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. 2018 Jan 27;8(2):21.
doi: 10.3390/brainsci8020021.

Nucleus Accumbens Deep Brain Stimulation in Patients With Substance Use Disorders and Delay Discounting

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Free PMC article

Nucleus Accumbens Deep Brain Stimulation in Patients With Substance Use Disorders and Delay Discounting

Canan B Peisker et al. Brain Sci. .
Free PMC article

Abstract

Deep brain stimulation (DBS) of the nucleus accumbens (NAc) shows first promising results in patients with severe substance use disorder (SUD), a patient group known to have deficits in self-control. One facet of self-control is the ability to forego smaller sooner rewards in favor of larger later rewards (delay discounting, DD). The NAc has been suggested to integrate motivational information to guide behavior while the consequences of NAc-DBS on DD are unknown. To this end, nine patients with SUD performed a DD task with DBS on and after a 24 h DBS off period. Furthermore, 18 healthy controls were measured to assess possible alterations in DD in patients with SUD. Our findings implicate that DD was not significantly modulated by NAc-DBS and also that patients with SUD did not differ from healthy controls. While null results must be interpreted with caution, the commonly observed association of impaired DD in SUD might suggest a long-term effect of NAc-DBS that was not sufficiently modulated by a 24 h DBS off period.

Keywords: alcohol use disorder; deep brain stimulation; delay discounting; nucleus accumbens; opioid use disorder; self-control; substance use disorder.

Conflict of interest statement

Peisker, Schüller, Peters, Wagner, Müller, Schilbach and Visser-Vandewalle declare no conflict of interest. In the last two years, Kuhn has received research support from AstraZeneca, Lilly, Lundbeck, and Otsuka Pharma for lecturing at conferences and financial support to travel. Kuhn received financial support for IIT-DBS studies (not the present investigation) from Medtronic GmbH (Meerbusch, Germany). The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
Timeline of the clinical studies and the successive delay discounting (DD) assessment. The sequence of deep brain simulation (DBS) on and off was pseudo-randomized. (A) The timeline of the NASA study and successive DD assessment. (B) The timeline of the DeBraSTRA study and successive DD assessment. (DBS, deep brain stimulation; DD, delay discounting).
Figure 2
Figure 2
DBS electrode locations: (A) The left NAc is depicted in green and the right NAc in blue. (B) In the close up view the NAc is depicted in blue and the nucleus caudatus in red. (DBS, deep brain stimulation; NAc, nucleus accumbens).
Figure 3
Figure 3
Depiction of one trial, subjects must choose between 20 € now (default option) and a larger but delayed reward.
Figure 4
Figure 4
(A) Boxplots for AUC-values of NAc-DBS patients with SUD and (B) healthy controls; (C) depiction of subjective value as a proportion of objective value for NAc-DBS patients with SUD and (D) healthy controls. (CON, Healthy controls; DBS, Deep brain stimulation; Pat, Patients with SUD).
Figure 5
Figure 5
(A) Group-level posterior distributions of log(k) for patients and controls; (B) Group-level distributions of decision noise (temp) for patients with SUD and controls. (CON, Healthy controls; Pat, Patients with SUD).
Figure 6
Figure 6
Absolute differences in log(k)-values between testing sessions in patients with SUD and healthy controls.
Figure 7
Figure 7
Retest stability (log(k) value) in (A) DBS patients with SUD and in (B) healthy controls. Decision noise (temp) in (C) DBS patients with SUD and in (D) healthy controls (DBS, deep brain stimulation; SUD, substance use disorder).

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