药物成瘾脑深部电刺激术研究进展

Research progress of deep brain stimulation for the treatment of drug addiction

药物成瘾是严重的全球性医学和社会问题,其治疗分为脱毒和防止复吸两个阶段,后者是治疗成功的关键。以立体定向伏隔核毁损术为代表的外科手术方法,在戒断后预防复吸中显示出较好疗效,但因其具有破坏性,临床应用受到限制。随着脑深部电刺激术在运动障碍性疾病中的成功应用,该疗法预防戒断后复吸的动物实验和临床研究逐步深入。在药物成瘾相关神经核团中伏隔核仍是目前研究最多、预防复吸疗效最好的手术靶点。同时,以伏隔核为基础的多靶点联合刺激目前也在研究中。尽管目前治疗机制尚不明确,脑深部电刺激术可能成为难治性药物成瘾的尝试性治疗方法。刺激参数设置、获得客观治疗反馈、医学伦理学争议等尚待进一步大样本、长期的临床研究。

Drug addiction is a serious problem all over the world involving both medical and social issues. The treatment strategy lies in two aspects, promoting detoxification and preventing relapse. The latter is the key for successful treatment. Although surgical measures, like stereotactic ablation of nucleus accumbens （NAc）, had already been proven to be effective for relapse prevention clinically, the application was restricted because of the damage to brain tissues. Deep brain stimulation （DBS）, which had been successfully applied in movement disorders, was recently performed in addiction studies on both animals and humankind. Among numbers of brain areas related to addiction, NAc is the hottest target studied and may bring better clinical effect. In addition, combining stimulation of multiple brain targets is currently performed for relapse prevention. The mechanism of DBS for treatment of addiction remains unclear right now, however, DBS may be an experimental method to treat refractory addictive patients. Certainly, lots of problems need to be solved in large sample study before the wide application of DBS for addiction treatment, such as the setting of stimulation parameters, recognition of objective treatment feedback and ethical issues.