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Zammit Dimech D, Zammit Dimech AA, Hughes M, Zrinzo L. A systematic review of deep brain stimulation for substance use disorders. Transl Psychiatry 2024; 14:361. [PMID: 39237552 PMCID: PMC11377568 DOI: 10.1038/s41398-024-03060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Pharmaco-psychiatric techniques remain the mainstay, first line treatments in substance use disorders (SUD), assisting in detoxification but largely ineffective at reducing dependence. The path to rehabilitation and freedom from addiction often proves uncertain and laborious for both patients and their significant others. Relapse rates for multiple substances of abuse are considerable and the number of SUD patients is on the increase worldwide. OBJECTIVE To assess efficacy of deep brain stimulation (DBS) as a therapeutic solution for SUDs. METHODS A systematic electronic database search of PubMed and EMBASE retrieved DBS addiction-focused studies on humans, of which a total of 26 (n = 71) from 2007 to 2023 were deemed eligible, including the first randomized controlled trial (RCT) in this field. This review was prospectively registered with PROSPERO: CRD42023411631. RESULTS In addressing SUDs, DBS targeting primarily the nucleus accumbens (NAcc), with or without the anterior limb of the internal capsule, presented encouraging levels of efficacy in reducing cravings and consumption, followed by remission in some subjects, but still reporting relapses in 73.2% of patients. CONCLUSIONS For treatment-refractory addictions DBS use seems limited to reducing cravings with a satisfactory degree of success, yet not clinically consistent in inducing abstinence, suggesting involvement of factors unaffected by DBS intervention. Furthermore, costs and the scale of the problem are such that DBS is unlikely to have a significant societal impact. Nevertheless, DBS may provide insight into the biology of addiction and is worthy of further research using increased methodological rigor, standardized outcome measures, and pre-established surgical protocols.
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Affiliation(s)
| | | | - Mark Hughes
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ludvic Zrinzo
- UCL Institute of Neurology, Functional Neurosurgery Unit, Department of Clinical & Motor Neurosciences, University College London, London, UK
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Sakai JT, Tanabe J, Battula S, Zipperly M, Mikulich-Gilbertson SK, Kern DS, Thompson JA, Raymond K, Gerecht PD, Foster K, Abosch A. Deep brain stimulation for the treatment of substance use disorders: a promising approach requiring caution. Front Psychiatry 2024; 15:1435109. [PMID: 39071229 PMCID: PMC11272460 DOI: 10.3389/fpsyt.2024.1435109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Substance use disorders are prevalent, causing extensive morbidity and mortality worldwide. Evidence-based treatments are of low to moderate effect size. Growth in the neurobiological understanding of addiction (e.g., craving) along with technological advancements in neuromodulation have enabled an evaluation of neurosurgical treatments for substance use disorders. Deep brain stimulation (DBS) involves surgical implantation of leads into brain targets and subcutaneous tunneling to connect the leads to a programmable implanted pulse generator (IPG) under the skin of the chest. DBS allows direct testing of neurobiologically-guided hypotheses regarding the etiology of substance use disorders in service of developing more effective treatments. Early studies, although with multiple limitations, have been promising. Still the authors express caution regarding implementation of DBS studies in this population and emphasize the importance of safeguards to ensure patient safety and meaningful study results. In this perspectives article, we review lessons learned through the years of planning an ongoing trial of DBS for methamphetamine use disorder.
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Affiliation(s)
- Joseph T. Sakai
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jody Tanabe
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Sharonya Battula
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
| | - Morgan Zipperly
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
| | | | - Drew S. Kern
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - John A. Thompson
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Kristen Raymond
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
| | - Pamela David Gerecht
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Katrina Foster
- National Institute on Drug Abuse, Bethesda, MD, United States
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, United States
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Allawala A, Bijanki KR, Oswalt D, Mathura RK, Adkinson J, Pirtle V, Shofty B, Robinson M, Harrison MT, Mathew SJ, Goodman WK, Pouratian N, Sheth SA, Borton DA. Prefrontal network engagement by deep brain stimulation in limbic hubs. Front Hum Neurosci 2024; 17:1291315. [PMID: 38283094 PMCID: PMC10813208 DOI: 10.3389/fnhum.2023.1291315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Prefrontal circuits in the human brain play an important role in cognitive and affective processing. Neuromodulation therapies delivered to certain key hubs within these circuits are being used with increasing frequency to treat a host of neuropsychiatric disorders. However, the detailed neurophysiological effects of stimulation to these hubs are largely unknown. Here, we performed intracranial recordings across prefrontal networks while delivering electrical stimulation to two well-established white matter hubs involved in cognitive regulation and depression: the subcallosal cingulate (SCC) and ventral capsule/ventral striatum (VC/VS). We demonstrate a shared frontotemporal circuit consisting of the ventromedial prefrontal cortex, amygdala, and lateral orbitofrontal cortex where gamma oscillations are differentially modulated by stimulation target. Additionally, we found participant-specific responses to stimulation in the dorsal anterior cingulate cortex and demonstrate the capacity for further tuning of neural activity using current-steered stimulation. Our findings indicate a potential neurophysiological mechanism for the dissociable therapeutic effects seen across the SCC and VC/VS targets for psychiatric neuromodulation and our results lay the groundwork for personalized, network-guided neurostimulation therapy.
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Affiliation(s)
- Anusha Allawala
- School of Engineering, Brown University, Providence, RI, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Kelly R. Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Denise Oswalt
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Raissa K. Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Joshua Adkinson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Victoria Pirtle
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ben Shofty
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States
| | - Meghan Robinson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Matthew T. Harrison
- Division of Applied Mathematics, Brown University, Providence, RI, United States
| | - Sanjay J. Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Wayne K. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - David A. Borton
- School of Engineering, Brown University, Providence, RI, United States
- Department of Veterans Affairs, Center for Neurorestoration and Neurotechnology, Providence, RI, United States
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Zammit Dimech D, Ranjan R. A protocol of a systematic review on deep brain stimulation surgery and its efficacy in addressing substance abuse addiction. Health Sci Rep 2023; 6:e1409. [PMID: 37431486 PMCID: PMC10329741 DOI: 10.1002/hsr2.1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/17/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023] Open
Abstract
Background Pharmacotherapy and psychotherapeutic approaches are still the mainstay first line of treatment for substance use disorder. However, the path to rehabilitation and cessation of dependence often proves uncertain and laborious, with risks of relapse being considerable despite exposure to current therapeutic modalities. For cases of treatment-refractory addiction, deep brain stimulation (DBS) interventions can prove a more effective long term therapeutic solution for the patient. Objectives The aim of the study will be to systematically assess whether attempts at correcting substance use disorder via DBS neurosurgical interventions have been successful in inducing remission or ameliorating relapse rates. Methods The current study will analyze available literature from database inception up to 15th April 2023, reviewing all publications documenting results achieved with human patients undergoing DBS for substance use disorder in PubMed, Ovid, Cochrane, and Web of Science. The electronic database search will exclude animal studies in the field and focus solely on the application of DBS for the purposes of addressing addiction disorders. Results The expectation is for a reduced number of trial results to have been reported, namely due to the relatively recent application of DBS to address severe addiction. Nonetheless, numbers should be in sufficient amount to inform about the efficacy of the intervention. Conclusion This study will attempt to demonstrate the viability of DBS as a solution for tackling treatment-refractory substance use disorder, proposing it as a valid therapeutic option that can deliver robust results and help combat an expanding societal plague that is drug dependence.
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Affiliation(s)
- David Zammit Dimech
- Department of Surgical SciencesSurgical Sciences Programme, University of EdinburghEdinburghUK
| | - Redoy Ranjan
- Department of Surgical SciencesSurgical Sciences Programme, University of EdinburghEdinburghUK
- Department of SurgeryFaculty of Surgery, Bangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
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Eskandari K, Fattahi M, Yazdanian H, Haghparast A. Is Deep Brain Stimulation an Effective Treatment for Psychostimulant Dependency? A Preclinical and Clinical Systematic Review. Neurochem Res 2022; 48:1255-1268. [PMID: 36445490 DOI: 10.1007/s11064-022-03818-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/30/2022]
Abstract
Addiction to psychostimulants significantly affects public health. Standard medical therapy is often not curative. Deep brain stimulation (DBS) is a promising treatment that has attracted much attention for addiction treatment in recent years. The present review aimed to systematically identify the positive and adverse effects of DBS in human and animal models to evaluate the feasibility of DBS as a treatment for psychostimulant abuse. The current study also examined the possible mechanisms underlying the therapeutic effects of DBS. In February 2022, a comprehensive search of four databases, including Web of Science, PubMed, Cochrane, and Scopus, was carried out to identify all reports that DBS was a treatment for psychostimulant addiction. The selected studies were extracted, summarized, and evaluated using the appropriate methodological quality assessment tools. The results indicated that DBS could reduce relapse and the desire for the drug in human and animal subjects without any severe side effects. The underlying mechanisms of DBS are complex and likely vary from region to region in terms of stimulation parameters and patterns. DBS seems a promising therapeutic option. However, clinical experiences are currently limited to several uncontrolled case reports. Further studies with controlled, double-blind designs are needed. In addition, more research on animals and humans is required to investigate the precise role of DBS and its mechanisms to achieve optimal stimulation parameters and develop new, less invasive methods.
