Surgeons treat opioid addict by surgically implanting electrodes in his brain
Brain surgeons have surgically implanted electrodes into the brain of an opioid addiction patient’s for the first time in the US.
West Virginia University (WVU) scientists believe that so-called deep brain stimulation can help ease cravings for the addictive and dangerous drugs.
Admittedly, they aren’t sure exactly how deep brain stimulation works to treat addiction.
But based on promising research using it to treat symptoms of Parkinson’s epilepsy and depression, the WVU team think that it may have to do with the neurotransmitter, dopamine, and interfere with the brain’s reward circuit.
The method has been attempted in Holland and China, but the researchers believe this is its first trial in the US – and so far, Gerod Buckhalter, 33, is recovering well, though the device is not yet turned on.
Led by Dr Ali Rezai (center), brain surgeons implanted electrode wire’s into the brain of 33-year-old Gerod Buckhalter (pictured right, on screen and awake for surgery) in a first-of-its-kind treatment for opioid addiction in the US
Over the course of the last decade, the patient, Gerod Buckhalter, has suffered multiple overdoses from his addiction to opioids and benzodiazepines.
The hotel employee told the Washington Post that he hasn’t spent more than four months sober since the age of 15.
He has tried inpatient and outpatient addiction treatment, with and without medication.
Nothing has worked. Buckhalter’s addiction is ‘treatment-resistant,’ in medical parlance.
About 2.1 million Americans were addicted to opioids by 2016, according to the latest data from the Substance Abuse and Mental Health Services Administration. That number has undoubtedly swollen as the epidemic has persisted.
For most of those people, attempts to break the addiction will fail at least once, but ultimately once.
A small subset exhaust all options.
‘Despite our best efforts using current, evidence-based treatment modalities, there exist a number of patients who simply don’t respond,’ said Dr James Berry, director of the school’s addiction services.
And there are many addiction patients to see in West Virginia, which has the highest rate of opioid addictions and overdoses of any state in the US.
Gerod Buckhalter was wheeled into surgery at WVU on November 1, 2019
Before inserting it into Buckhalter’s brain, Dr Rezai examines one of the electrodes for deep brain stimulation
Scans show the electrode wires that neurosurgeons fed into Buckhalter’s nucleus accumbens to act like a ‘brain pacemaker’ (left). The electrodes will deliver ‘deep brain’ stimulation, so-called because of the nucleus accumbens’ location in the center of the brain (right)
‘Some of these patients remain at very high risk for ongoing catastrophic health problems and even death.’
But Dr Ali Rezai and his team at WVU want to add brain surgery to the end of the list of treatment options.
They call the operation a ‘brain pacemaker’ surgery.
Dr Rezai and his neurosurgical team cut a hole, about the size of a nickel into the Buckhalter’s skull while he was under anesthesia, according to the Washington Post.
Once the bit of bone was removed, they lightened the anesthesia, waking him up so they check that none of the procedure interfered with Buckhalter’s cognitive functions, speech or any other normal brain activty.
Buckhalter lay awake during the surgery so that doctors could monitor his speech and cognition as well as the electrical activity in his brain
Buckhalter has struggled with addiction to opioids and benzodiazepines since he was 15. He, his parents and the WVU team hope deep brain stimulation might at last help him break free
They then fed electrode wires through the hole into the ‘deep brain’ – specifically, the nucleus accumbens, a hub for information about past experiences and, therefore, addiction in the brain.
Much like a heart pacemaker, the wires can then deliver regular, tiny shocks to the brain. In response, the brain fires back shots of dopamine, a ‘feel good’ neurotransmitter.
Opioids make their way through the blood-brain barrier to the nucleus accumbens and kick off a cascade of processes that triggers the release of more dopamine, flooding it with pleasure.
And when the drug is gone – in withdrawals – the brain feels starved for dopamine until an addict gets their next fix.
The hope is that the electrodes will keep Buckhalter’s brain pumping steady, healthy doses of dopamine out, rather than the wild addiction swing from feast to famine and back again.
‘Addiction is a brain disease involving the reward centers in the brain, and we need to explore new technologies, such as the use of DBS, to help those severely impacted by opioid use disorder,’ said Dr Rezei.
Brain surgery is certainly no minor intervention, and would be far from a first line therapy, but for the hardest to treat addiction patients, like Buckhalter, it might offer hope where there was none.