Outcomes of deep brain stimulation surgery for substance use disorder: a systematic review
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REVIEW
Outcomes of deep brain stimulation surgery for substance use disorder: a systematic review Omron Hassan 1
&
Sheshanna Phan 1 & Nicole Wiecks 1 & Christian Joaquin 2 & Vladimir Bondarenko 1
Received: 18 May 2020 / Revised: 31 August 2020 / Accepted: 7 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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. Keywords Deep brain stimulation . Substance use disorder . Addiction . Psychosurgery . Neuromodulation . Systematic review
Introduction Substance use disorder (SUD) is a preventable condition but also a leading cause of injury death in the USA resulting in approximately 70,237 deaths in 2017 [51]. However, the public perception towards SUD patients creates barriers to their treatment as they are the most stigmatized group of selfinflicted diseases [36, 46]. SUD patients are also deterred from seeking treatment due to high costs or lack of desired treatment [63]. However, studies have shown that early or enhanced treatment programs are cost-effective and reduce economic burden because it not only reduces the burden on society but also increases savings due to a decreased need for * Omron Hassan [email protected] 1
Department of Basic Sciences, College of Osteopathic Medicine, Touro University Nevada, 874 American Pacific Drive, Henderson, NV, USA
2
Department of Clinical Education, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
treatment in the years after [4, 10, 49, 53]. The common treatment options for SUD are currently pharmacotherapy, psychotherapy, and rehabil
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