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Yuen J, Kouzani AZ, Berk M, Tye SJ, Rusheen AE, Blaha CD, Bennet KE, Lee KH, Shin H, Kim JH, Oh Y. Deep Brain Stimulation for Addictive Disorders-Where Are We Now? Neurotherapeutics 2022; 19:1193-1215. [PMID: 35411483 PMCID: PMC9587163 DOI: 10.1007/s13311-022-01229-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 10/18/2022] Open
Abstract
In the face of a global epidemic of drug addiction, neglecting to develop new effective therapies will perpetuate the staggering human and economic costs of substance use. This review aims to summarize and evaluate the preclinical and clinical studies of deep brain stimulation (DBS) as a novel therapy for refractory addiction, in hopes to engage and inform future research in this promising novel treatment avenue. An electronic database search (MEDLINE, EMBASE, Cochrane library) was performed using keywords and predefined inclusion criteria between 1974 and 6/18/2021 (registered on Open Science Registry). Selected articles were reviewed in full text and key details were summarized and analyzed to understand DBS' therapeutic potential and possible mechanisms of action. The search yielded 25 animal and 22 human studies. Animal studies showed that DBS of targets such as nucleus accumbens (NAc), insula, and subthalamic nucleus reduces drug use and seeking. All human studies were case series/reports (level 4/5 evidence), mostly targeting the NAc with generally positive outcomes. From the limited evidence in the literature, DBS, particularly of the NAc, appears to be a reasonable last resort option for refractory addictive disorders. We propose that future research in objective electrophysiological (e.g., local field potentials) and neurochemical (e.g., extracellular dopamine levels) biomarkers would assist monitoring the progress of treatment and developing a closed-loop DBS system. Preclinical literature also highlighted the prefrontal cortex as a promising DBS target, which should be explored in human research.
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Affiliation(s)
- Jason Yuen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong VIC 3216, Australia
| | - Abbas Z Kouzani
- School of Engineering, Deakin University, Geelong VIC 3216, Australia
| | - Michael Berk
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong VIC 3216, Australia
| | - Susannah J Tye
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, 4072, Australia
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, 55455, USA
- Department of Psychiatry, Emory University, Atlanta, GA, 30322, USA
| | - Aaron E Rusheen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Charles D Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kevin E Bennet
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
- Division of Engineering, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, USA
| | - Hojin Shin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jee Hyun Kim
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong VIC 3216, Australia.
| | - Yoonbae Oh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, USA.
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Mahoney JJ, Koch-Gallup N, Scarisbrick DM, Berry JH, Rezai AR. Deep brain stimulation for psychiatric disorders and behavioral/cognitive-related indications: Review of the literature and implications for treatment. J Neurol Sci 2022; 437:120253. [DOI: 10.1016/j.jns.2022.120253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/23/2022] [Accepted: 04/03/2022] [Indexed: 11/15/2022]
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Dezachyo O, Kozak S, Bar-Haim Y, Censor N, Dayan E. Intrinsic Functional Connectivity of the Anterior Cingulate Cortex Is Associated with Tolerance to Distress. eNeuro 2021; 8:ENEURO.0277-21.2021. [PMID: 34593518 PMCID: PMC8577043 DOI: 10.1523/eneuro.0277-21.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
The ability to adapt under significant adversity, defined as psychological resilience, is instrumental in preventing stress-related disorders. An important aspect of resilience is the capacity to endure affective distress when in pursuit of goals, also known as distress tolerance. Evidence that links intrinsic baseline interactions within large-scale functional networks with performance under distress remains missing. We hypothesized that the anterior cingulate cortex (ACC) may engage in distress tolerance because of its involvement in attention and emotion regulation. Accordingly, we tested whether behavioral performance under distress is associated with baseline resting-state ACC functional connectivity (FC). Distress tolerance was measured in 97 participants using the behavioral indicator of resiliency to distress (BIRD) task. Analyses contrasted participants who quit the task before its designated termination (n = 51) with those who persisted throughout it (n = 46). Seed-based FC analysis indicated greater connectivity between the ACC and dorsolateral prefrontal cortex (DLPFC) in subjects who persisted throughout the task, along with greater FC between the ACC and the precentral gyrus in those who quit before its termination. The results shed light on the mechanisms underlying interindividual differences in the ability to handle distress.
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Affiliation(s)
- Or Dezachyo
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Stas Kozak
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nitzan Censor
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eran Dayan
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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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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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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11
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Role of the nucleus accumbens in functional recovery from spinal cord injury. Neurosci Res 2021; 172:1-6. [PMID: 33895202 DOI: 10.1016/j.neures.2021.04.006] [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: 10/28/2020] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 11/21/2022]
Abstract
Post brain damage depression impedes functional recovery. On the other hand, higher motivation facilitates functional recovery after damage to the central nervous system, but the neural mechanism of psychological effects on functional recovery is unclear. The nucleus accumbens (NAcc), a motivation center, has not been considered directly involved in motor function. Recently, it was demonstrated that the NAcc makes a direct contribution to motor performance after spinal cord injury by facilitating motor cortex activity. In this perspective, we first summarize our investigation of role of NAcc in motor control during the recovery course after spinal cord injury, followed by a discussion of the current knowledge regarding the relationship between the recovery and NAcc after neuronal damage.
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12
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Alternatives to Pharmacological and Psychotherapeutic Treatments in Psychiatric Disorders. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Nowadays, most of the patients affected by psychiatric disorders are successfully treated with psychotherapy and pharmacotherapy. Nevertheless, according to the disease, a variable percentage of patients results resistant to such modalities, and alternative methods can then be considered. The purpose of this review is to summarize the techniques and results of invasive modalities for several treatment-resistant psychiatric diseases. A literature search was performed to provide an up-to-date review of advantages, disadvantages, efficacy, and complications of Deep-Brain Stimulation, Magnetic Resonance-guided Focused-Ultrasound, radiofrequency, and radiotherapy lesioning for depression, obsessive-compulsive disorder, schizophrenia, addiction, anorexia nervosa, and Tourette’s syndrome. The literature search did not strictly follow the criteria for a systematic review: due to the large differences in methodologies and patients’ cohort, we tried to identify the highest quality of available evidence for each technique. We present the data as a comprehensive, narrative review about the role, indication, safety, and results of the contemporary instrumental techniques that opened new therapeutic fields for selected patients unresponsive to psychotherapy and pharmacotherapy.
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Vannemreddy P, Slavin K. Nucleus Accumbens as a Novel Target for Deep Brain Stimulation in the Treatment of Addiction: A Hypothesis on the Neurochemical and Morphological Basis. Neurol India 2020; 67:1220-1224. [PMID: 31744946 DOI: 10.4103/0028-3886.271239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Addiction is a major cause of mortality and morbidity. Apart from psychotropic substances, alcohol and nicotine remain the common addictive materials responsible for the majority of deaths. Conventional conservative therapies are beneficial to certain populations, but the majority may require interventional treatments such as deep brain stimulation (DBS) in view of increasing mortality from drug abuse in recent years. We present a brief review on a novel neuromodulation target of the nucleus accumbens (NA) and its promising role in the management of addiction. The three stages of the addiction cycle are known to be mediated by dopaminergic pathways located in the mesolimbic dopamine system with connections to dorsal striatum, extended amygdala, cingulate gyrus, orbitofrontal cortex, prefrontal cortex, and ventral tegmental area. Recent advanced neuroimaging in humans and several animal studies demonstrated NA to be a vital anatomical area modulating this network. DBS of NA in animals reduced addictive behavior to alcohol, cocaine, and other narcotics significantly. The accidental observation that DBS of NA for psychiatric illnesses induced relief from addiction to alcohol and smoking has encouraged further research of late. Bilateral NA ablative surgery had shown nonrelapse in more than 50% of cases. Small series of patients have benefited so far from DBS of NA, but larger numbers are required to provide evidence-based treatment. The modulation of dopaminergic pathways through DBS of NA as a valid treatment for addiction is substantiated extensively by animal studies and also in a few clinical studies. However, this needs to be validated by a well-structured, multicenter controlled study in a large group of patients suffering from substance abuse.
