Deep Brain Stimulation: Really?

DBS, or Deep Brain Stimulation: we’ve heard of it, but what the hell is it? Can placing electrodes in your brain really fight the forces driving addiction? DBS is a surgical procedure performed under general anesthesia, after MRI scans have identified a target in the brain. A small area of the scalp is removed, and a probe places an electrode at the desired location. Mild electrical impulses then stimulate the area in question. A recent article in the journal Addiction calls for well-controlled clinical trials of DBS for addiction, despite the substantial risks involved.

To date, DBS has been employed mainly as a controversial treatment for Parkinson’s disease and epilepsy. It was first used in the US in 1997 by neurosurgeons at the Mayo Clinic, and is now being considered for depression and OCD, as well as addiction. Studies on rats have shown that using DBS on a brain region called the subthalamus nucleus can influence cocaine dependence; but an earlier Addiction contributor argued that the scientific rationale for this was poor, and the clinical evidence unconvincing. The ultimate target is a tiny region known as the nucleus accumbens, where addictive drugs do much of their work.

Last year, some Chinese neurosurgeons horrified the world by actually destroying the nucleus accumbens in an attempt to “cure” addiction. DBS wouldn't be as drastic, but the possible complications—like intracerebral hemorrhage, infection and emotional disturbances—are daunting. Still, a recent article in the journal Nature presents evidence that direct brain stimulation of the nucleus accumbens could lead to “reversal of cocaine-evoked synaptic plasticity,” which might lead to loss of interest in addictive drugs. The jury's out.