug
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013 Paris, France.
| | - K Bihan
- Regional pharmacovigilance center, department of pharmacology, Pitié-Salpêtrière hospital, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Duriez
- Institute of Psychiatry and Neurosciences of Paris, Unité Mixte de Recherche en Santé (UMRS) 1266 Institut National de la Santé et de la Recherche Médicale (INSERM), University Paris Descartes, Paris, France; Clinique des Maladies Mentales et de l'Encéphale, Groupement Hospitalier Universitaire (GHU) Paris Psychiatry and Neuroscience, Sainte-Anne Hospital, Paris, France
| | - P Podevin
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013 Paris, France
| | - L Silveira-Reis-Brito
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013 Paris, France; Rede mater dei de saúde, Brazil
| | - A Benyamina
- Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France; Département de psychiatrie et d'addictologie, Hôpital Paul Brousse, Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, 94800 Villejuif, France
| | - A Valero-Cabré
- Institut du Cerveau et de la Moelle Epinière (ICM), CNRS UMR 7225, INSERM U 1127 and Sorbonne Université, Paris, France; Laboratory for Cerebral Dynamics Plasticity and Rehabilitation, Boston University, School of Medicine, Boston, MA, USA; Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Spain
| | - B Millet
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013 Paris, France
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11
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Ranjan M, Ranjan N, Deogaonkar M, Rezai A. Deep Brain Stimulation for Refractory Depression, Obsessive-Compulsive Disorder and Addiction. Neurol India 2021; 68:S282-S287. [PMID: 33318363 DOI: 10.4103/0028-3886.302459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Depression, Obsessive-compulsive Disorder (OCD), and addiction are the leading disabling psychiatric conditions with huge health care and psychosocial burden besides increased morbidity and mortality. Deep brain stimulation (DBS) for depression, OCD, and addiction is increasingly explored and is quite challenging. We present a brief review of the pertinent literature of DBS for depression, OCD, and addiction and present the status and challenges. Objective The aim of this study was to review the current status and challenges with the DBS for Depression, Obsessive-compulsive Disorder (OCD), and addiction. Method The pertinent brief literature was reviewed in reference to the DBS for Depression, Obsessive-compulsive Disorder (OCD), and addiction. Results To date, OCD is the only psychiatric condition approved for DBS therapy (under humanitarian device exemption). Although the initial encouraging results of DBS in depression were encouraging but the two larger multicenter clinical trials failed to meet the primary objective. Further evaluation and studies are ongoing. Similarly, the initial results of DBS for addiction are encouraging; however, the experience is limited. Conclusion DBS for depression, OCD, and addiction seem challenging but promising. Further refinement of the target and evaluation in a larger and controlled setting is needed, specifically for depression and addiction.
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Affiliation(s)
- Manish Ranjan
- Department of Neurosurgery, Rockefeller Neuroscience Institute, USA
| | - Nutan Ranjan
- Department of Behavioral Medicine and Psychiatry, West Virginia University, West Virginia, USA
| | | | - Ali Rezai
- Department of Neurosurgery, Rockefeller Neuroscience Institute, USA
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12
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Navarro PA, Paranhos T, Lovo E, De Oliveira-Souza R, Gorgulho AA, De Salles A, López WOC. Safety and Feasibility of Nucleus Accumbens Surgery for Drug Addiction: A Systematic Review. Neuromodulation 2021; 25:171-184. [PMID: 33460201 DOI: 10.1111/ner.13348] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Substance addiction encompasses the incapacity to discontinue urgent drug use; many severely disabled patients might be considered appropriate candidates for surgery due to the high rates of relapse despite conservative treatment. A crucial finding in the brain of these patients is increased extracellular concentrations of dopamine in the nucleus accumbens (NAcc). OBJECTIVES To determine the efficacy and safety of NAcc surgery for the treatment of substance dependence. MATERIALS AND METHODS Adhering to PRISMA guidelines, we performed a systematic review to identify all original studies in which NAcc surgery was performed to treat relapsing drug addiction with a minimum follow-up of six months. From database inception to April 10, 2020, we searched PubMed, Scopus, and LILACS. Two reviewers independently selected studies and extracted data. The main outcome was the relapse rate. The GRADE methods were applied to evaluate the quality of evidence. This study was registered with PROSPERO CRD42020177054. RESULTS Fifteen studies involving 359 participants met inclusion criteria; eight (56%) included NAcc deep brain stimulation (DBS) in 13 patients with addiction for alcohol (N = 6, 46.1%), opioid (N = 4, 30.7%), and nicotine (N = 3, 15.3%); seven studies (N = 346, 44%) performed NAcc radiofrequency (RF) ablation for opioid (N = 334) and alcohol (N = 12) dependence. Relapse rates were 38.4% for DBS and 39% for RF ablation. CONCLUSIONS Despite available studies reporting a benefit in the treatment of drug addictions with NAcc surgery, this systematic review stresses the need for carefully planned prospective studies in order to further address the efficacy and indications.
