Clinical Study for Alleviating Opiate Drug Psychological Dependence by a Method of Ablating the Nucleus accumbens with Stereotactic Surgery

Abstract

The aim of this study was to explore a new way of treating drug addiction by ablating the nucleus accumbens (NA_C), which has a close relationship with drug-induced psychological dependence, using stereotactic surgery, blocking the mesocorticolimbic dopamine circuit, alleviating craving for drugs and lowering the relapse rate after detoxification. On the basis of animal experiments, stereotactic surgery was performed in 28 patients by making a lesion in the NA_C bilaterally to treat opiate drug dependence. Indications, the criterion of therapeutic effect, treatment process and the therapeutic and safety evaluation index of the surgery were formulated particularly. The mean follow-up period was 15 months. Relapse has not occurred in 11 cases up till now. Drug-free time in these patients has been more than half a year in 4 cases (more than a year in 3 cases), and less than half a year in 7 cases. Relapse occurred in 15 cases after surgery. Drug-free time in these patients was more than half a year in 3 cases, between 1 month and half a year in 10 cases and less than 1 month in 2 cases. The therapeutic effect was excellent in 7 cases (26.9%), good in 10 cases (38.5%) and poor in 2 cases (7.7%). Another 7 cases were still under investigation at the time of writing. Relapse rates after surgery were 7.7, 38.5 and 57.5% within 1 month, between 1 month and half a year and after more than half a year, respectively. There were no common complications of surgery such as intracranial hematoma or infection in these patients after operation. Character type was changed slightly in 2 cases, and 4 cases suffered temporary memory loss, which did not affect their daily lives and learning function. They all recovered within 1 month. There were different degrees of effectiveness of treating drug addicts’ psychological dependence by making lesions in the NA_C bilaterally with stereotactic surgery. No particular complications occurred. The operation is safe and feasible. The mean follow-up time in this study was 15 months. The effectiveness was satisfactory. The relapse rate of drug addicts after detoxification was clearly reduced.

Associations between personality changes and nucleus accumbens ablation in opioid addicts

“…By November 2004, this operation had been performed on a total of 272 opiate addicts, and short-term follow-ups revealed satisfactory results [7,8] . However, this treatment was halted due to ethical problems associated with irreversible damage to the brain structure and the lack of long-term follow-up data.…”

Reducing the desire for cocaine with subthalamic nucleus deep brain stimulation

“…However, it is now largely accepted that interfering with the DA system affects motivation in general. Other surgical targets such as the nucleus accumbens (8) or the cortex (9) have been tested in animals or in opiates addicts (10) with no convincing results so far.…”

The neurosurgical treatment of addiction

“…In 2003, Gao et al 12 reported on ablation of the nucleus accumbens to treat addiction, based on several animal experiments and recent studies that had revealed the relationship between psychological dependence induced by drug addiction and the mesocorticolimbic dopamine circuit. Ablation of the nucleus accumbens would lead to blockage of the mesocorticolimbic dopamine circuit.…”