Grupo de investigación NEMOD, división de neurocirugía funcional, departamento de neurocirugía, clínica FOSCAL, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Neuromodulation. 2022 Feb;25(2):171-184. doi: 10.1111/ner.13348.
Substance addiction encompasses the incapacity to discontinue urgent drug use; many severely disabled patients might be considered appropriate candidates for surgery due to the high rates of relapse despite conservative treatment. A crucial finding in the brain of these patients is increased extracellular concentrations of dopamine in the nucleus accumbens (NAcc).
To determine the efficacy and safety of NAcc surgery for the treatment of substance dependence.
Adhering to PRISMA guidelines, we performed a systematic review to identify all original studies in which NAcc surgery was performed to treat relapsing drug addiction with a minimum follow-up of six months. From database inception to April 10, 2020, we searched PubMed, Scopus, and LILACS. Two reviewers independently selected studies and extracted data. The main outcome was the relapse rate. The GRADE methods were applied to evaluate the quality of evidence. This study was registered with PROSPERO CRD42020177054.
Fifteen studies involving 359 participants met inclusion criteria; eight (56%) included NAcc deep brain stimulation (DBS) in 13 patients with addiction for alcohol (N = 6, 46.1%), opioid (N = 4, 30.7%), and nicotine (N = 3, 15.3%); seven studies (N = 346, 44%) performed NAcc radiofrequency (RF) ablation for opioid (N = 334) and alcohol (N = 12) dependence. Relapse rates were 38.4% for DBS and 39% for RF ablation.
Despite available studies reporting a benefit in the treatment of drug addictions with NAcc surgery, this systematic review stresses the need for carefully planned prospective studies in order to further address the efficacy and indications.
物质成瘾包括无法停止紧急药物使用；许多严重残疾的患者可能被认为是手术的合适候选人，因为尽管采用保守治疗，仍有很高的复发率。这些患者大脑中的一个关键发现是伏隔核（NAcc）中多巴胺的细胞外浓度增加。
确定 NAcc 手术治疗物质依赖的疗效和安全性。
根据 PRISMA 指南，我们进行了系统评价，以确定所有原始研究，其中 NAcc 手术用于治疗复发性药物成瘾，最低随访时间为 6 个月。从数据库开始到 2020 年 4 月 10 日，我们在 PubMed、Scopus 和 LILACS 上进行了搜索。两位评审员独立选择研究并提取数据。主要结果是复发率。应用 GRADE 方法评估证据质量。本研究已在 PROSPERO CRD42020177054 上注册。
有 15 项研究涉及 359 名参与者符合纳入标准；其中 8 项（56%）包括 NAcc 深部脑刺激（DBS）在 13 名酒精（N=6，46.1%）、阿片类药物（N=4，30.7%）和尼古丁（N=3，15.3%）成瘾患者中；7 项研究（N=346，44%）对阿片类药物（N=334）和酒精（N=12）成瘾患者进行了 NAcc 射频（RF）消融。DBS 的复发率为 38.4%，RF 消融的复发率为 39%。
尽管现有研究报告 NAcc 手术治疗药物成瘾有一定疗效，但本系统评价强调需要精心设计前瞻性研究，以进一步确定其疗效和适应证。