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Affiliation(s)
- Prasad Vannemreddy
- Department of Neurosurgery, University of Illinois at Chicago, Chicago,IL, USA
| | - Konstantin Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago,IL, USA
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14
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Wang TR, Moosa S, Dallapiazza RF, Elias WJ, Lynch WJ. Deep brain stimulation for the treatment of drug addiction. Neurosurg Focus 2019; 45:E11. [PMID: 30064320 DOI: 10.3171/2018.5.focus18163] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Drug addiction represents a significant public health concern that has high rates of relapse despite optimal medical therapy and rehabilitation support. New therapies are needed, and deep brain stimulation (DBS) may be an effective treatment. The past 15 years have seen numerous animal DBS studies for addiction to various drugs of abuse, with most reporting decreases in drug-seeking behavior with stimulation. The most common target for stimulation has been the nucleus accumbens, a key structure in the mesolimbic reward pathway. In addiction, the mesolimbic reward pathway undergoes a series of neuroplastic changes. Chief among them is a relative hypofunctioning of the prefrontal cortex, which is thought to lead to the diminished impulse control that is characteristic of drug addiction. The prefrontal cortex, as well as other targets involved in drug addiction such as the lateral habenula, hypothalamus, insula, and subthalamic nucleus have also been stimulated in animals, with encouraging results. Although animal studies have largely shown promising results, current DBS studies for drug addiction primarily use stimulation during active drug use. More data are needed on the effect of DBS during withdrawal in preventing future relapse. The published human experience for DBS for drug addiction is currently limited to several promising case series or case reports that are not controlled. Further animal and human work is needed to determine what role DBS can play in the treatment of drug addiction.
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Affiliation(s)
- Tony R Wang
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Shayan Moosa
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert F Dallapiazza
- 2Division of Neurosurgery, Toronto Western Hospital University Health Network, Toronto, Ontario, Canada; and
| | - W Jeffrey Elias
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Wendy J Lynch
- 3Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia
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15
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Tsai ST, Liew HK, Li HM, Lin SZ, Chen SY. Harnessing Neurogenesis and Neuroplasticity with Stem Cell Treatment for Addictive Disorders. Cell Transplant 2019; 28:1127-1131. [PMID: 31271057 PMCID: PMC6767895 DOI: 10.1177/0963689719859299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Drug and alcohol addiction has become an emerging public health issue and is a great
burden to patients, their families, and society. It is characterized by high relapse rates
and significant morbidity and mortality, and most available treatments result in only
modest improvement. These findings highlight the necessity for new approaches to treat
addiction. Scientific reports in the past two decades suggest that addiction involves
impaired neural plasticity and decreased hippocampal neurogenesis. Stem cell therapy and
its derived neurotrophic factors can potentially target the underlying pathophysiology of
addiction. Stem cell applications are showing promise in several preclinical studies and
may provide new and noninvasive treatment strategies. Future clinical research is
warranted to investigate whether stem cell-based therapy could support the treatment of
addiction.
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Affiliation(s)
- Sheng-Tzung Tsai
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien.,Institute of Medical Sciences, Tzu Chi University, Hualien.,*Sheng-Tzung Tsai and Hock-Kean Liew contributed equally to this review
| | - Hock-Kean Liew
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien.,*Sheng-Tzung Tsai and Hock-Kean Liew contributed equally to this review
| | - Hao-Ming Li
- Department of Psychiatry, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien
| | - Shinn-Zong Lin
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien.,Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien
| | - Shin-Yuan Chen
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien.,Institute of Medical Sciences, Tzu Chi University, Hualien
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16
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Fattahi M, Ashabi G, Karimian SM, Riahi E. Preventing morphine reinforcement with high-frequency deep brain stimulation of the lateral hypothalamic area. Addict Biol 2019; 24:685-695. [PMID: 29737638 DOI: 10.1111/adb.12634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/03/2018] [Accepted: 04/17/2018] [Indexed: 12/31/2022]
Abstract
Deep brain stimulation (DBS) has been proposed as a promising intervention for patients with treatment-refractory substance use disorder. Here, we investigated if high-frequency DBS in the lateral hypothalamic area (LHA) could affect drug-induced reinforcement. Rats were bilaterally implanted with bipolar stimulation electrodes in the LHA and trained to the morphine conditioned place preference. DBS (monophasic square pulses, 130 Hz, 100-microsecond pulse duration and 150 μA) was applied during the morphine-pairing trials (30 minutes daily for 4 days) or drug-free postconditioning test (15 minutes) to determine its effect on the acquisition or expression of morphine reward, respectively. LHA DBS during morphine-conditioning trials blocked subsequent preference for the drug-associated context. In contrast, DBS in the postconditioning phase failed to inhibit expression of morphine-induced conditioned place preference. These results were further controlled by ruling out significant changes by DBS in physical performance and anxiety-like behavior as measured by an open field test and by precluding anhedonia-like behavior as measured by sucrose consumption test. Our results suggest that LHA DBS can prevent development of morphine reward without diminishing the motivation for naturally rewarding stimuli. Therefore, the LHA could be a potential target for research in the field of DBS-based treatment of intractable substance use disorder. Further studies will be necessary to assess the translatability of these findings to the clinic.
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Affiliation(s)
- Mojdeh Fattahi
- Department of Physiology, School of MedicineTehran University of Medical Sciences Tehran Iran
| | - Ghorbangol Ashabi
- Department of Physiology, School of MedicineTehran University of Medical Sciences Tehran Iran
| | - Seyed Morteza Karimian
- Department of Physiology, School of MedicineTehran University of Medical Sciences Tehran Iran
| | - Esmail Riahi
- Department of Physiology, School of MedicineTehran University of Medical Sciences Tehran Iran
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17
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Kluger BM, Zhao Q, Tanner JJ, Schwab NA, Levy SA, Burke SE, Huang H, Ding M, Price C. Structural brain correlates of fatigue in older adults with and without Parkinson's disease. NEUROIMAGE-CLINICAL 2019; 22:101730. [PMID: 30818269 PMCID: PMC6396012 DOI: 10.1016/j.nicl.2019.101730] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/24/2019] [Accepted: 02/20/2019] [Indexed: 12/16/2022]
Abstract
Fatigue is one of the most common and disabling nonmotor symptoms seen in Parkinson's disease (PD) and is also commonly seen in healthy older adults. Our understanding of the etiology of fatigue in older adults with or without PD is limited and it remains unclear whether fatigue in PD is specifically related to PD pathology. The objective of this study was thus to determine whether fatigue in PD was associated with structural changes in gray or white matter and explore whether these changes were similar in older adults without PD. Magnetic resonance imaging (T1 weighted) and diffusion tensor imaging were performed in 60 patients with PD (17 females; age = 67.58 ± 5.51; disease duration = 5.67 ± 5.83 years) and 41 age- and sex- matched healthy controls. FSL image processing was used to measure gray matter volume, fractional anisotropy, and leukoariosis differences. Voxel-based morphometry confirmed gray matter loss across the dorsal striatum and insula in the PD patient cohort. PD patients with fatigue had reduced gray matter volume in dorsal striatum relative to PD patients without fatigue (P < 0.05 False Discovery Rate corrected). No significant fatigue-related structural atrophy was found in controls. There were no areas of significant fractional anisotropy differences between high and low fatigue subjects in either the PD or non-PD groups. Control participants with high fatigue, but not PD, showed significantly greater total leukoariosis volumes (p = 0.03). Fatigue in PD is associated with unique structural changes in the caudate and putamen suggesting fatigue in PD is primarily related to PD pathology, particularly in the dorsal striatum, and not simply a consequence of aging. Fatigue is a disabling symptom in Parkinson's disease (PD) and healthy older adults. We studied structural correlates of fatigue using MRI morphometry. PD patients with high fatigue had caudate atrophy. Healthy older adults with fatigue had increased burden of leukoariosis. Patterns of structural brain changes were distinct between PD and healthy group.
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Affiliation(s)
- Benzi M Kluger
- Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Qing Zhao
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Jared J Tanner
- Clinical and Health Psychology, Center for Movement Disorders and Neurorestoration, Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Nadine A Schwab
- Clinical and Health Psychology, Center for Movement Disorders and Neurorestoration, Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Shellie-Anne Levy
- Clinical and Health Psychology, Center for Movement Disorders and Neurorestoration, Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Sarah E Burke
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Haiqing Huang
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Mingzhou Ding
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Catherine Price
- Clinical and Health Psychology, Center for Movement Disorders and Neurorestoration, Anesthesiology, University of Florida, Gainesville, FL, USA.