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Affiliation(s)
- Paula Alejandra Navarro
- Grupo de investigación NEMOD, división de neurocirugía funcional, departamento de neurocirugía, clínica FOSCAL, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Thiago Paranhos
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo Lovo
- Centro Internacional de Cáncer Hospital de Diagnóstico, San Salvador, El Salvador
| | - Ricardo De Oliveira-Souza
- Department of Neurology and Neuropsychiatry, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | | | | | - William Omar Contreras López
- Grupo de investigación NEMOD, división de neurocirugía funcional, departamento de neurocirugía, clínica FOSCAL, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
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13
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Outcomes of deep brain stimulation surgery for substance use disorder: a systematic review. Neurosurg Rev 2020; 44:1967-1976. [PMID: 33037538 DOI: 10.1007/s10143-020-01415-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/31/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
Long has the standard of care for substance use disorder (SUD) been pharmacotherapy, psychotherapy, or rehabilitation with varying success. Deep brain stimulation (DBS) may have a beneficial reduction in the addiction-reward pathway. Recent studies have found reduced relapse and improvements in quality of life following DBS stimulation of the nucleus accumbens. We aim to identify positive outcomes and adverse effects to assess the viability of DBS as a treatment of addiction. A PubMed search following PRISMA guidelines was conducted to identify the entirety of reports reporting DBS as a treatment for SUD. Outcomes were extracted from the literature to be summarized, and a review of the quality of publications was also performed. From 2305 publications, 14 studies were found to fit the inclusion criteria published between 2007 and 2019. All studies targeted the nucleus accumbens (NAc) and remission rates at 6 months, 1 year, 2 years, and more than 6 years were 61% (20/33), 53% (17/32), 43% (14/30), and 50% (3/6), respectively. Not all studies detailed the stimulation settings or coordinates. The most common adverse effect across studies was a weight change of at least 2 kg. DBS shows potential as a long-term treatment of SUD in refractory patients. Further studies with controlled double-blind paradigms are needed for evaluation of the efficacy and safety of this treatment. Future studies should also investigate other brain regions for stimulation and optimal device stimulation parameters.
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14
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Wang J, Zhang Y, Zhang H, Wang K, Wang H, Qian D, Qi S, Yang K, Long H. Nucleus accumbens shell: A potential target for drug-resistant epilepsy with neuropsychiatric disorders. Epilepsy Res 2020; 164:106365. [PMID: 32460115 DOI: 10.1016/j.eplepsyres.2020.106365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
The nucleus accumbens (NAc) is an important component of the ventral striatum, involving motivational and emotional processes, limbic-motor interfaces. Recently, experimental and clinical data have shown that NAc, particularly NAc shell (NAcs), participates in ictogenesis and epileptogensis in drug-resistant epilepsy (DRE). Therefore, we summarize the existing literature on NAcs and potential role in epilepsy, from the bench to the clinic. Connection abnormalities between NAcs and remainings, degeneration of NAc neurons, and an aberrant distribution of neuroactive substances have been reported in patients with DRE. These changes may be underlying the pathophysiological mechanism of the involvement of NAcs in DRE. Furthermore, alterations in NAcs may also be involved in neuropsychiatric disorders in patients with DRE. These observational studies demonstrate the multiple properties of NAcs and the complex relationship between the limbic system and DRE with neuropsychiatric disorders. NAcs can be a potential target for DBS and stereotactic lesioning to manage DRE with neuropsychiatric disorders. Future studies are warranted to further clarify the role of NAcs in epilepsy.
