AbstractBackgroundPharmaco-psychiatric techniques remain the mainstay, first line treatments in substance use disorders (SUD), assisting in detoxification but largely ineffective at reducing dependence. The path to rehabilitation and freedom from addiction often proves uncertain and laborious for both patients and their significant others.

摘要背景药物精神病学技术仍然是物质使用障碍（SUD）的主要一线治疗方法，有助于排毒，但在减少依赖方面基本无效。对于患者及其重要他人来说，康复和摆脱成瘾的道路往往不确定且费力。

Relapse rates for multiple substances of abuse are considerable and the number of SUD patients is on the increase worldwide.ObjectiveTo assess efficacy of deep brain stimulation (DBS) as a therapeutic solution for SUDs.MethodsA systematic electronic database search of PubMed and EMBASE retrieved DBS addiction-focused studies on humans, of which a total of 26 (n = 71) from 2007 to 2023 were deemed eligible, including the first randomized controlled trial (RCT) in this field.

多种滥用药物的复发率相当高，全世界SUD患者的数量正在增加。目的评估深部脑刺激（DBS）作为SUD治疗方案的疗效。方法对PubMed和EMBASE进行系统的电子数据库搜索，检索以DBS成瘾为重点的人类研究，其中2007年至2023年共有26项（n=71）被认为符合条件，包括该领域的第一项随机对照试验（RCT）。

This review was prospectively registered with PROSPERO: CRD42023411631.ResultsIn addressing SUDs, DBS targeting primarily the nucleus accumbens (NAcc), with or without the anterior limb of the internal capsule, presented encouraging levels of efficacy in reducing cravings and consumption, followed by remission in some subjects, but still reporting relapses in 73.2% of patients.ConclusionsFor treatment-refractory addictions DBS use seems limited to reducing cravings with a satisfactory degree of success, yet not clinically consistent in inducing abstinence, suggesting involvement of factors unaffected by DBS intervention.

这篇综述前瞻性地在PROSPERO注册：CRD42023411631。结果在解决SUD时，主要针对伏隔核（NAcc）的DBS，无论是否有内囊前肢，在减少渴望和消耗方面表现出令人鼓舞的疗效水平，随后在一些受试者中缓解，但仍有73.2%的患者报告复发。结论对于治疗难治性成瘾，DBS的使用似乎仅限于减少渴望，取得了令人满意的成功程度，但在诱导戒断方面临床上并不一致，这表明涉及不受DBS干预影响的因素。

Furthermore, costs and the scale of the problem are such that DBS is unlikely to have a significant societal impact. Nevertheless, DBS may provide insight into the biology of addiction and is worthy of further research using increased methodological rigor, standardized outcome measures, and pre-established surgical protocols..

此外，成本和问题的规模使得DBS不太可能产生重大的社会影响。然而，DBS可以提供对成瘾生物学的深入了解，值得进一步研究，使用更严格的方法学，标准化的结果测量和预先建立的手术方案。。

IntroductionSubstance addiction is a chronic relapsing disorder, with compulsive behaviors for seeking and consuming substances that cause dependence, persisting regardless of negative consequences [1]. It encompasses an element of impulsivity, and is defined as “a failure to resist an impulse, drive or temptation to perform an act that is harmful to the person or others” [2].

简介物质成瘾是一种慢性复发性疾病，具有寻求和消费导致依赖的物质的强迫行为，无论负面后果如何，都会持续存在（1）。它包含冲动的因素，被定义为“未能抵抗冲动，驱动或诱惑来执行对人或他人有害的行为”〔2〕。

Addiction is a functional brain pathology demonstrating behavioral anomalies when interacting with the substance of abuse, characterized by progressively less controllable compulsions, resulting in deleterious physiological and psychosocial consequences. Frequent, careless and irresponsible use of the substance causes refocusing of priorities that privilege the addiction over duties and other activities [3].The social burden of addictionOn a global scale, substance use disorders (SUDs) are a leading contributor to morbidity and mortality, generating severe health concerns and significant hardship for those afflicted by the addiction and their significant others [4].