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18
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Deep Brain Stimulation of Nucleus Accumbens for Methamphetamine Addiction: Two Case Reports. World Neurosurg 2019; 122:512-517. [DOI: 10.1016/j.wneu.2018.11.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 01/06/2023]
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19
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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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20
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Casquero-Veiga M, García-García D, Pascau J, Desco M, Soto-Montenegro ML. Stimulating the nucleus accumbens in obesity: A positron emission tomography study after deep brain stimulation in a rodent model. PLoS One 2018; 13:e0204740. [PMID: 30261068 PMCID: PMC6160153 DOI: 10.1371/journal.pone.0204740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/13/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The nucleus accumbens (NAcc) has been suggested as a possible target for deep brain stimulation (DBS) in the treatment of obesity. Our hypothesis was that NAcc-DBS would modulate brain regions related to reward and food intake regulation, consequently reducing the food intake and, finally, the weight gain. Therefore, we examined changes in brain glucose metabolism, weight gain and food intake after NAcc-DBS in a rat model of obesity. PROCEDURES Electrodes were bilaterally implanted in 2 groups of obese Zucker rats targeting the NAcc. One group received stimulation one hour daily during 15 days, while the other remained as control. Weight and daily consumption of food and water were everyday registered the days of stimulation, and twice per week during the following month. Positron emission tomography (PET) studies with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) were performed 1 day after the end of DBS. PET data was assessed by statistical parametric mapping (SPM12) software and region of interest (ROI) analyses. RESULTS NAcc-DBS lead to increased metabolism in the cingulate-retrosplenial-parietal association cortices, and decreased metabolism in the NAcc, thalamic and pretectal nuclei. Furthermore, ROIs analyses confirmed these results by showing a significant striatal and thalamic hypometabolism, and a cortical hypermetabolic region. However, NAcc-DBS did not induce a decrease in either weight gain or food intake. CONCLUSIONS NAcc-DBS led to changes in the metabolism of regions associated with cognitive and reward systems, whose impairment has been described in obesity.
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Affiliation(s)
| | | | - Javier Pascau
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés, Spain
| | - Manuel Desco
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - María Luisa Soto-Montenegro
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid, Spain
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21
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Ho AL, Salib AMN, Pendharkar AV, Sussman ES, Giardino WJ, Halpern CH. The nucleus accumbens and alcoholism: a target for deep brain stimulation. Neurosurg Focus 2018; 45:E12. [DOI: 10.3171/2018.5.focus18157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Alcohol use disorder (AUD) is a difficult to treat condition with a significant global public health and cost burden. The nucleus accumbens (NAc) has been implicated in AUD and identified as an ideal target for deep brain stimulation (DBS). There are promising preclinical animal studies of DBS for alcohol consumption as well as some initial human clinical studies that have shown some promise at reducing alcohol-related cravings and, in some instances, achieving long-term abstinence. In this review, the authors discuss the evidence and concepts supporting the role of the NAc in AUD, summarize the findings from published NAc DBS studies in animal models and humans, and consider the challenges and propose future directions for neuromodulation of the NAc for the treatment of AUD.
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Affiliation(s)
| | - Anne-Mary N. Salib
- Departments of 1Neurosurgery and
- 2Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | | | - William J. Giardino
- 2Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Casey H. Halpern
- Departments of 1Neurosurgery and
- 2Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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22
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Taghipour M, Derakhshan N, Saffarian A, Eghbal K, Yazdanpanah H. Deep Brain Stimulation of Nucleus Accumbens: High Hopes for Simulating Orgasm in Spinal Cord Injury Patients. World Neurosurg 2018; 116:492-493. [PMID: 30049042 DOI: 10.1016/j.wneu.2018.05.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Mousa Taghipour
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Derakhshan
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Arash Saffarian
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Yazdanpanah
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
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23
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Neuromodulatory Treatments for Alcohol Use Disorder: A Review. Brain Sci 2018; 8:brainsci8060095. [PMID: 29843426 PMCID: PMC6025548 DOI: 10.3390/brainsci8060095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/15/2018] [Accepted: 05/21/2018] [Indexed: 11/18/2022] Open
Abstract
Alcohol use disorder (AUD) is a prevalent condition characterized by chronic alcohol-seeking behaviors and has become a significant economic burden with global ramifications on public health. While numerous treatment options are available for AUD, many are unable to sustain long-term sobriety. The nucleus accumbens (NAcc) upholds an integral role in mediating reward behavior and has been implicated as a potential target for deep brain stimulation (DBS) in the context of AUD. DBS is empirically thought to disrupt pathological neuronal synchrony, a hallmark of binge behavior. Pre-clinical animal models and pilot human clinical studies utilizing DBS for the treatment of AUD have shown promise for reducing alcohol-related cravings and prolonging abstinence. In this review, we outline the various interventions available for AUD, and the translational potential DBS has to modulate functionality of the NAcc as a treatment for AUD.
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24
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Rivas-Grajales AM, Sawyer KS, Karmacharya S, Papadimitriou G, Camprodon JA, Harris GJ, Kubicki M, Oscar-Berman M, Makris N. Sexually dimorphic structural abnormalities in major connections of the medial forebrain bundle in alcoholism. Neuroimage Clin 2018; 19:98-105. [PMID: 30035007 PMCID: PMC6051309 DOI: 10.1016/j.nicl.2018.03.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 01/24/2018] [Accepted: 03/21/2018] [Indexed: 12/22/2022]
Abstract
Background The mesocorticolimbic system is particularly susceptible to the effects of chronic alcoholism. Disruption of this system has been linked to drug seeking and the development of Reward Deficiency Syndrome, a neurobiological framework for describing the development and relapsing patterns of addictions. In this study, we evaluated the association of alcoholism and sex with major connections of the medial forebrain bundle (MFB), a prominent mesocorticolimbic fiber pathway connecting the ventral tegmental area with the basal forebrain. Given sex differences in clinical consequences of alcohol consumption, we hypothesized that alcoholic men and women would differ in structural abnormalities of the MFB. Methods Diffusion magnetic resonance imaging (dMRI) data were acquired from 30 abstinent long-term alcoholic individuals (ALC; 9 men) and 25 non-alcoholic controls (NC; 8 men). Major connections of the MFB were extracted using multi-tensor tractography. We compared groups on MFB volume, fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD), with hemisphere and sex as independent variables. We also evaluated associations between abnormal structural measures and drinking measures. Results Analyses revealed significant group-by-sex interactions for FA and RD: while ALC men had lower FA and higher RD compared to NC men, ALC women had higher FA and lower RD compared to NC women. We also detected a significant negative association between FA and number of daily drinks in ALC women. Conclusion Alcoholism is associated with sexually dimorphic structural abnormalities in the MFB. The results expand upon other findings of differences in brain reward circuitry of alcoholic men and women.
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Affiliation(s)
- Ana María Rivas-Grajales
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Kayle S Sawyer
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Sawyer Scientific, LLC, Boston, MA, USA
| | - Sarina Karmacharya
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George Papadimitriou
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Center for Morphometric Analysis, Massachusetts General Hospital, Boston, MA, USA
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Gordon J Harris
- Center for Morphometric Analysis, Massachusetts General Hospital, Boston, MA, USA; Radiology Computer Aided Diagnostics Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Marek Kubicki
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Center for Morphometric Analysis, Massachusetts General Hospital, Boston, MA, USA
| | - Marlene Oscar-Berman
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Nikos Makris
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA; Center for Morphometric Analysis, Massachusetts General Hospital, Boston, MA, USA.
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25
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Coles AS, Kozak K, George TP. A review of brain stimulation methods to treat substance use disorders. Am J Addict 2018; 27:71-91. [PMID: 29457674 DOI: 10.1111/ajad.12674] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/26/2017] [Accepted: 12/16/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) are a leading cause of disability worldwide. While several pharmacological and behavioral treatments for SUDs are available, these may not be effective for all patients. Recent studies using non-invasive neuromodulation techniques including Repetitive Transcranial Magnetic Stimulation (rTMS), Transcranial Direct Current Stimulation (tDCS), and Deep Brain Stimulation (DBS) have shown promise for SUD treatment. OBJECTIVE Multiple studies were evaluated investigating the therapeutic potential of non-invasive brain stimulation techniques in treatment of SUDs. METHOD Through literature searches (eg, PubMed, Google Scholar), 60 studies (2000-2017) were identified examining the effect of rTMS, tDCS, or DBS on cravings and consumption of SUDs, including tobacco, alcohol, cannabis, opioids, and stimulants. RESULTS rTMS and tDCS demonstrated decreases in drug craving and consumption, while early studies with DBS suggest similar results. Results are most encouraging when stimulation is targeted to the Dorsolateral Prefrontal Cortex (DLPFC). CONCLUSIONS Short-term treatment with rTMS and tDCS may have beneficial effects on drug craving and consumption. Future studies should focus on extending therapeutic benefits by increasing stimulation frequency and duration of treatment. SCIENTIFIC SIGNIFICANCE The utility of these methods in SUD treatment and prevention are unclear, and warrants further study using randomized, controlled designs. (Am J Addict 2018;27:71-91).
