PMID- 37329519
OWN - NLM
STAT- MEDLINE
DCOM- 20240103
LR  - 20240103
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
VI  - 140
IP  - 1
DP  - 2024 Jan 1
TI  - Safety and feasibility clinical trial of nucleus accumbens deep brain stimulation 
      for treatment-refractory opioid use disorder.
PG  - 231-239
LID - 10.3171/2023.4.JNS23114 [doi]
AB  - OBJECTIVE: There were more than 107,000 drug overdose deaths in the US in 2021, 
      the most ever recorded. Despite advances in behavioral and pharmacological 
      treatments, over 50% of those receiving treatment for opioid use disorder (OUD) 
      experience drug use recurrence (relapse). Given the prevalence of OUD and other 
      substance use disorders (SUDs), the high rate of drug use recurrence, and the 
      number of drug overdose deaths, novel treatment strategies are desperately 
      needed. The objective of this study was to evaluate the safety and feasibility of 
      deep brain stimulation (DBS) targeting the nucleus accumbens (NAc)/ventral 
      capsule (VC) and potential impact on outcomes in individuals with 
      treatment-refractory OUD. METHODS: A prospective, open-label, single-arm study 
      was conducted among participants with longstanding treatment-refractory OUD 
      (along with other co-occurring SUDs) who underwent DBS in the NAc/VC. The primary 
      study endpoint was safety; secondary/exploratory outcomes included opioid and 
      other substance use, substance craving, and emotional symptoms throughout 
      follow-up and 18FDG-PET neuroimaging. RESULTS: Four male participants were 
      enrolled and all tolerated DBS surgery well with no serious adverse events (AEs) 
      and no device- or stimulation-related AEs. Two participants sustained complete 
      substance abstinence for > 1150 and > 520 days, respectively, with significant 
      post-DBS reductions in substance craving, anxiety, and depression. One 
      participant experienced post-DBS drug use recurrences with reduced frequency and 
      severity. The DBS system was explanted in one participant due to noncompliance 
      with treatment requirements and the study protocol. 18FDG-PET neuroimaging 
      revealed increased glucose metabolism in the frontal regions for the participants 
      with sustained abstinence only. CONCLUSIONS: DBS of the NAc/VC was safe, 
      feasible, and can potentially reduce substance use, craving, and emotional 
      symptoms in those with treatment-refractory OUD. A randomized, sham-controlled 
      trial in a larger cohort of patients is being initiated.
FAU - Rezai, Ali R
AU  - Rezai AR
AD  - 1Departments of Neurosurgery.
AD  - 2Neuroscience.
FAU - Mahoney, James J
AU  - Mahoney JJ
AD  - 2Neuroscience.
AD  - 3Behavioral Medicine and Psychiatry.
FAU - Ranjan, Manish
AU  - Ranjan M
AD  - 1Departments of Neurosurgery.
FAU - Haut, Marc W
AU  - Haut MW
AD  - 2Neuroscience.
AD  - 3Behavioral Medicine and Psychiatry.
AD  - 4Neurology.
AD  - 5Radiology, and.
FAU - Zheng, Wanhong
AU  - Zheng W
AD  - 2Neuroscience.
AD  - 3Behavioral Medicine and Psychiatry.
FAU - Lander, Laura R
AU  - Lander LR
AD  - 2Neuroscience.
AD  - 3Behavioral Medicine and Psychiatry.
FAU - Berry, James H
AU  - Berry JH
AD  - 2Neuroscience.
AD  - 3Behavioral Medicine and Psychiatry.
FAU - Farmer, Daniel L
AU  - Farmer DL
AD  - 2Neuroscience.
AD  - 3Behavioral Medicine and Psychiatry.
FAU - Marton, Jennifer L
AU  - Marton JL
AD  - 2Neuroscience.
AD  - 3Behavioral Medicine and Psychiatry.
FAU - Tirumalai, Padma
AU  - Tirumalai P
AD  - 2Neuroscience.
FAU - Mears, Ashley
AU  - Mears A
AD  - 1Departments of Neurosurgery.
FAU - Thompson-Lake, Daisy G Y
AU  - Thompson-Lake DGY
AD  - 2Neuroscience.
FAU - Finomore, Victor S
AU  - Finomore VS
AD  - 2Neuroscience.
FAU - D'Haese, Pierre-Francois
AU  - D'Haese PF
AD  - 10Neuroradiology, West Virginia University School of Medicine, Rockefeller 
      Neuroscience Institute, Morgantown, West Virginia.
FAU - Aklin, Will M
AU  - Aklin WM
AD  - 6National Institute on Drug Abuse, and.
FAU - George, David T
AU  - George DT
AD  - 7National Institute on Alcohol Abuse and Addiction, NIH, Bethesda, Maryland.
FAU - Corrigan, John D
AU  - Corrigan JD
AD  - 8Department of Physical Medicine and Rehabilitation, The Ohio State University, 
      Columbus, Ohio; and.
FAU - Hodder, Sally L
AU  - Hodder SL
AD  - 9West Virginia Clinical & Translational Science Institute, West Virginia 
      University, Morgantown, West Virginia.
LA  - eng
PT  - Journal Article
DEP - 20230609
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
RN  - 0Z5B2CJX4D (Fluorodeoxyglucose F18)
SB  - IM
MH  - Humans
MH  - Male
MH  - Nucleus Accumbens/diagnostic imaging
MH  - *Deep Brain Stimulation/methods
MH  - Fluorodeoxyglucose F18
MH  - Prospective Studies
MH  - Feasibility Studies
MH  - Neoplasm Recurrence, Local
MH  - *Opioid-Related Disorders/therapy
MH  - *Drug Overdose
OTO - NOTNLM
OT  - addiction
OT  - deep brain stimulation
OT  - functional neurosurgery
OT  - neuromodulation
OT  - nucleus accumbens
OT  - opioid use disorder
OT  - overdose
OT  - treatment refractory
EDAT- 2023/06/17 19:16
MHDA- 2024/01/03 09:44
CRDT- 2023/06/17 13:13
PHST- 2023/02/01 00:00 [received]
PHST- 2023/04/21 00:00 [accepted]
PHST- 2024/01/03 09:44 [medline]
PHST- 2023/06/17 19:16 [pubmed]
PHST- 2023/06/17 13:13 [entrez]
AID - 10.3171/2023.4.JNS23114 [doi]
PST - epublish
SO  - J Neurosurg. 2023 Jun 9;140(1):231-239. doi: 10.3171/2023.4.JNS23114. Print 2024 
      Jan 1.