• Juergen Voges, Ulf Müller, Bernhard Bogerts, Thomas Münte, and Hans-Jochen Heinze.
• Departments of Stereotactic Neurosurgery, Neurology and Psychiatry, Otto-von Guericke University, Magdeburg; Leibniz Institute for Neurobiology, Magdeburg; and Department of Neurology, University Lübeck, Lübeck, Germany. Electronic address: juergen.voges@med.ovgu.de.
• World Neurosurg. 2013 Sep 1;80(3-4):S28.e21-31.

BackgroundThe consequences of chronic alcohol dependence cause important health and economic burdens worldwide. Relapse rates after standard treatment (medication and psychotherapy) are high. There is evidence from in vivo investigations and from studies in patients that the brain's reward system is critically involved in the development and maintenance of addictive behavior, suggesting that modification of this system could significantly improve the prognosis of addictive patients. Motivated by an accidental observation, we used the nucleus accumbens (NAc), which has a central position in the dopaminergic reward system for deep brain stimulation (DBS) of alcohol addiction.MethodsWe report our first experiences with NAc DBS for alcohol dependence and review the literature addressing the mechanisms leading to addiction.ResultsFive patients were treated off-label with bilateral NAc DBS for severe alcohol addiction (average follow-up 38 months). All patients experienced significant and ongoing improvement of craving. Two patients remained completely abstinent for more than 4 years. NAc stimulation was tolerated without permanent side effects. Simultaneous recording of local field potentials from the target area and surface electroencephalography while patients performed neuropsychological tasks gave a hint on the pivotal role of the NAc in processing alcohol-related cues.ConclusionsTo our knowledge, the data presented here reflect the first attempt to treat alcohol-addicted patients with NAc DBS. Electrical NAc stimulation probably counterbalances the effect of drug-related stimuli triggering involuntarily drug-seeking behavior. Meanwhile, two prospective clinical studies using randomized, double-blind, and crossover stimulation protocols for DBS are underway to corroborate these preliminary results.Published by Elsevier Inc.

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