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Affiliation(s)
- Alexandria S Coles
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karolina Kozak
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada
| | - Tony P George
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada.,Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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26
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Schippers MC, Bruinsma B, Gaastra M, Mesman TI, Denys D, De Vries TJ, Pattij T. Deep Brain Stimulation of the Nucleus Accumbens Core Affects Trait Impulsivity in a Baseline-Dependent Manner. Front Behav Neurosci 2017; 11:52. [PMID: 28386221 PMCID: PMC5362621 DOI: 10.3389/fnbeh.2017.00052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/07/2017] [Indexed: 12/29/2022] Open
Abstract
Deep brain stimulation (DBS) of the nucleus accumbens (NA) is explored as a treatment for refractory psychiatric disorders, such as obsessive-compulsive disorder (OCD), depressive disorder (MDD), and substance use disorder (SUD). A common feature of some of these disorders is pathological impulsivity. Here, the effects of NAcore DBS on impulsive choice and impulsive action, two distinct forms of impulsive behavior, were investigated in translational animal tasks, the delayed reward task (DRT) and five-choice serial reaction time task (5-CSRTT), respectively. In both tasks, the effects of NAcore DBS were negatively correlated with baseline impulsive behavior, with more pronounced effects in the 5-CSRTT. To further examine the effects of DBS on trait impulsive action, rats were screened for high (HI) and low (LI) impulsive responding in the 5-CSRTT. NAcore DBS decreased impulsive, premature responding in HI rats under conventional conditions. However, upon challenged conditions to increase impulsive responding, NAcore DBS did not alter impulsivity. These results strongly suggest a baseline-dependent effect of DBS on impulsivity, which is in line with clinical observations.
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Affiliation(s)
- Maria C Schippers
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
| | - Bastiaan Bruinsma
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
| | - Mathijs Gaastra
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
| | - Tanja I Mesman
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
| | - Damiaan Denys
- Amsterdam Neuroscience, Department of Psychiatry, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands
| | - Taco J De Vries
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
| | - Tommy Pattij
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
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27
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Salling MC, Martinez D. Brain Stimulation in Addiction. Neuropsychopharmacology 2016; 41:2798-2809. [PMID: 27240657 PMCID: PMC5061891 DOI: 10.1038/npp.2016.80] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/13/2016] [Accepted: 05/20/2016] [Indexed: 12/12/2022]
Abstract
Localized stimulation of the human brain to treat neuropsychiatric disorders has been in place for over 20 years. Although these methods have been used to a greater extent for mood and movement disorders, recent work has explored brain stimulation methods as potential treatments for addiction. The rationale behind stimulation therapy in addiction involves reestablishing normal brain function in target regions in an effort to dampen addictive behaviors. In this review, we present the rationale and studies investigating brain stimulation in addiction, including transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation. Overall, these studies indicate that brain stimulation has an acute effect on craving for drugs and alcohol, but few studies have investigated the effect of brain stimulation on actual drug and alcohol use or relapse. Stimulation therapies may achieve their effect through direct or indirect modulation of brain regions involved in addiction, either acutely or through plastic changes in neuronal transmission. Although these mechanisms are not well understood, further identification of the underlying neurobiology of addiction and rigorous evaluation of brain stimulation methods has the potential for unlocking an effective, long-term treatment of addiction.
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Affiliation(s)
- Michael C Salling
- Department of Anesthesiology, Columbia University, New York, NY, USA,Department of Anesthesiology, Columbia University, 630 West 168th Street, New York, NY 10032, USA, Tel: +1 212 305 0944, E-mail:
| | - Diana Martinez
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
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28
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Ross SE, Lehmann Levin E, Itoga CA, Schoen CB, Selmane R, Aldridge JW. Deep brain stimulation in the central nucleus of the amygdala decreases 'wanting' and 'liking' of food rewards. Eur J Neurosci 2016; 44:2431-2445. [PMID: 27422085 DOI: 10.1111/ejn.13342] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 11/28/2022]
Abstract
We investigated the potential of deep brain stimulation (DBS) in the central nucleus of the amygdala (CeA) in rats to modulate functional reward mechanisms. The CeA is the major output of the amygdala with direct connections to the hypothalamus and gustatory brainstem, and indirect connections with the nucleus accumbens. Further, the CeA has been shown to be involved in learning, emotional integration, reward processing, and regulation of feeding. We hypothesized that DBS, which is used to treat movement disorders and other brain dysfunctions, might block reward motivation. In rats performing a lever-pressing task to obtain sugar pellet rewards, we stimulated the CeA and control structures, and compared stimulation parameters. During CeA stimulation, animals stopped working for rewards and rejected freely available rewards. Taste reactivity testing during DBS exposed aversive reactions to normally liked sucrose tastes and even more aversive taste reactions to normally disliked quinine tastes. Interestingly, given the opportunity, animals implanted in the CeA would self-stimulate with 500 ms trains of stimulation at the same frequency and current parameters as continuous stimulation that would stop reward acquisition. Neural recordings during DBS showed that CeA neurons were still active and uncovered inhibitory-excitatory patterns after each stimulus pulse indicating possible entrainment of the neural firing with DBS. In summary, DBS modulation of CeA may effectively usurp normal neural activity patterns to create an 'information lesion' that not only decreased motivational 'wanting' of food rewards, but also blocked 'liking' of rewards.
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Affiliation(s)
- Shani E Ross
- Biomedical Engineering Department, Ann Arbor, MI, USA
| | | | | | - Chelsea B Schoen
- Department of Psychology, 530 Church Street, Ann Arbor, MI, 48109-1043, USA
| | - Romeissa Selmane
- Department of Psychology, 530 Church Street, Ann Arbor, MI, 48109-1043, USA.,Department of Biology, University of Michigan, Ann Arbor, MI, USA
| | - J Wayne Aldridge
- Department of Neurosurgery, Ann Arbor, MI, USA. .,Department of Psychology, 530 Church Street, Ann Arbor, MI, 48109-1043, USA.
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29
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Kang D, Liu Y, Miskovic V, Keil A, Ding M. Large-scale functional brain connectivity during emotional engagement as revealed by beta-series correlation analysis. Psychophysiology 2016; 53:1627-1638. [PMID: 27453345 DOI: 10.1111/psyp.12731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/22/2016] [Indexed: 12/23/2022]
Abstract
It has been hypothesized that the medial prefrontal cortex (mPFC) is a hub in the network that mediates appetitive responses whereas the amygdala is thought to mediate both aversive and appetitive processing. Both structures may facilitate adaptive responses to emotional challenge by linking perception, attention, memory, and motor circuits. We provide an initial exploration of these hypotheses by recording simultaneous EEG-fMRI in eleven participants viewing affective pictures. MPFC- and amygdala-seeded functional connectivity maps were generated by applying the beta-series correlation method. The mPFC-seeded correlation map encompassed visual regions, sensorimotor areas, prefrontal cortex, and medial temporal lobe structures, exclusively for pleasant content. For the amygdala-seeded correlation map, a similar set of distributed brain areas appeared in the unpleasant-neutral contrast, with the addition of structures such as the insula and thalamus. A substantially sparser network was recruited for the pleasant-neutral contrast. Using the late positive potential (LPP) to index the intensity of emotional engagement, functional connectivity was found to be stronger in trials with larger LPP. These results demonstrate that mPFC-mediated functional interactions are engaged specifically during appetitive processing, whereas the amygdala is coupled to distinct sets of brain regions during both aversive and appetitive processing. The strength of these interactions varies as a function of the intensity of emotional engagement.
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Affiliation(s)
- Daesung Kang
- The J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Yuelu Liu
- The J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Vladimir Miskovic
- Department of Psychology and Center for Affective Science, State University of New York at Binghamton, Binghamton, New York, USA
| | - Andreas Keil
- Department of Psychology and Center for the Study of Emotion and Attention, University of Florida, Gainesville, Florida, USA.
| | - Mingzhou Ding
- The J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA.