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Affiliation(s)
- Jun Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China.
| | - Yuzhen Zhang
- The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China
| | - Henghui Zhang
- The First Clinical Medicine College, Southern Medical University, China; Neural Networks Surgery Team, Southern Medical University, China
| | - Kewan Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Hongxiao Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Dadi Qian
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China
| | - Kaijun Yang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China.
| | - Hao Long
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, China; The First Clinical Medicine College, Southern Medical University, China.
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15
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Ma S, Zhang C, Yuan TF, Steele D, Voon V, Sun B. Neurosurgical treatment for addiction: lessons from an untold story in China and a path forward. Natl Sci Rev 2019; 7:702-712. [PMID: 34692088 PMCID: PMC8288968 DOI: 10.1093/nsr/nwz207] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/15/2019] [Accepted: 12/13/2019] [Indexed: 12/11/2022] Open
Abstract
Addiction is a major public-health crisis associated with significant disability and mortality. Although various pharmacological and behavioral treatments are currently available, the clinical efficacy of these treatments is limited. Given this situation, there is a growing interest in finding an effective neurosurgical treatment for addiction. First, we discuss the use of ablative surgery in treating addiction. We focus on the rise and fall of nucleus accumbens ablation for addiction in China. Subsequently, we review recent studies that have explored the efficacy and safety of deep-brain-stimulation treatment for addiction. We conclude that neurosurgical procedures, particularly deep-brain stimulation, have a potentially valuable role in the management of otherwise intractable addictive disorders. Larger well-controlled clinical trials, however, are needed to assess clinical efficacy and safety. We end by discussing several key issues involved in this clinical field and identifying some areas of progress.
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Affiliation(s)
- Shuo Ma
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ti-fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Douglas Steele
- Division of Imaging Science and Technology, Medical School, University of Dundee, Dundee DD1 4HN, UK
| | - Valerie Voon
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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16
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Qu L, Ge S, Li N, Wang W, Yang K, Wu P, Wang X, Shi J. Clinical evaluation of deep brain stimulation of nucleus accumbens/anterior limb of internal capsule for opioid relapse prevention: protocol of a multicentre, prospective and double-blinded study. BMJ Open 2019; 9:e023516. [PMID: 30765398 PMCID: PMC6398661 DOI: 10.1136/bmjopen-2018-023516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) is a new potential surgical treatment for opioid dependence. However, the implement of DBS treatment in addicted patients is currently controversial due to the significant associated risks. The aim of this study was mainly to investigate the therapeutic efficacy and safety of bilateral DBS of nucleus accumbens and the anterior limb of the internal capsule (NAc/ALIC-DBS) in patients with refractory opioid dependence (ROD). METHODS AND ANALYSIS 60 patients with ROD will be enrolled in this multicentre, prospective, double-blinded study, and will be followed up for 25 weeks (6 months) after surgery. Patients with ROD (semisynthetic opioids) who meet the criteria for NAc/ALIC-DBS surgery will be allocated to either the early stimulation group or the late stimulation group (control group) based on the randomised ID number. The primary outcome was defined as the abstinence rate at 25 weeks after DBS stimulation on, which will be confirmed by an opiate urine tests. The secondary outcomes include changes in the Visual Analogue Scale (VAS) score for craving for opioid drugs, body weight, as well as psychological evaluation measured using the 17-item Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Pittsburgh Sleep Quality Index, Fagerstrom test for nicotine dependence assessment, social disability screening schedule, the Activity of Daily Living Scale, the 36-item Short Form-Health Survey and safety profiles of both groups. ETHICS AND DISSEMINATION The study received ethical approval from the medical ethical committee of Tangdu Hospital, The Fourth Military Medical University, Xi'an, China. The results of this study will be published in a peer-reviewed journal and presented at international conferences. TRIAL REGISTRATION NUMBER NCT03424616; Pre-results.
