Observations on unaided smoking cessation after deep brain stimulation of the nucleus accumbens.
OBJECTIVE
We explore whether clinical research on deep brain stimulation (DBS) of the nucleus accumbens (NAc) to treat addiction is justified besides theoretical speculation.


METHODS
Since 2004, 10 patients who were also smokers were treated at the University of Cologne for Tourette's syndrome (TS), obsessive-compulsive disorders (OCD) or anxiety disorders (AD) by DBS of the NAc. We assessed their smoking behavior after DBS and (in retrospection) before by the Fagerstrom Test for Nicotine Dependence (FTND) and additional items.


RESULTS
Three male patients were able to quit smoking after DBS. They were less dependent and higher motivated compared to the rest of the sample. They are stimulated with a higher voltage. During 1-year, 2-year, and 30-month follow-ups, we found a higher rate of successful smoking cessation (20, 30 and 30%) compared to unaided smoking cessation in the general population (13, 19 and 8.7%).


CONCLUSIONS
Albeit the results of the study are severely limited by the method of retrospective self-assessment of psychiatric patients, further research of DBS of the NAc to treat addiction seems justified. In addition to biological mediators, psychosocial factors should be assessed in further prospective studies.
Kuhn
J
J
Department of Psychiatry and Psychotherapy, University of Cologne, DE-50937 Cologne, Germany. Jens.Kuhn@uk-koeln.de
Bauer
R
R
Pohl
S
S
Lenartz
D
D
Huff
W
W
Kim
E H
EH
Klosterkoetter
J
J
Sturm
V
V
D000328:Adult; D016739:Behavior, Addictive / Q000628:therapy; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009042:Motivation; D009714:Nucleus Accumbens; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome