Jo Kennelly places a device beside Frank Plummer's shoulder that turns his deep brain stimulation on and off on Dec 10 2019.Fred Lum/the Globe and Mail
In a pilot study, Toronto researchers found they were able to safely reduce alcohol cravings and consumption in individuals with severe alcohol use disorder by treating them with deep brain stimulation.
Their findings, published in the journal Molecular Psychiatry on Thursday, add support to the view that alcohol use disorder is a brain circuitry disorder.
“It’s a brain disease requiring a brain treatment,” said principal investigator Nir Lipsman, a neurosurgeon and director of the Harquail Centre for Neuromodulation at Sunnybrook Health Sciences Centre. “For many patients, it was validating as well to hear that their condition is, indeed, driven by circuits in the brain that are pathological, and that in highly select populations there may be an emerging treatment option.”
In their phase 1 trial, the researchers delivered deep brain stimulation to six participants with severe alcohol use disorder, for whom other forms of treatments had not worked, and followed them over a year. The researchers reported all six experienced a decline in the euphoric sensation associated with alcohol, which translated to reduced alcohol intake among all, and a sustained reduction in alcohol consumption among five of them.
At their 12-month follow-up, the participants’ alcohol consumption, measured as the average number of standard alcoholic drinks a day over the past 28 days, declined to 2.7 from 10.4.
Deep brain stimulation, sometimes described as a pacemaker for the brain, is widely used for the treatment of movement disorders, such as Parkinson’s disease. It is increasingly being studied for other conditions, including post-traumatic stress disorder and anorexia nervosa, but this study is the first to examine its effects for treatment-resistant alcohol use disorder in North America.
The treatment involves surgically implanting electrodes into the brain, as well as a battery pack that powers them under the collarbone. For this study, researchers targeted the nucleus accumbens, a structure that plays an important role in the reward system.
One of the participants was the late Frank Plummer, a renowned Canadian microbiologist, who died of a condition unrelated to this study in February, 2020. His participation helped shed light on alcohol use disorder, which is often stigmatized.
Much more research is needed, however, before deep brain stimulation can be used as a treatment for alcohol use disorder, Dr. Lipsman said. And there is a risk of side effects. Overall, patients tolerated it well, but one participant developed an infection about 12 months after surgery and the electrodes and battery pack were removed.
An estimated 10 per cent of Canadians have alcohol use disorder, which is considered a spectrum, from mild, where individuals may binge but still have an element of control over their drinking, to moderate and severe, where they progressively lose control, according to Peter Butt, an expert on the disorder and an associate professor with the college of medicine at the University of Saskatchewan.
Dr. Butt, who was not involved in the study, said the research should inform the way the disorder is treated, beyond deep brain stimulation, as typically patients receive inadequate support for too short a period. Treatment should be more like that for stroke or acquired brain injury, where it’s a team approach using multimodal interventions, he said.
“I think it helps to broaden out the way we look at this,” Dr. Butt said, “and perhaps how we think about treating it over a longer period of time with more individualized approaches.”
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