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Affiliation(s)
- Liang Qu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Shunnan Ge
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Nan Li
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Wei Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Kaijun Yang
- Department of Neurosurgery, Southern Hospital, Southern Medical University, Guangzhou, China
| | - Ping Wu
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Xuelian Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Jie Shi
- National Institute on Drug Dependence, Peking University, Beijing, China
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17
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Chen L, Li N, Ge S, Lozano AM, Lee DJ, Yang C, Li L, Bai Q, Lu H, Wang J, Wang X, Li J, Jing J, Su M, Wei L, Wang X, Gao G. Long-term results after deep brain stimulation of nucleus accumbens and the anterior limb of the internal capsule for preventing heroin relapse: An open-label pilot study. Brain Stimul 2019; 12:175-183. [DOI: 10.1016/j.brs.2018.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 08/24/2018] [Accepted: 09/10/2018] [Indexed: 01/28/2023] Open
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Bari A, DiCesare J, Babayan D, Runcie M, Sparks H, Wilson B. Neuromodulation for substance addiction in human subjects: A review. Neurosci Biobehav Rev 2018; 95:33-43. [PMID: 30268433 DOI: 10.1016/j.neubiorev.2018.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/11/2018] [Accepted: 09/20/2018] [Indexed: 12/22/2022]
Abstract
Substance abuse is one of the most prevalent and costly health problems in the world today. Standard medical therapy is often not curative, and relapse is common. Research over the past several decades on the neural underpinnings of addiction has implicated a network of structures within the brain shown to be altered in patients with substance abuse. The field of neuromodulation aims to utilize this knowledge to treat dysfunctional circuits by targeting and modulating specific brain circuits. While invasive neuromodulation such as DBS and VNS have proven to be effective in treating movement disorders, OCD and epilepsy, there is increasing interest and data with regards to its potential application for the treatment of severe, intractable addiction. Several neuromodulatory techniques and brain targets are currently under investigation in patients with various substance abuse disorders. This review aims to summarize the current state of evidence for neurosurgical neuromodulation as a therapy for substance abuse and addiction, and to provide additional expert opinions as to the obstacles and future directions of this endeavor.
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Affiliation(s)
- Ausaf Bari
- Department of Neurosurgery, University of California, Los Angeles 300 Stein Plaza Driveway #420, Los Angeles, CA 90095, United States
| | - Jasmine DiCesare
- Department of Neurosurgery, University of California, Los Angeles 300 Stein Plaza Driveway #420, Los Angeles, CA 90095, United States
| | - Diana Babayan
- Department of Neurosurgery, University of California, Los Angeles 300 Stein Plaza Driveway #420, Los Angeles, CA 90095, United States
| | - Mariama Runcie
- School of Medicine, University of California, Los Angeles 10833 Le Conte Ave, Los Angeles, CA 90095, United States
| | - Hiro Sparks
- School of Medicine, University of California, Los Angeles 10833 Le Conte Ave, Los Angeles, CA 90095, United States
| | - Bayard Wilson
- Department of Neurosurgery, University of California, Los Angeles 300 Stein Plaza Driveway #420, Los Angeles, CA 90095, United States.
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19
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Wei Y, Li H, Wang H, Zhang S, Sun Y. Psychological Status of Volunteers in a Phase I Clinical Trial Assessed by Symptom Checklist 90 (SCL-90) and Eysenck Personality Questionnaire (EPQ). Med Sci Monit 2018; 24:4968-4973. [PMID: 30015333 PMCID: PMC6067027 DOI: 10.12659/msm.909524] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The psychological status of volunteers was investigated to provide a theoretical method for Phase I clinical trial management and result analysis. Material/Methods The Symptom Checklist 90 (SCL-90) and Eysenck Personality Questionnaire (EPQ) were used to assess the psychological status 200 healthy Chinese volunteers. Results SCL-90 results indicate that the average value of positive factors is 10.32±14.26 by self-assessment of healthy volunteers, somatization factor is 1.13±0.13, compulsive symptom factor is 1.29±0.27, interpersonal sensitivity factor is 1.31±0.21, depression factor is 1.26±0.33, anxiety factor is 1.21±0.21, hostility factor is 1.08±0.26, phobia factor is 1.05±0.18, paranoid factor is 1.12±0.23, and psychotic symptom factor is 1.17±0.26. Conclusions Compared to the norm in China, the score of each factor of healthy volunteers was relatively low, with a statistically significant difference (P<0.001). EPQ results show that P score was 4.59±2.33, E score is 13.13±4.32, N score was 6.89±5.26, and L score was 13.21±4.25 for the 200 healthy volunteers. Compared to the norm in China, the P and N scores were lower, and the E and L scores were higher, with a statistically significant difference (P<0.001).
