Deep brain stimulation removal after successful treatment for heroin addiction

To the Editor

Deep brain stimulation (DBS) has emerged as a promising neurosurgical intervention for patients who have failed to respond to multiple conventional drug-addiction treatments (Spagnolo and Goldman, 2017). DBS implantation allows clinicians to modulate the dysfunctional brain systems that mediate the reinforcing and re-warding effects of addictive drugs (Zhang et al., 2019). The removal of DBS at the end of studies or clinical trials has become an important issue, including the demands and cost (Sierra-Mercado et al., 2019). DBS removal may be more relevant in psychiatric disorders than in neurological disorders, such as movement disorders, which need long-term treatment.

Herein, we describe for the first time a male patient whose brain implants were removed after successful treatment of heroin addiction with continuous DBS. The 42-year-old patient had developed a pattern of repeated heroin abuse from his early teens. The amount of intravenously injected heroin had gradually increased to 0.05 g per day throughout his addiction. He had tried several standard addiction treatments before participating in a clinical trial of DBS for opiate addiction at Ruijin Hospital.

The DBS target was the nucleus accumbens, a small but critical structure within the brain’s reward system (Figure 1(A) and (B)). After two-electrode implantation, the patient received continuous bilateral stimulation for 1 year, along with weekly psychological counseling and urine drug testing. Over the DBS treatment course, the patient experienced a marked reduction in drug cravings and remained drug-free, except for a single incident of heroin use at 6 months after surgery.

Figure 1.

Structural brain images of a male patient whose brain implants were removed after successful treatment of heroin addiction with continuous DBS: (A) Image before DBS surgery, (B) image after DBS surgery, (C) image after DBS removal. The location of an implanted electrode targeting the nucleus accumbens on one side is indicated by the black arrows in B. DBS, deep brain stimulation.

One year after surgery, the patient asked for the DBS implants to be removed in order to feel ‘normal’ again. He agreed with us to blindly switch off the DBS to assess the clinical efficacy over a subsequent 9-month period of sham stimulation. No relapse occurred in this period or the following months. Two years after initial surgery, the DBS implants were safely removed from the patient’s brain (Figure 1(C)). The cost of DBS removal was covered by reallocating study resources, as recommended (Sierra-Mercado et al., 2019).

DBS removal can improve the patient’s psychological well-being and reduce the rate of hardware-related complications. A reliable evaluation protocol and pre-scheduled resources for covering the cost are needed to optimize DBS removal after recovery from addiction.