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Original Research ARTICLE

Counteracting incentive sensitization in severe alcohol dependence using deep brain stimulation of the nucleus accumbens: clinical and basic science aspects

1
Department of Neurology, University of Magdeburg, Magdeburg, Germany
2
Leibniz Institute of Neurobiology, Magdeburg, Germany
3
Stereotactic Neurosurgery, University of Magdeburg, Magdeburg, Germany
4
Department of Neuropsychology, University of Magdeburg, Magdeburg, Germany
5
Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
6
Department of Psychiatry, University of Magdeburg, Magdeburg, Germany
7
Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany
The ventral striatum/nucleus accumbens (NAcc) has been implicated in the craving for drugs and alcohol which is a major reason for relapse of addicted people. Craving might be induced by drug-related cues. This suggests that disruption of craving-related neural activity in the NAcc may significantly reduce craving in alcohol-dependent patients. Here we report on preliminary clinical and neurophysiological evidence in three male patients who were treated with high frequency deep brain stimulation of the NAcc bilaterally. All three had been alcohol-dependent for many years, unable to abstain from drinking, and had experienced repeated relapses prior to the stimulation. After the operation, craving was greatly reduced and all three patients were able to abstain from drinking for extended periods of time. Immediately after the operation but prior to connection of the stimulation electrodes to the stimulator, local field potentials were obtained from the externalized cables in two patients while they performed cognitive tasks addressing action monitoring and incentive salience of drug-related cues. LFPs in the action monitoring task provided further evidence for a role of the NAcc in goal-directed behaviors. Importantly, alcohol-related cue stimuli in the incentive salience task modulated LFPs even though these cues were presented outside of the attentional focus. This implies that cue-related craving involves the NAcc and is highly automatic.
Keywords:
local field potentials, intracranial recordings, deep brain stimulation, addiction, reward processing, action monitoring, nucleus accumbens
Citation:
Heinze H-J, Heldmann M, Voges J, Hinrichs H, Marco-Pallares J, Hopf J-M, Müller UJ, Galazky I, Sturm V, Bogerts B and Münte TF (2009). Counteracting incentive sensitization in severe alcohol dependence using deep brain stimulation of the nucleus accumbens: clinical and basic science aspects. Front. Hum. Neurosci. 3:22. doi: 10.3389/neuro.09.022.2009
Received:
17 May 2009;
 Paper pending published:
26 June 2009;
Accepted:
12 August 2009;
 Published online:
02 September 2009.

Edited by:

Olivier Bertrand, INSERM, France; Lyon I University, France

Reviewed by:

Veerle Visser-Vandewalle, Maastricht University Medical Center, The Netherlands
Stephane Thobois, Hôpital Neurologique Pierre Wertheimer, France
Copyright:
© 2009 Heinze, Heldmann, Voges, Hinrichs, Marco-Pallares, Hopf, Müller, Galazky, Sturm, Bogerts and Münte. This is an open-access article subject to an exclusive license agreement between the authors and the Frontiers Research Foundation, which permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited.
*Correspondence:
Thomas F. Münte, Department of Neuropsychology, University of Magdeburg, Gebäude 24, Universitätsplatz 2, 39106 Magdeburg, Germany. e-mail: thomas.muente@medizin.uni-magdeburg.de

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