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Affiliation(s)
- Yudong Wei
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China (mainland)
| | - Haiyan Li
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China (mainland).,Department of Cardiology, Peking University Third Hospital, Beijing, China (mainland)
| | - Huali Wang
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China (mainland)
| | - Shuang Zhang
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China (mainland)
| | - Yumei Sun
- Peking University School of Nursing, Beijing, China (mainland)
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20
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Bina RW, Langevin JP. Closed Loop Deep Brain Stimulation for PTSD, Addiction, and Disorders of Affective Facial Interpretation: Review and Discussion of Potential Biomarkers and Stimulation Paradigms. Front Neurosci 2018; 12:300. [PMID: 29780303 PMCID: PMC5945819 DOI: 10.3389/fnins.2018.00300] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/18/2018] [Indexed: 01/06/2023] Open
Abstract
The treatment of psychiatric diseases with Deep Brain Stimulation (DBS) is becoming more of a reality as studies proliferate the indications and targets for therapies. Opinions on the initial failures of DBS trials for some psychiatric diseases point to a certain lack of finesse in using an Open Loop DBS (OLDBS) system in these dynamic, cyclical pathologies. OLDBS delivers monomorphic input into dysfunctional brain circuits with modulation of that input via human interface at discrete time points with no interim modulation or adaptation to the changing circuit dynamics. Closed Loop DBS (CLDBS) promises dynamic, intrinsic circuit modulation based on individual physiologic biomarkers of dysfunction. Discussed here are several psychiatric diseases which may be amenable to CLDBS paradigms as the neurophysiologic dysfunction is stochastic and not static. Post-Traumatic Stress Disorder (PTSD) has several peripheral and central physiologic and neurologic changes preceding stereotyped hyper-activation behavioral responses. Biomarkers for CLDBS potentially include skin conductance changes indicating changes in the sympathetic nervous system, changes in serum and central neurotransmitter concentrations, and limbic circuit activation. Chemical dependency and addiction have been demonstrated to be improved with both ablation and DBS of the Nucleus Accumbens and as a serendipitous side effect of movement disorder treatment. Potential peripheral biomarkers are similar to those proposed for PTSD with possible use of environmental and geolocation based cues, peripheral signs of physiologic arousal, and individual changes in central circuit patterns. Non-substance addiction disorders have also been serendipitously treated in patients with OLDBS for movement disorders. As more is learned about these behavioral addictions, DBS targets and effectors will be identified. Finally, discussed is the use of facial recognition software to modulate activation of inappropriate responses for psychiatric diseases in which misinterpretation of social cues feature prominently. These include Autism Spectrum Disorder, PTSD, and Schizophrenia-all of which have a common feature of dysfunctional interpretation of facial affective clues. Technological advances and improvements in circuit-based, individual-specific, real-time adaptable modulation, forecast functional neurosurgery treatments for heretofore treatment-resistant behavioral diseases.
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Affiliation(s)
- Robert W Bina
- Division of Neurosurgery, Banner University Medical Center, Tucson, AZ, United States
| | - Jean-Phillipe Langevin
- Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
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Zhao X, Yang R, Wang K, Zhang Z, Wang J, Tan X, Zhang J, Mei Y, Chan Q, Xu J, Feng Q, Xu Y. Connectivity-based parcellation of the nucleus accumbens into core and shell portions for stereotactic target localization and alterations in each NAc subdivision in mTLE patients. Hum Brain Mapp 2017; 39:1232-1245. [PMID: 29266652 DOI: 10.1002/hbm.23912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/18/2017] [Accepted: 11/30/2017] [Indexed: 01/01/2023] Open
Abstract
The nucleus accumbens (NAc), an important target of deep brain stimulation for some neuropsychiatric disorders, is thought to be involved in epileptogenesis, especially the shell portion. However, little is known about the exact parcellation within the NAc, and its structural abnormalities or connections alterations of each NAc subdivision in temporal lobe epilepsy (TLE) patients. Here, we used diffusion probabilistic tractography to subdivide the NAc into core and shell portions in individual TLE patients to guide stereotactic localization of NAc shell. The structural and connection abnormalities in each NAc subdivision in the groups were then estimated. We successfully segmented the NAc in 24 of 25 controls, 14 of 16 left TLE patients, and 14 of 18 right TLE patients. Both left and right TLE patients exhibited significantly decreased fractional anisotropy (FA) and increased radial diffusivity (RD) in the shell, while there was no significant alteration in the core. Moreover, relatively distinct structural connectivity of each NAc subdivision was demonstrated. More extensive connection abnormalities were detected in the NAc shell in TLE patients. Our results indicate that neuronal degeneration and damage caused by seizure mainly exists in NAc shell and provide anatomical evidence to support the role of NAc shell in epileptogenesis. Remarkably, those NAc shell tracts with increased connectivities in TLE patients were found decreased in FA, which indicates disruption of fiber integrity. This finding suggests the regeneration of aberrant connections, a compensatory and repair process ascribed to recurrent seizures that constitutes part of the characteristic changes in the epileptic network.
