Abstract
The influence of bilateral deep brain stimulation (DBS) of the nucleus nucleus (NAcc) on the processing of reward in a gambling paradigm was investigated using H2[15O]-PET (positron emission tomography) in a 38-year-old man treated for severe alcohol addiction. Behavioral data analysis revealed a less risky, more careful choice behavior under active DBS compared to DBS switched off. PET showed win- and loss-related activations in the paracingulate cortex, temporal poles, precuneus and hippocampus under active DBS, brain areas that have been implicated in action monitoring and behavioral control. Except for the temporal pole these activations were not seen when DBS was deactivated. These findings suggest that DBS of the NAcc may act partially by improving behavioral control.
Highlights
Positive and negative reinforcement are assumed to be key mechanisms in the acquisition and maintenance of drug addiction [1]
To study how the deep brain stimulation (DBS) treatment impacts the processing of rewards in the brain, we examined this patient while he engaged in a gambling paradigm using H2[15O]-PET
Behavior DBS status had a marked effect on choice behavior and response speed
Summary
Positive and negative reinforcement are assumed to be key mechanisms in the acquisition and maintenance of drug addiction [1]. While negative reinforcement drives motivated behavior during withdrawal, positive reinforcement takes place during the early stages of addiction, where alcohol/drug intake leads to pronounced release of dopamine and assigns, via reward driven learning mechanisms, ‘‘incentive salience’’ to drug associated cues. These cues can elicit a strong and uncontrollable desire for a drug [2], resulting in cue-induced craving, one major reason for the high relapse rates in addiction treatment. Given the central position of the stimulation site within the reward processing matrix, we expected changes in blood flow in parts of this network and in distant cortical areas
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