In December 2018, researchers at Sunnybrook were the first in North America to begin a clinical trial investigating the use of deep brain stimulation (DBS) for the treatment of alcohol use disorder (AUD).
One year later, Dr. Nir Lipsman, principal investigator of the study and director of Sunnybrook’s Harquail Centre for Neuromodulation, and Dr. Benjamin Davidson, study co-investigator, PhD student and neurosurgical resident at Sunnybrook, who are part of the team behind this innovative research into treatment-resistant chronic alcohol dependence, reflect on the trial and its progress so far.
How can DBS help treat a person with severe alcohol use disorder?
Dr. Lipsman: Since the 1980s, DBS has been used to help treat movement disorders such as Parkinson’s disease. It’s a neurosurgical procedure that involves implanting electrodes in the brain to affect abnormal activity in specific brain circuits. It’s been described as a ‘pacemaker for the brain.’
The area of the brain that we are targeting in this trial is the nucleus accumbens, which is involved in addiction as well as mood and anxiety. In treatment-resistant AUD, these brain circuits are not functioning properly. The goal with DBS is to directly stimulate the specific neural pathways that aren’t functioning, to reset them and the broader network driving these conditions.
Dr. Davidson: Often patients with AUD have also been diagnosed with depression or other mood disorders. Directly influencing the related brain circuitry could impact both of these disorders and lead to improvements in alcohol consumption and mood, and potentially with overall treatment.
How have trial participants responded so far to DBS?
Dr. Lipsman: So far, we have treated three patients in the trial and they have tolerated the procedure well. The first person in Canada to receive DBS for treatment-resistant AUD, Dr. Frank Plummer, a world-renowned researcher, wrote about his experience. We are happy to see Frank doing well and will continue to monitor his progress. This positive feedback drives our team’s passion forward in the discovery of innovative treatments to help patients today and in the future.
Is DBS a cure for AUD?
Dr. Nir Lipsman: It’s important to understand that DBS is not a cure for AUD. Our trial is in the early days of investigating the safety and efficacy of DBS as part of a larger strategy, in combination with other therapies, to treat this highly complex condition. While we are encouraged by results so far, there is still more research that needs to be done.
Where does the research go from here?
Dr. Davidson: Our research in this phase 1 study continues as we investigate the safety and efficacy of DBS for treatment resistant chronic alcohol dependence. What follows could include a larger study to include more participants and a greater examination of DBS as a potential next generation treatment for patients diagnosed with treatment resistant AUD.
For more information about trial eligibility, contact Sachie Sharma at harquailcentre@sunnybrook.ca