成瘾是一种功能性脑部病理学，在与滥用物质相互作用时表现出行为异常，其特征是逐渐难以控制的强迫，导致有害的生理和心理社会后果。频繁，粗心和不负责任地使用该物质会导致优先事项的重新集中，使成瘾优先于职责和其他活动（3）。成瘾的社会负担在全球范围内，物质使用障碍（SUDs）是导致发病率和死亡率的主要因素，对那些受成瘾影响的人及其重要他人产生严重的健康问题和重大困难。

A 2020 US national survey found that 38.7 million individuals suffered from a SUD [5]. Substances commonly subject to abuse and the creation of dependence include alcohol, opioids, cocaine, nicotine, amphetamines, methamphetamines, cannabis, hallucinogens, sedatives and tranquilizers [2]. In the West, 25% of deaths are connected to use of psychotropic substances.

2020年美国全国调查发现，3870万人患有SUD（5）。通常受到滥用和产生依赖的物质包括酒精、阿片类药物、可卡因、尼古丁、苯丙胺、甲基苯丙胺、大麻、致幻剂、镇静剂和镇静剂。。

Worldwide, 284 million individuals aged between 15 and 64 abused drugs in 2020 [6, 7]. 21st century US victims of drug overdose are over 1 million. In 2021, 88% of them were ascribed to synthetic opioids, namely fentanyl [8]. In the EU, heroin is the major cause of drug-induced fatalities [9, 10] but a shift towards fentanyl, the main cause of the US opioid epidemic, is noted .

2020年，全球有2.84亿年龄在15至64岁之间的人滥用药物[6，7]。21世纪美国吸毒过量受害者超过100万。2021年，其中88%归因于合成阿片类药物，即芬太尼（8）。在欧盟，海洛因是药物引起死亡的主要原因[9，10]，但注意到芬太尼是美国阿片类药物流行的主要原因。

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Download referencesFundingThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Author informationAuthors and AffiliationsUniversity of Edinburgh, Clinical & Surgical Sciences, Edinburgh, UKDavid Zammit Dimech & Audrey-Ann Zammit DimechCentre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UKMark HughesUCL Institute of Neurology, Functional Neurosurgery Unit, Department of Clinical & Motor Neurosciences, University College London, London, UKLudvic ZrinzoAuthorsDavid Zammit DimechView author publicationsYou can also search for this author in.

下载参考文献资助这项研究没有从公共，商业或非营利性部门的资助机构获得任何特定资助。作者信息作者和附属机构爱丁堡大学，临床与外科科学，爱丁堡，英国David Zammit Dimech＆Audrey Ann Zammit DimechCentre for Clinical Brain Sciences，爱丁堡大学，爱丁堡，英国马克·休斯UCL神经病学研究所，功能神经外科，临床与运动神经科学系，伦敦大学学院，伦敦，UKLudvic ZrinzoAuthorsDavid Zammit DimechView作者出版物您也可以在中搜索这位作者。

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PubMed Google ScholarContributionsDZD: study concept and design, literature search and data acquisition, analysis and interpretation of data, manuscript drafting. AAZD: study concept and design, literature search and data acquisition, analysis and interpretation of data, manuscript drafting.

PubMed谷歌学术贡献SDZD：研究概念和设计，文献检索和数据采集，数据分析和解释，手稿起草。AAZD：研究概念和设计，文献检索和数据采集，数据分析和解释，手稿起草。

MH: supervision, manuscript revision. LZ: analysis and interpretation of data, supervision, manuscript revision.Corresponding authorCorrespondence to.

MH：监督，稿件修订。LZ：数据分析和解释，监督，稿件修订。对应作者对应。

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大卫·扎米特·迪梅奇。道德宣言

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Reprints and permissionsAbout this articleCite this articleZammit Dimech, D., Zammit Dimech, AA., Hughes, M. et al. A systematic review of deep brain stimulation for substance use disorders.

转载和许可本文引用本文Zammit Dimech，D.，Zammit Dimech，AA。，Hughes，M。等人对物质使用障碍的深部脑刺激的系统评价。

Transl Psychiatry 14, 361 (2024). https://doi.org/10.1038/s41398-024-03060-1Download citationReceived: 30 March 2024Revised: 19 August 2024Accepted: 22 August 2024Published: 06 September 2024DOI: https://doi.org/10.1038/s41398-024-03060-1Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

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