Clinical Study for Alleviating Opiate Drug Psychological Dependence by a Method of Ablating the Nucleus accumbens with Stereotactic Surgery
by
Gao G, Wang X, He S, Li W, Wang Q, Liang Q,
Zhao Y, Hou F, Chen L, Li A.
Department of Neurosurgery,
Tangdu Hospital,
Fourth Military Medical University,
Xian, China.
Stereotact Funct Neurosurg. 2003;81(1-4):96-104


ABSTRACT

The aim of this study was to explore a new way of treating drug addiction by ablating the nucleus accumbens (NA(C)), which has a close relationship with drug-induced psychological dependence, using stereotactic surgery, blocking the mesocorticolimbic dopamine circuit, alleviating craving for drugs and lowering the relapse rate after detoxification. On the basis of animal experiments, stereotactic surgery was performed in 28 patients by making a lesion in the NA(C) bilaterally to treat opiate drug dependence. Indications, the criterion of therapeutic effect, treatment process and the therapeutic and safety evaluation index of the surgery were formulated particularly. The mean follow-up period was 15 months. Relapse has not occurred in 11 cases up till now. Drug-free time in these patients has been more than half a year in 4 cases (more than a year in 3 cases), and less than half a year in 7 cases. Relapse occurred in 15 cases after surgery. Drug-free time in these patients was more than half a year in 3 cases, between 1 month and half a year in 10 cases and less than 1 month in 2 cases. The therapeutic effect was excellent in 7 cases (26.9%), good in 10 cases (38.5%) and poor in 2 cases (7.7%). Another 7 cases were still under investigation at the time of writing. Relapse rates after surgery were 7.7, 38.5 and 57.5% within 1 month, between 1 month and half a year and after more than half a year, respectively. There were no common complications of surgery such as intracranial hematoma or infection in these patients after operation. Character type was changed slightly in 2 cases, and 4 cases suffered temporary memory loss, which did not affect their daily lives and learning function. They all recovered within 1 month. There were different degrees of effectiveness of treating drug addicts' psychological dependence by making lesions in the NA(C) bilaterally with stereotactic surgery. No particular complications occurred. The operation is safe and feasible. The mean follow-up time in this study was 15 months. The effectiveness was satisfactory. The relapse rate of drug addicts after detoxification was clearly reduced.
Mu
Pain
Heroin
SOD mu
Tolerance
Methadone
Receptor subtypes
Morphine/verapamil
Fentanyl and ketamine
Dynorphin and dopamine
Depression, opioids and the HPA
Kappa upregulation and addiction
Opioids, goldfish and the giant toad
Opioids, depression and learned helplessness
Stress, noradrenaline and endogenous opioids


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