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Affiliation(s)
- Xixi Zhao
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Ru Yang
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, 510515, China
| | - Kewan Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | | | - Junling Wang
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiangliang Tan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jiajun Zhang
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yingjie Mei
- Philips Healthcare, Guangzhou, Guangdong, 510055, China
| | | | - Jun Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Qianjin Feng
- School of Biomedical Engineering and Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, 510515, China
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
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Neumaier F, Paterno M, Alpdogan S, Tevoufouet EE, Schneider T, Hescheler J, Albanna W. Surgical Approaches in Psychiatry: A Survey of the World Literature on Psychosurgery. World Neurosurg 2017; 97:603-634.e8. [DOI: 10.1016/j.wneu.2016.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 12/11/2022]
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De Ridder D, Manning P, Glue P, Cape G, Langguth B, Vanneste S. Anterior Cingulate Implant for Alcohol Dependence. Neurosurgery 2016; 78:E883-93. [DOI: 10.1227/neu.0000000000001248] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Alcohol dependence is related to dysfunctional brain processes, in which a genetic background and environmental factors shape brain mechanisms involved with alcohol consumption. Craving, a major component determining relapses in alcohol abuse, has been linked to abnormal brain activity.
CLINICAL PRESENTATION:
We report the results of a treatment-intractable, alcohol-addicted patient with associated agoraphobia and anxiety. Functional imaging studies consisting of functional magnetic resonance imaging and resting-state electroencephalogram were performed as a means to localize craving-related brain activation and for identification of a target for repetitive transcranial magnetic stimulation and implant insertion. Repetitive transcranial magnetic stimulation of the dorsal anterior cingulate cortex with a double-cone coil transiently suppressed his very severe alcohol craving for up to 6 weeks. For ongoing stimulation, 2 “back-to-back” paddle electrodes were implanted with functional magnetic resonance imaging neuronavigation guidance for bilateral dorsal anterior cingulate cortex stimulation. Using a recently developed novel stimulation design, burst stimulation, a quick improvement was obtained on craving, agoraphobia, and associated anxiety without the expected withdrawal symptoms. The patient has remained free of alcohol intake and relieved of agoraphobia and anxiety for over 18 months, associated with normalization of his alpha and beta activity on electroencephalogram in the stimulated area. He perceives a mental freedom by not being constantly focused on alcohol.
CONCLUSION:
This case report proposes a new pathophysiology-based target for the surgical treatment of alcohol dependence and suggests that larger studies are warranted to explore this potentially promising avenue for the treatment of intractable alcohol dependence with or without anxiety and agoraphobia.
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Affiliation(s)
- Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Patrick Manning
- Section of Endocrinology, Department of Internal Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gavin Cape
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Sven Vanneste
- School of Behavioral and Brain Sciences, The University of Texas, Dallas, Texas
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Dupré DA, Tomycz N, Oh MY, Whiting D. Deep brain stimulation for obesity: past, present, and future targets. Neurosurg Focus 2016; 38:E7. [PMID: 26030707 DOI: 10.3171/2015.3.focus1542] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The authors review the history of deep brain stimulation (DBS) in patients for treating obesity, describe current DBS targets in the brain, and discuss potential DBS targets and nontraditional stimulation parameters that may improve the effectiveness of DBS for ameliorating obesity. Deep brain stimulation for treating obesity has been performed both in animals and in humans with intriguing preliminary results. The brain is an attractive target for addressing obesity because modulating brain activity may permit influencing both sides of the energy equation--caloric intake and energy expenditure.
