Abstract：
Deep brain stimulation (DBS) is currently used to treat addiction, with the nucleus accumbens (NAc) as one promising target. The anterior limb of the internal capsule (ALIC) is also a potential target, as it carries fiber tracts connecting the mesocorticolimbic circuits that are crucially involved in several psychiatric disorders, including addiction. Stimulating the NAc and ALIC simultaneously may have a synergistic effect against addiction.
Eight patients with a long history of heroin use and multiple relapses, despite optimal conventional treatments, were enrolled. Customized electrodes were implanted through the ALIC into the NAc, and deep brain stimulation (DBS) treatment began two weeks after surgery. The patients were followed for at least 24 months. The duration of drug-free time, severity of drug cravings, psychometric evaluations, and PET studies of glucose metabolism before and after DBS were conducted. All adverse events were recorded.
With DBS, five patients were abstinent for more than three years, two relapsed after abstaining for six months, and one was lost of follow-up at three months. The degree of cravings for drug use after DBS was reduced if the patients remained abstinent (p < 0.001). Simultaneous DBS of the NAc and ALIC also improved the quality of life, alleviated psychiatric symptoms, and increased glucose metabolism in addiction-related brain regions. Moreover, stimulation-related adverse events were few and reversible.
Simultaneous DBS of the NAc and ALIC appears to be safe, with few side effects, and may prevent long-term heroin relapse after detoxification in certain patients. (This trial was registered at ClinicalTrials.gov, NCT01274988).
Eight patients with a long history of heroin use and multiple relapses, despite optimal conventional treatments, were enrolled. Customized electrodes were implanted through the ALIC into the NAc, and deep brain stimulation (DBS) treatment began two weeks after surgery. The patients were followed for at least 24 months. The duration of drug-free time, severity of drug cravings, psychometric evaluations, and PET studies of glucose metabolism before and after DBS were conducted. All adverse events were recorded.
With DBS, five patients were abstinent for more than three years, two relapsed after abstaining for six months, and one was lost of follow-up at three months. The degree of cravings for drug use after DBS was reduced if the patients remained abstinent (p < 0.001). Simultaneous DBS of the NAc and ALIC also improved the quality of life, alleviated psychiatric symptoms, and increased glucose metabolism in addiction-related brain regions. Moreover, stimulation-related adverse events were few and reversible.
Simultaneous DBS of the NAc and ALIC appears to be safe, with few side effects, and may prevent long-term heroin relapse after detoxification in certain patients. (This trial was registered at ClinicalTrials.gov, NCT01274988).
摘要：
深部脑刺激（DBS）目前用于治疗成瘾，伏隔核（NAc）作为一个有希望的目标。内囊前肢（ALIC）也是一个潜在的目标，因为它携带纤维束，连接在几种精神疾病中至关重要的中皮质边缘回路，包括上瘾。同时刺激NAc和ALIC可能具有对抗成瘾的协同作用。
8名长期使用海洛因和多次复发的患者，尽管有最佳的常规治疗方法,已注册。定制电极通过ALIC植入NAc，术后两周开始脑深部电刺激（DBS）治疗。患者随访至少24个月。无药时间的持续时间，药物渴望的严重程度，心理测量评估，并对DBS前后的糖代谢进行PET研究。记录所有不良事件。
使用DBS,五名患者戒断三年以上，两个人在弃权六个月后复发，其中一个在三个月时失去了随访。如果患者保持戒断，则DBS后对药物使用的渴望程度降低（p<0.001）。同时，NAc和ALIC的DBS也提高了生活质量，精神症状缓解,成瘾相关脑区的葡萄糖代谢增加。此外，刺激相关的不良事件很少且可逆.
NAc和ALIC的同时DBS似乎是安全的，副作用很少，并可能防止某些患者戒毒后长期海洛因复发。（该试验已在ClinicalTrials.gov注册，NCT01274988).
8名长期使用海洛因和多次复发的患者，尽管有最佳的常规治疗方法,已注册。定制电极通过ALIC植入NAc，术后两周开始脑深部电刺激（DBS）治疗。患者随访至少24个月。无药时间的持续时间，药物渴望的严重程度，心理测量评估，并对DBS前后的糖代谢进行PET研究。记录所有不良事件。
使用DBS,五名患者戒断三年以上，两个人在弃权六个月后复发，其中一个在三个月时失去了随访。如果患者保持戒断，则DBS后对药物使用的渴望程度降低（p<0.001）。同时，NAc和ALIC的DBS也提高了生活质量，精神症状缓解,成瘾相关脑区的葡萄糖代谢增加。此外，刺激相关的不良事件很少且可逆.
NAc和ALIC的同时DBS似乎是安全的，副作用很少，并可能防止某些患者戒毒后长期海洛因复发。（该试验已在ClinicalTrials.gov注册，NCT01274988).