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30
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Hadar R, Vengeliene V, Barroeta Hlusicke E, Canals S, Noori HR, Wieske F, Rummel J, Harnack D, Heinz A, Spanagel R, Winter C. Paradoxical augmented relapse in alcohol-dependent rats during deep-brain stimulation in the nucleus accumbens. Transl Psychiatry 2016; 6:e840. [PMID: 27327255 PMCID: PMC4931598 DOI: 10.1038/tp.2016.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/14/2016] [Accepted: 04/20/2016] [Indexed: 12/24/2022] Open
Abstract
Case reports indicate that deep-brain stimulation in the nucleus accumbens may be beneficial to alcohol-dependent patients. The lack of clinical trials and our limited knowledge of deep-brain stimulation call for translational experiments to validate these reports. To mimic the human situation, we used a chronic-continuous brain-stimulation paradigm targeting the nucleus accumbens and other brain sites in alcohol-dependent rats. To determine the network effects of deep-brain stimulation in alcohol-dependent rats, we combined electrical stimulation of the nucleus accumbens with functional magnetic resonance imaging (fMRI), and studied neurotransmitter levels in nucleus accumbens-stimulated versus sham-stimulated rats. Surprisingly, we report here that electrical stimulation of the nucleus accumbens led to augmented relapse behavior in alcohol-dependent rats. Our associated fMRI data revealed some activated areas, including the medial prefrontal cortex and caudate putamen. However, when we applied stimulation to these areas, relapse behavior was not affected, confirming that the nucleus accumbens is critical for generating this paradoxical effect. Neurochemical analysis of the major activated brain sites of the network revealed that the effect of stimulation may depend on accumbal dopamine levels. This was supported by the finding that brain-stimulation-treated rats exhibited augmented alcohol-induced dopamine release compared with sham-stimulated animals. Our data suggest that deep-brain stimulation in the nucleus accumbens enhances alcohol-liking probably via augmented dopamine release and can thereby promote relapse.
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Affiliation(s)
- R Hadar
- Department of Psychiatry and Psychotherapy, University Hospital Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - V Vengeliene
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - E Barroeta Hlusicke
- Department of Psychiatry and Psychotherapy, University Hospital Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - S Canals
- Cellular and Systems Neurobiology Unit, Instituto de Neurociencias, Consejo Superior de Investigaciones Científicas and Universidad Miguel Hernández, Sant Joan d'Alacant, Spain
| | - H R Noori
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - F Wieske
- Department of Psychiatry and Psychotherapy, University Hospital Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J Rummel
- Department of Psychiatry and Psychotherapy, University Hospital Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - D Harnack
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - R Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Winter
- Department of Psychiatry and Psychotherapy, University Hospital Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany,Department of Psychiatry and Psychotherapy, University Hospital Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany. E-mail:
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31
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Batra V, Guerin GF, Goeders NE, Wilden JA. A General Method for Evaluating Deep Brain Stimulation Effects on Intravenous Methamphetamine Self-Administration. J Vis Exp 2016:e53266. [PMID: 26863392 PMCID: PMC4781683 DOI: 10.3791/53266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Substance use disorders, particularly to methamphetamine, are devastating, relapsing diseases that disproportionally affect young people. There is a need for novel, effective and practical treatment strategies that are validated in animal models. Neuromodulation, including deep brain stimulation (DBS) therapy, refers to the use of electricity to influence pathological neuronal activity and has shown promise for psychiatric disorders, including drug dependence. DBS in clinical practice involves the continuous delivery of stimulation into brain structures using an implantable pacemaker-like system that is programmed externally by a physician to alleviate symptoms. This treatment will be limited in methamphetamine users due to challenging psychosocial situations. Electrical treatments that can be delivered intermittently, non-invasively and remotely from the drug-use setting will be more realistic. This article describes the delivery of intracranial electrical stimulation that is temporally and spatially separate from the drug-use environment for the treatment of IV methamphetamine dependence. Methamphetamine dependence is rapidly developed in rodents using an operant paradigm of intravenous (IV) self-administration that incorporates a period of extended access to drug and demonstrates both escalation of use and high motivation to obtain drug.
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Affiliation(s)
- Vinita Batra
- Department of Neurosurgery, Louisiana State University
| | - Glenn F Guerin
- Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University
| | - Nicholas E Goeders
- Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University
| | - Jessica A Wilden
- Department of Neurosurgery, Louisiana State University; Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University;
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32
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Müller UJ, Truebner K, Schiltz K, Kuhn J, Mawrin C, Dobrowolny H, Bernstein HG, Bogerts B, Steiner J. Postmortem volumetric analysis of the nucleus accumbens in male heroin addicts: implications for deep brain stimulation. Eur Arch Psychiatry Clin Neurosci 2015; 265:647-53. [PMID: 26189034 DOI: 10.1007/s00406-015-0617-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 07/07/2015] [Indexed: 12/12/2022]
Abstract
Deep brain stimulation (DBS) of the nucleus accumbens (NAc) is increasingly investigated in neuropsychiatric disorders. DBS requires computer-assisted 3D planning to implant the stimulation electrode precisely. Recently, there has been a debate about the true dimensions of NAc in healthy as well as in mentally ill individuals. Knowing its true dimensions in different neuropsychiatric disorders may improve even more precise targeting of NAc for therapeutic DBS. Volumes of NAc of heroin addicts (n = 14) and healthy controls (n = 12) were calculated by using morphometry of serial whole-brain sections. Total brain volume was larger in the heroin group (mean 1478.85 ± 62.34 vs. mean 1352.38 ± 103.24 cm(3)), as the heroin group was more than 10 years younger (p = 0.001). However, the mean volume of the NAc in heroin addicts was smaller than in controls (0.528 ± 0.166 vs. 0.623 ± 0.196 cm(3); p = 0.019). This group effect did not significantly differ between the hemispheres. When assessed separately, left-hemispheric NAc volume was 15 % lower (p = 0.020), while right-hemispheric NAc volume was 16 % lower (p = 0.047) in the heroin-addicted group compared to controls. Based on these diagnosis-related differences, we believe it is important to further analyze NAc volumes in different psychiatric disorders to further improve precise targeting and electrode placement.
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Affiliation(s)
- Ulf J Müller
- Department of Psychiatry, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. .,Center for Behavioral Brain Sciences, Magdeburg, Germany.
| | - Kurt Truebner
- Institute of Legal Medicine, University of Duisburg-Essen, Essen, Germany
| | - Kolja Schiltz
- Department of Psychiatry, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Christian Mawrin
- Center for Behavioral Brain Sciences, Magdeburg, Germany.,Department of Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Henrik Dobrowolny
- Department of Psychiatry, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Hans-Gert Bernstein
- Department of Psychiatry, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Bernhard Bogerts
- Department of Psychiatry, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Johann Steiner
- Department of Psychiatry, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
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33
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Salgado S, Kaplitt MG. The Nucleus Accumbens: A Comprehensive Review. Stereotact Funct Neurosurg 2015; 93:75-93. [PMID: 25720819 DOI: 10.1159/000368279] [Citation(s) in RCA: 271] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 09/10/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Sanjay Salgado
- Laboratory of Molecular Neurosurgery, Department of Neurological Surgery, Weill Cornell Medical College, New York, N.Y., USA
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34
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Alba-Ferrara L, Fernandez F, Salas R, de Erausquin GA. Transcranial Magnetic Stimulation and Deep Brain Stimulation in the treatment of alcohol dependence. ADDICTIVE DISORDERS & THEIR TREATMENT 2014; 13:159-169. [PMID: 25598743 PMCID: PMC4292849 DOI: 10.1097/adt.0b013e31829cf047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Alcohol dependence is a major social, economic, and public health problem. Alcoholism can lead to damage of the gastrointestinal, nervous, cardiovascular, and respiratory systems and it can be lethal, costing hundreds of billions to the health care system. Despite the existence of cognitive-behavioral therapy, psychosocial interventions, and spiritually integrated treatment to treat it, alcohol dependence has a high relapse rate and poor prognosis, albeit with high interindividual variability. In this review, we discuss the use of two neuromodulation techniques, namely repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS), and their advantages and disadvantages compared to first-line pharmacological treatment for alcohol dependence. We also discuss rTMS and DBS targets for alcohol dependence treatment, considering experimental animal and human evidence, with careful consideration of methodological issues preventing the identification of feasible targets for neuromodulation treatments, as well as inter-individual variability factors influencing alcoholism prognosis. Lastly, we anticipate future research aiming to tailor the treatment to each individual patient by combining neurofunctional, neuroanatomical and neurodisruptive techniques optimizing the outcome.
