Deep Brain Stimulation for Addictive Disorders-Where Are We Now?

• Type of Material: Article
• Authors: Jason Yuen, Mayo Clinic; Abbas Z Kouzani, Deakin University; Michael Berk, Deakin University; Susannah Tye, Emory University; Aaron E Rusheen, Mayo Clinic; Charles D Blaha, Mayo Clinic; Kevin E Bennet, Mayo Clinic; Kendall H Lee, Mayo Clinic; Hojin Shin, Mayo Clinic; Jee Hyun Kim, Deakin University; Yoonbae Oh, Mayo Clinic
• Language: English
• Date: 2022-04-11
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s13311-022-01229-4
• Title of Journal or Parent Work: NEUROTHERAPEUTICS
• Volume: 19
• Issue: 4
• Start Page: 1193
• End Page: 1215
• Grant/Funding Information: Open Access funding enabled and organized by CAUL and its Member Institutions. This research was supported by the NIH (R01NS112176) and the Minnesota Partnership for Biotechnology and Medical Genomics (MNP #19.13).
• Keywords: SUBSTANCE USE DISORDERS; NUCLEUS-ACCUMBENS SHELL; Life Sciences & Biomedicine; DRUG SEEKING; COCAINE SEEKING; Clinical Neurology; Animal models; ALCOHOL; ELECTRICAL-STIMULATION; Neuromodulation; Neurosciences & Neurology; ETHANOL-CONSUMPTION; Neurosciences; PREFRONTAL CORTEX; Deep brain stimulation; Addiction; Pharmacology & Pharmacy; HEROIN-SEEKING BEHAVIORS; Neuropsychiatry; DOPAMINE; Science & Technology; Biomarkers
• Research Categories: Health Sciences, Mental Health

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.