A single case report of STN-DBS for severe crack-cocaine dependence: double-blind ON vs. SHAM randomized controlled assessment

Florence Vorspan; Philippe Domenech; David Grabli; Jérôme Yelnik; Marine Delavest; Charles Dauré; Frank Bellivier; Antoine Pelissolo; Hayat Belaid; Christelle Baunez; Carine Karachi; Luc Mallet

doi:10.3389/fpsyt.2023.1146492

A single case report of STN-DBS for severe crack-cocaine dependence: double-blind ON vs. SHAM randomized controlled assessment

Front Psychiatry. 2023 May 25:14:1146492. doi: 10.3389/fpsyt.2023.1146492. eCollection 2023.

Authors

Florence Vorspan^#^{1

2}, Philippe Domenech^#^{3

4}, David Grabli^{3

5}, Jérôme Yelnik³, Marine Delavest², Charles Dauré¹, Frank Bellivier^{1

2}, Antoine Pelissolo^{4

6}, Hayat Belaid⁷, Christelle Baunez⁸, Carine Karachi^{3

7}, Luc Mallet^{3

4

9}

Affiliations

¹ Université de Paris Cité, INSERM UMRS 1144, Paris, Île-de-France, France.
² Assistance Publique - Hôpitaux de Paris, GHU NORD, GH Lariboisière-Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, Île-de-France, France.
³ Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM U1127, CNRS UMR 7225, Paris, Île-de-France, France.
⁴ Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Créteil, France.
⁵ Assistance Publique - Hôpitaux de Paris, GHU Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Neurologie, Paris, Île-de-France, France.
⁶ Université Paris-Est Créteil, Créteil, Ile-de-France, France.
⁷ Assistance Publique - Hôpitaux de Paris, GHU Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Neurochirurgie, Paris, Île-de-France, France.
⁸ UMR7289 CNRS & Aix-Marseille Université, Marseille, Provence-Alpes-Côôte-d'Azur, France.
⁹ Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland.

^# Contributed equally.

Abstract

Crack-cocaine dependence is a severe condition with a high mortality rate. This single case study report details the first deep brain stimulation (DBS) trial targeting the sub-thalamic nucleus (STN) for crack-cocaine dependence. The investigation aimed to assess the effects of STN-DBS on cocaine craving and cocaine use, as well as STN-DBS safety and tolerance in this indication. In this pilot study, we performed double blind cross-over trials, with "ON-DBS" vs. "SHAM-DBS" for 1-month periods. STN-DBS failed to reduce cocaine craving and use. An episode of DBS-induced hypomania occurred after several weeks of cocaine intake at stimulation parameters previously well tolerated. Future research on cocaine dependence should be conducted after a prolonged abstinence period and/or explore novel types of stimulation patterns.

Keywords: cocaine dependence; controlled clinical trial; crack-cocaine; deep brain stimulation; subthalamic nucleus.

Publication types

Case Reports

Grants and funding

This work was supported by Ministère de la Santé (France), PHRC-Régional 2011, AOR11036 to LM.