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Affiliation(s)
- L. Alba-Ferrara
- Roskamp Laboratory of Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neuroscience, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - F. Fernandez
- Institute for Research in Psychiatry, Department of Psychiatry and Behavioral Neuroscience, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - R. Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - G. A. de Erausquin
- Roskamp Laboratory of Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neuroscience, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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35
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Williams NR, Taylor JJ, Lamb K, Hanlon CA, Short EB, George MS. Role of functional imaging in the development and refinement of invasive neuromodulation for psychiatric disorders. World J Radiol 2014; 6:756-778. [PMID: 25349661 PMCID: PMC4209423 DOI: 10.4329/wjr.v6.i10.756] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/17/2014] [Accepted: 08/31/2014] [Indexed: 02/07/2023] Open
Abstract
Deep brain stimulation (DBS) is emerging as a powerful tool for the alleviation of targeted symptoms in treatment-resistant neuropsychiatric disorders. Despite the expanding use of neuropsychiatric DBS, the mechanisms responsible for its effects are only starting to be elucidated. Several modalities such as quantitative electroencephalography as well a intraoperative recordings have been utilized to attempt to understand the underpinnings of this new treatment modality, but functional imaging appears to offer several unique advantages. Functional imaging techniques like positron emission tomography, single photon emission computed tomography and functional magnetic resonance imaging have been used to examine the effects of focal DBS on activity in a distributed neural network. These investigations are critical for advancing the field of invasive neuromodulation in a safe and effective manner, particularly in terms of defining the neuroanatomical targets and refining the stimulation protocols. The purpose of this review is to summarize the current functional neuroimaging findings from neuropsychiatric DBS implantation for three disorders: treatment-resistant depression, obsessive-compulsive disorder, and Tourette syndrome. All of the major targets will be discussed (Nucleus accumbens, anterior limb of internal capsule, subcallosal cingulate, Subthalamic nucleus, Centromedial nucleus of the thalamus-Parafasicular complex, frontal pole, and dorsolateral prefrontal cortex). We will also address some apparent inconsistencies within this literature, and suggest potential future directions for this promising area.
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36
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Enhanced cognitive flexibility in reversal learning induced by removal of the extracellular matrix in auditory cortex. Proc Natl Acad Sci U S A 2014; 111:2800-5. [PMID: 24550310 DOI: 10.1073/pnas.1310272111] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
During brain maturation, the occurrence of the extracellular matrix (ECM) terminates juvenile plasticity by mediating structural stability. Interestingly, enzymatic removal of the ECM restores juvenile forms of plasticity, as for instance demonstrated by topographical reconnectivity in sensory pathways. However, to which degree the mature ECM is a compromise between stability and flexibility in the adult brain impacting synaptic plasticity as a fundamental basis for learning, lifelong memory formation, and higher cognitive functions is largely unknown. In this study, we removed the ECM in the auditory cortex of adult Mongolian gerbils during specific phases of cortex-dependent auditory relearning, which was induced by the contingency reversal of a frequency-modulated tone discrimination, a task requiring high behavioral flexibility. We found that ECM removal promoted a significant increase in relearning performance, without erasing already established-that is, learned-capacities when continuing discrimination training. The cognitive flexibility required for reversal learning of previously acquired behavioral habits, commonly understood to mainly rely on frontostriatal circuits, was enhanced by promoting synaptic plasticity via ECM removal within the sensory cortex. Our findings further suggest experimental modulation of the cortical ECM as a tool to open short-term windows of enhanced activity-dependent reorganization allowing for guided neuroplasticity.
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37
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Okun MS, Weintraub D. Should impulse control disorders and dopamine dysregulation syndrome be indications for deep brain stimulation and intestinal levodopa? Mov Disord 2013; 28:1915-9. [PMID: 24243803 DOI: 10.1002/mds.25735] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/06/2013] [Accepted: 10/11/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Michael S Okun
- University of Florida Center for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, Gainesville, Florida
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38
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Pujara M, Koenigs M. Mechanisms of reward circuit dysfunction in psychiatric illness: prefrontal-striatal interactions. Neuroscientist 2013; 20:82-95. [PMID: 23924665 DOI: 10.1177/1073858413499407] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The brain's "reward circuit" has been widely implicated in the pathophysiology of mental illness. Although there has been significant progress in identifying the functional characteristics of individual nodes within the circuit and linking dysfunction of these brain areas to various forms of psychopathology, there remains a substantial gap in understanding how the nodes of the circuit interact with one another, and how the growing neurobiological knowledge may be applied to improve psychiatric patient care. In this article, we summarize what is currently known about the functions and interactions of two key nodes of this circuit-the ventral striatum and the ventromedial prefrontal/orbital frontal cortex-in relation to mental illness.
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Affiliation(s)
- Maia Pujara
- 1Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
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39
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Arulpragasam AR, Chou T, Kaur N, Corse AK, Deckersbach T, Camprodon JA. Future Directions of Deep Brain Stimulation: Current Disorders, New Technologies. Psychiatr Ann 2013. [DOI: 10.3928/00485713-20130806-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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40
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Craving in alcohol-dependent patients after detoxification is related to glutamatergic dysfunction in the nucleus accumbens and the anterior cingulate cortex. Neuropsychopharmacology 2013; 38:1401-8. [PMID: 23403696 PMCID: PMC3682141 DOI: 10.1038/npp.2013.45] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The upregulation of glutamatergic excitatory neurotransmission is thought to be partly responsible for the acute withdrawal symptoms and craving experienced by alcohol-dependent patients. Most physiological evidence supporting this hypothesis is based on data from animal studies. In addition, clinical data show that GABAergic and anti-glutamatergic drugs ameliorate withdrawal symptoms, offering indirect evidence indicative of glutamatergic hyperexcitability in alcohol-dependent subjects. We used proton magnetic resonance spectroscopy to quantify the glutamate (Glu) levels in healthy control subjects and in alcohol-dependent patients immediately after detoxification. The volumes of interest were located in the nucleus accumbens (NAcc) and the anterior cingulate cortex (ACC), which are two brain areas that have important functions in reward circuitry. In addition to Glu, we quantified the levels of combined Glu and glutamine (Gln), N-acetylaspartate, choline-containing compounds, and creatine. The Glu levels in the NAcc were significantly higher in patients than in controls. Craving, which was measured using the Obsessive Compulsive Drinking Scale, correlated positively with levels of combined Glu and Gln in the NAcc and in the ACC. The levels of all other metabolites were not significantly different between patients and controls. The increased Glu levels in the NAcc in alcohol-dependent patients shortly after detoxification confirm the animal data and suggest that striatal glutamatergic dysfunction is related to ethanol withdrawal. The positive correlation between craving and glutamatergic metabolism in both key reward circuitry areas support the hypothesis that the glutamatergic system has an important role in the later course of alcohol dependence with respect to abstinence and relapse.
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41
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Mavridis IN. Nucleus accumbens stereotactic surgery: Achieving accuracy through area M. World J Neurol 2013; 3:7-9. [DOI: 10.5316/wjn.v3.i2.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 04/16/2013] [Indexed: 02/06/2023] Open
Abstract
The nucleus accumbens (NA), a major pleasure center of the human brain, is a limbic-motor interface involved in several neurological and psychiatric disorders. During the last decade, this nucleus is also a deep brain stimulation target for selected patients. Purpose of this paper is to comment on the article entitled “Stereotactic anatomy of the human nucleus accumbens: from applied mathematics to microsurgical accuracy” which was recently published in “Surgical and Radiologic Anatomy” and is one of the latest articles on NA anatomy and surgery. The described results included a probability-based guide for in vivo (side-depended) stereotactic localization of the human NA and a standard for the NA, specific stereotactic zone of the human brain (which can be used in combination for an accurate stereotactic NA targeting). Furthermore, two specific stereotactically standard NA areas were found which could be used as abundant stereotactic guides for targeting of the anterior limb of the internal capsule, with electrode’s contact 0 (lowest) placed in the vicinity of the NA. However, the most important finding of this paper was standard area M (Mavridis’ area), which is the most reliable stereotactically standard area of the human NA, regardless of side or gender, useful for highly accurate stereotactic NA targeting.
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42
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Ethics of the electrified mind: defining issues and perspectives on the principled use of brain stimulation in medical research and clinical care. Brain Topogr 2013; 27:33-45. [PMID: 23733209 DOI: 10.1007/s10548-013-0296-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/15/2013] [Indexed: 12/19/2022]
Abstract
In recent years, non-pharmacologic approaches to modifying human neural activity have gained increasing attention. One of these approaches is brain stimulation, which involves either the direct application of electrical current to structures in the nervous system or the indirect application of current by means of electromagnetic induction. Interventions that manipulate the brain have generally been regarded as having both the potential to alleviate devastating brain-related conditions and the capacity to create unforeseen and unwanted consequences. Hence, although brain stimulation techniques offer considerable benefits to society, they also raise a number of ethical concerns. In this paper we will address various dilemmas related to brain stimulation in the context of clinical practice and biomedical research. We will survey current work involving deep brain stimulation, transcranial magnetic stimulation and transcranial direct current stimulation. We will reflect upon relevant similarities and differences between them, and consider some potentially problematic issues that may arise within the framework of established principles of medical ethics: nonmaleficence and beneficence, autonomy, and justice.
