Sakai Joseph T, Tanabe Jody, Battula Sharonya, Zipperly Morgan, Mikulich-Gilbertson Susan K, Kern Drew S, Thompson John A, Raymond Kristen, Gerecht Pamela David, Foster Katrina, Abosch Aviva
Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States.
Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States.
Front Psychiatry. 2024 Jul 12;15:1435109. doi: 10.3389/fpsyt.2024.1435109. eCollection 2024.
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.
物质使用障碍很普遍，在全球范围内导致广泛的发病率和死亡率。循证治疗的效应大小为低到中等。对成瘾（如渴望）的神经生物学理解的进展以及神经调节技术的进步，使得对物质使用障碍的神经外科治疗的评估成为可能。深部脑刺激（DBS）涉及将电极导线手术植入脑靶点，并通过皮下隧道将导线连接到胸部皮肤下的可编程植入式脉冲发生器（IPG）。DBS允许直接测试关于物质使用障碍病因的神经生物学指导假说，以开发更有效的治疗方法。早期研究虽然有多种局限性，但很有前景。不过，作者对在该人群中开展DBS研究表示谨慎，并强调保障措施对于确保患者安全和有意义的研究结果的重要性。在这篇观点文章中，我们回顾了多年来计划一项针对甲基苯丙胺使用障碍的DBS正在进行的试验所吸取的经验教训。
