Department of Basic Sciences, College of Osteopathic Medicine, Touro University Nevada, 874 American Pacific Drive, Henderson, NV, USA.
Department of Clinical Education, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
Neurosurg Rev. 2021 Aug;44(4):1967-1976. doi: 10.1007/s10143-020-01415-y. Epub 2020 Oct 10.
Long has the standard of care for substance use disorder (SUD) been pharmacotherapy, psychotherapy, or rehabilitation with varying success. Deep brain stimulation (DBS) may have a beneficial reduction in the addiction-reward pathway. Recent studies have found reduced relapse and improvements in quality of life following DBS stimulation of the nucleus accumbens. We aim to identify positive outcomes and adverse effects to assess the viability of DBS as a treatment of addiction. A PubMed search following PRISMA guidelines was conducted to identify the entirety of reports reporting DBS as a treatment for SUD. Outcomes were extracted from the literature to be summarized, and a review of the quality of publications was also performed. From 2305 publications, 14 studies were found to fit the inclusion criteria published between 2007 and 2019. All studies targeted the nucleus accumbens (NAc) and remission rates at 6 months, 1 year, 2 years, and more than 6 years were 61% (20/33), 53% (17/32), 43% (14/30), and 50% (3/6), respectively. Not all studies detailed the stimulation settings or coordinates. The most common adverse effect across studies was a weight change of at least 2 kg. DBS shows potential as a long-term treatment of SUD in refractory patients. Further studies with controlled double-blind paradigms are needed for evaluation of the efficacy and safety of this treatment. Future studies should also investigate other brain regions for stimulation and optimal device stimulation parameters.
长期以来，物质使用障碍（SUD）的标准治疗方法一直是药物治疗、心理治疗或康复治疗，但成功率不一。深部脑刺激（DBS）可能会对成瘾奖赏途径产生有益的减少。最近的研究发现，DBS 刺激伏隔核后，复发率降低，生活质量得到改善。我们旨在确定积极的结果和不良反应，以评估 DBS 作为治疗成瘾的可行性。按照 PRISMA 指南进行了 PubMed 搜索，以确定全部报告 DBS 作为 SUD 治疗方法的报告。从文献中提取结果进行总结，并对出版物的质量进行了回顾。从 2305 篇出版物中，找到了 14 项符合纳入标准的研究，这些研究发表于 2007 年至 2019 年之间。所有研究都针对伏隔核（NAc），6 个月、1 年、2 年和 6 年以上的缓解率分别为 61%（20/33）、53%（17/32）、43%（14/30）和 50%（3/6）。并非所有研究都详细说明了刺激设置或坐标。最常见的不良反应是体重至少增加 2 公斤。DBS 显示出作为难治性患者 SUD 的长期治疗方法的潜力。需要进行具有对照双盲范式的进一步研究，以评估这种治疗的疗效和安全性。未来的研究还应研究其他大脑区域的刺激和最佳设备刺激参数。
