Joe Kennelly places a device next to Frank Plummer’s shoulder that turns his deep brain stimulation on and off on December 10, 2019. Fred Lum/The Globe and Mail
In a pilot study, Toronto researchers found they were able to safely reduce hunger and alcohol consumption in people 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 circuit disorder.
“This is a brain disease that requires a brain treatment,” said principal investigator Nir Lipsman, a neurosurgeon and director of the Harquail Neuromodulation Center at Sunnybrook Health Sciences Center. “For many patients, it was also a confirmation to hear that their condition is indeed driven by circuits in the brain that are pathological, and that in highly selected populations there may be an emerging treatment option.”
In their phase 1 study, the researchers gave deep brain stimulation to six participants with severe alcohol use disorder for whom other forms of treatment had not worked and followed them for a year. The researchers reported that all six had a decline in alcohol-related euphoria, meaning reduced alcohol intake among all and sustained reductions 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 per day over the previous 28 days, had decreased to 2.7 from 10.4.
Deep brain stimulation, sometimes described as a pacemaker for the brain, is widely used to treat 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 on treatment-resistant alcohol use disorder in North America.
Treatment involves surgically implanting electrodes in the brain, as well as a battery that powers them under the collarbone. For this study, the 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 involvement helped shine a light on alcohol use disorder, which is often stigmatized.
However, much more research is needed 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. Patients generally tolerated it well, but one participant developed an infection about 12 months after surgery and the electrodes and battery were removed.
Approximately 10 per cent of Canadians have an alcohol use disorder, which is considered a spectrum from mild, where people 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 associate professor at the University of Saskatchewan College of Medicine.
Dr Butt, who was not involved in the study, said the research should inform how the condition is treated, beyond deep brain stimulation, as patients typically 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 expand how we look at this,” Dr. Butt said, “and maybe how we think about treating it over a longer period of time with more individualized approaches.”
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