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Schmuckermair C, Gaburro S, Sah A, Landgraf R, Sartori SB, Singewald N. Behavioral and neurobiological effects of deep brain stimulation in a mouse model of high anxiety- and depression-like behavior. Neuropsychopharmacology 2013; 38:1234-44. [PMID: 23325324 PMCID: PMC3656366 DOI: 10.1038/npp.2013.21] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Increasing evidence suggests that high-frequency deep brain stimulation of the nucleus accumbens (NAcb-DBS) may represent a novel therapeutic strategy for individuals suffering from treatment-resistant depression, although the underlying mechanisms of action remain largely unknown. In this study, using a unique mouse model of enhanced depression- and anxiety-like behavior (HAB), we investigated behavioral and neurobiological effects of NAcb-DBS. HAB mice either underwent chronic treatment with one of three different selective serotonin reuptake inhibitors (SSRIs) or received NAcb-DBS for 1 h per day for 7 consecutive days. Animals were tested in established paradigms revealing depression- and anxiety-related behaviors. The enhanced depression-like behavior of HAB mice was not influenced by chronic SSRI treatment. In contrast, repeated, but not single, NAcb-DBS induced robust antidepressant and anxiolytic responses in HAB animals, while these behaviors remained unaffected in normal depression/anxiety animals (NAB), suggesting a preferential effect of NAcb-DBS on pathophysiologically deranged systems. NAcb-DBS caused a modulation of challenge-induced activity in various stress- and depression-related brain regions, including an increase in c-Fos expression in the dentate gyrus of the hippocampus and enhanced hippocampal neurogenesis in HABs. Taken together, these findings show that the normalization of the pathophysiologically enhanced, SSRI-insensitive depression-like behavior by repeated NAcb-DBS was associated with the reversal of reported aberrant brain activity and impaired adult neurogenesis in HAB mice, indicating that NAcb-DBS affects neuronal activity as well as plasticity in a defined, mood-associated network. Thus, HAB mice may represent a clinically relevant model for elucidating the neurobiological correlates of NAcb-DBS.
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Affiliation(s)
- Claudia Schmuckermair
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria
| | - Stefano Gaburro
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria
| | - Anupam Sah
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria
| | | | - Simone B Sartori
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria,Department of Pharmacology and Toxicology, Institute of Pharmacy and Centre for Molecular Biosciences Innsbruck (CMBI), Leopold-Franzens-University of Innsbruck, Innrain 80-82, Innsbruck 6020, Austria, Tel: +43 512 507 58803, Fax: +43 512 507 58889, E-mail: or
| | - Nicolas Singewald
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria,Department of Pharmacology and Toxicology, Institute of Pharmacy and Centre for Molecular Biosciences Innsbruck (CMBI), Leopold-Franzens-University of Innsbruck, Innrain 80-82, Innsbruck 6020, Austria, Tel: +43 512 507 58803, Fax: +43 512 507 58889, E-mail: or
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Koch K, Wagner G, Schachtzabel C, Schultz CC, Güllmar D, Reichenbach JR, Sauer H, Zimmer C, Schlösser RGM. Association between white matter fiber structure and reward-related reactivity of the ventral striatum. Hum Brain Mapp 2013; 35:1469-76. [PMID: 23616433 DOI: 10.1002/hbm.22284] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 12/19/2012] [Accepted: 02/12/2013] [Indexed: 11/11/2022] Open
Abstract
Individual responsiveness to rewards or rewarding stimuli may affect various domains of normal as well as pathological behavior. The ventral striatum/nucleus accumbens (NAcc) constitutes a key brain structure in the regulation of reward-appetitive behavior. It remains unclear, however, to which extent individual reward-related BOLD response in the NAcc is dependent on individual characteristics of connecting white matter fiber tracts. Using tract-based spatial statistics (TBSS) and statistical parametric mapping (SPM) this combined DTI - fMRI study investigated this question by correlating NAcc BOLD signal upon receipt of a monetary reward with different white matter characteristics (FA, axial diffusivity, radial diffusivity). The results show that increased integrity of white matter as assessed by FA in the cingulate and corpus callosum, the inferior fronto-occipital fasciculus, the anterior thalamic radiation and the anterior limb of the internal capsule was positively correlated with reward-related activation in the NAcc. There were no negative correlations as well as no significant results regarding axial and radial diffusivity. These findings indicate that microstructural properties of fiber tracts connecting, amongst others, the cortex with the striatum may influence intensity of reward-related responsiveness of the ventral striatum by constraining or increasing efficiency in information transfer within relevant circuitries involved in processing of reward.
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Affiliation(s)
- Kathrin Koch
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany; Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743 Jena, Germany
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Martire SI, Tran DMD, Reichelt AC. Preventing Binge Eating with Deep Brain Stimulation - Can Compulsive Eating be Switched Off? Front Psychiatry 2013; 4:168. [PMID: 24379789 PMCID: PMC3861866 DOI: 10.3389/fpsyt.2013.00168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/02/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah I Martire
- School of Psychology, University of New South Wales , Sydney, NSW , Australia
| | - Dominic M D Tran
- School of Psychology, University of New South Wales , Sydney, NSW , Australia
| | - Amy C Reichelt
- School of Psychology, University of New South Wales , Sydney, NSW , Australia ; School of Medical Sciences, University of New South Wales , Sydney, NSW , Australia
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Abstract
Hintergrund: Alkohol-assoziierte Reize lösen bei alkoholabhängigen Patienten konditionierte Reaktionen aus, die zu einer erhöhten Motivation der Alkoholeinnahme führen können. Klassische Konditionierungsprozesse scheinen demnach sowohl zur Aufrechterhaltung der Abhängigkeit als auch zum Rückfallgeschehen nach Entzug beizutragen. Bildgebende Studien weisen darauf hin, dass das dopaminerge Neurotransmittersystem an assoziativen Lernvorgängen beteiligt ist und Veränderungen innerhalb dieses Systems bei entgifteten alkoholabhängigen Patienten zum Rückfall beitragen könnten. Die genauen Mechanismen in diesem Zusammenhang sind bisher jedoch ungeklärt. Zielsetzung: Ziel dieser Arbeit ist die Darstellung von motivationalen Veränderungen und deren (neuroadaptiven) Grundlagen bei Alkoholabhängigkeit. Ein genaueres Verständnis davon, welche neuronalen und motivationalen Prozesse im Rahmen des Rückfallgeschehens eine Rolle spielen, könnte sowohl pharmakologische als auch therapeutische Implikationen für die Behandlung der Alkoholabhängigkeit liefern. Methodik: Diese Arbeit umfasst eine Literaturanalyse über neuroadaptive Veränderungen bei Alkoholabhängigkeit mit besonderem Fokus auf Lernprozesse und deren Rolle beim Rückfallgeschehen. Die Literaturrecherche basiert auf Recherchen der Forschergruppe 1617 der Deutschen Forschungsgesellschaft (DFG; Learning and Habitization in Alcohol Dependence, LeAD). Schlussfolgerung: Bisher existieren keine Untersuchungen, in denen neuroadaptive Veränderungen der Alkoholabhängigkeit mit spezifischen Lerndefiziten in Zusammenhang gebracht werden. Die DFG Forschergruppe LeAD untersucht neuronale Korrelate von lernbezogenen Rückfallprädiktoren. Ein Ziel dieser Untersuchung ist es herauszufinden, warum alkoholabhängige Patienten nach ihrer Entgiftung oft nicht lernen, Alkohol durch alternative belohnende Reize und Situation zu ersetzen und welche neuronalen Grundlagen diesem Defizit zu Grunde liegen.
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Affiliation(s)
- Miriam Sebold
- Klinik für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - Claudia Hägele
- Klinik für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - Anne Beck
- Klinik für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - Andreas Heinz
- Klinik für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin
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Müller UJ, Voges J, Steiner J, Galazky I, Heinze HJ, Möller M, Pisapia J, Halpern C, Caplan A, Bogerts B, Kuhn J. Deep brain stimulation of the nucleus accumbens for the treatment of addiction. Ann N Y Acad Sci 2012; 1282:119-28. [PMID: 23227826 DOI: 10.1111/j.1749-6632.2012.06834.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Despite novel medications and other therapeutic strategies, addiction to psychotropic substances remains one of the most serious public health problems worldwide. In this review, beginning with an introduction of deep brain stimulation (DBS), we highlight the importance of the nucleus accumbens (NAc) in the context of the reward circuitry and addictive behavior. We will provide a short historic overview of other neurosurgical approaches to treat addiction and describe the experimental and preclinical data on DBS in addiction. Finally, we call attention to key ethical issues related to using DBS to treat addiction that are important for future research and the design of clinical trials.
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Affiliation(s)
- Ulf J Müller
- Department of Psychiatry, University of Magdeburg, Magdeburg, Germany.
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