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Affiliation(s)
- Derrick A Dupré
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Nestor Tomycz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Michael Y Oh
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Donald Whiting
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
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25
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Wu HM, Ge SN, Dai HB, Wang L, Chang CW, Wang XL, Li N, Gao GD. Long-Term Changes in Drug Craving and Nutritional Status of Opioid Addicts with Nucleus Accumbens Ablative Stereotactic Neurosurgery at Five Years Postoperatively. Stereotact Funct Neurosurg 2016; 93:407-14. [DOI: 10.1159/000441392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 09/30/2015] [Indexed: 11/19/2022]
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26
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Bari AA, King NKK, Lipsman N, Lozano AM. Deep Brain Stimulation for Neuropsychiatric Disorders. Transl Neurosci 2016. [DOI: 10.1007/978-1-4899-7654-3_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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27
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NMDA and dopamine D1 receptors within NAc-shell regulate IEG proteins expression in reward circuit during cocaine memory reconsolidation. Neuroscience 2015; 315:45-69. [PMID: 26674058 DOI: 10.1016/j.neuroscience.2015.11.063] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/03/2015] [Accepted: 11/29/2015] [Indexed: 01/11/2023]
Abstract
Reactivation of consolidated memory initiates a memory reconsolidation process, during which the reactivated memory is susceptible to strengthening, weakening or updating. Therefore, effective interference with the memory reconsolidation process is expected to be an important treatment for drug addiction. The nucleus accumbens (NAc) has been well recognized as a pathway component that can prevent drug relapse, although the mechanism underlying this function is poorly understood. We aimed to clarify the regulatory role of the NAc in the cocaine memory reconsolidation process, by examining the effect of applying different pharmacological interventions to the NAc on Zif 268 and Fos B expression in the entire reward circuit after cocaine memory reactivation. Through the cocaine-induced conditioned place preference (CPP) model, immunohistochemical and immunofluorescence staining for Zif 268 and Fos B were used to explore the functional activated brain nuclei after cocaine memory reactivation. Our results showed that the expression of Zif 268 and Fos B was commonly increased in the medial prefrontal cortex (mPFC), the infralimbic cortex (IL), the NAc-core, the NAc-shell, the hippocampus (CA1, CA2, and CA3 subregions), the amygdala, the ventral tegmental area (VTA), and the supramammillary nucleus (SuM) following memory reconsolidation, and Zif 268/Fos B co-expression was commonly observed (for Zif 268: 51-68%; for Fos B: 52-66%). Further, bilateral NAc-shell infusion of MK 801 and SCH 23390, but not raclopride or propranolol, prior to addictive memory reconsolidation, decreased Zif 268 and Fos B expression in the entire reward circuit, except for the amygdala, and effectively disturbed subsequent CPP-related behavior. In summary, N-methyl-d-aspartate (NMDA) and dopamine D1 receptors, but not dopamine D2 or β adrenergic receptors, within the NAc-shell, may regulate Zif 268 and Fos B expression in most brain nuclei of the reward circuit after cocaine memory reactivation. These findings indicated that the NAc played a key role in regulating addictive memory reconsolidation by influencing the function of the entire addictive memory network.
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Abstract
Since its successful application for the treatment of neurological disorders, deep brain stimulation (DBS) is currently also applied for the treatment of psychiatric disorders such as obsessive compulsive disorders or depression. DBS is being considered, or even applied, as a treatment for certain forms of addiction. We review here the cerebral structures aimed for such a strategy and discuss their respective positive and negative aspects.
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Affiliation(s)
- Yann Pelloux
- Équipe BAGAMORE (ganglions de la base, motivation et récompense), institut de neurosciences de la Timone, UMR7289 CNRS et Aix-Marseille université, campus santé Timone, 27, boulevard Jean Moulin, 13385 Marseille cedex 05, France
| | - Christelle Baunez
- Équipe BAGAMORE (ganglions de la base, motivation et récompense), institut de neurosciences de la Timone, UMR7289 CNRS et Aix-Marseille université, campus santé Timone, 27, boulevard Jean Moulin, 13385 Marseille cedex 05, France
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29
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Cleary DR, Ozpinar A, Raslan AM, Ko AL. Deep brain stimulation for psychiatric disorders: where we are now. Neurosurg Focus 2015; 38:E2. [DOI: 10.3171/2015.3.focus1546] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned.
Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry.
This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.
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Affiliation(s)
- Daniel R. Cleary
- 1Department of Neurology, Yale Medical School, New Haven, Connecticut
| | - Alp Ozpinar
- 2Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Ahmed M. Raslan
- 2Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Andrew L. Ko
- 3Department of Neurological Surgery, University of Washington, Seattle, Washington
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