Neurosurgery in the Treatment of Alcohol Use Disorder: A Systematic Literature Review

Alcohol abuse has impacts on public health worldwide. Conservative treatment to achieve abstinence consists of detoxification combined with psychotherapy and the use of drugs, but it is estimated that only half of the individuals achieve long-term abstinence with the available treatments. In this sense, neurosurgery appears as a therapeutic proposal. The present study aimed to gather information about the circuitry related to alcohol use disorder (AUD), to describe possible surgical targets, and to establish whether a surgical approach could be a safe and effective treatment option. A systematic review of the literature was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The 14 selected articles analyze ablative operations, deep brain stimulation (DBS), and a new procedure in which the patient is first submitted to repetitive transcranial magnetic stimulation to evaluate their response, and later an implant is surgically positioned on the evaluated target to obtain more lasting results. The most relevant outcomes were found when the anterior cingulate cortex (ACC) and the nucleus accumbens (NAcc) were used as targets, demonstrating a large reduction in alcohol intake and even its cessation. However, important side effects were observed, such as psychotic symptoms, right frontal venous infarction, seizures after implantation in the ACC and a hypomanic period after DBS in the NAcc, which could be reversed. Due to the lack of studies involving the surgical treatment of AUD, more clinical trials are needed to compare targets, to assess surgical techniques, and to estimate the safety of these techniques.

Distúrbios psiquiátricos relacionados ao álcool associados a diagnósticos de clínica médica e/ou intervençöes cirúrgicas, atendidos num hospital geral / Psychiatric disorders related to alcohol and associated to general clinical medical diagnoses and/or surgical interventions of patients admitted in a general hospital

Através de um inquérito epidemiológico, buscou-se detectar as co-morbidades dos diagnósticos psiquiátricos relacionados ao álcool. Para tanto, investigou-se os atendimentos num Hospital de Urgências Médicas no Setor de Psiquiatria, no período de 1988 a 1991, tendo por objetivo identificar quais as doenças clínicas e outros incidentes que acometem a populaçäo referida. Fizeram parte do levantamento os diagnósticos relacionados ao álcool, conforme CID 9 (291; 303 e 305.0) e os associados à näo pertencentes à psiquiatria. Evidenciou-se no período, 1835 casos com diagnósticos relacionados ao álcool e destes 487 (26,5 por cento) se referiram aos grupos 291-303-305.0, associados à outros näo psiquiátricos. Desse total a maior frequência de casos ocorreu nos grupos 340-349 (Outros transtornos do SNC) e 800-859 (Lesöes e complicaçöes traumáticas) com 80 (16,4 por cento) atendimentos, respectivamente. Observando-se os dados por ano, constata-se que dos diagnósticos relacionados ao álcool (com diagnósticos clínicos associados) o 303 (Síndrome de Dependência Alcoólica) foi que teve maior número de atendimento com 326 (67 por cento) casos, seguido de 291 (Psicose Alcoólica) com 117 (24 por cento) e 305.0 (Alcool) com 44 (9 por cento). No período, tanto o diagnóstico psiquiátrico 303 como o 291, apareceram mais frequentemente associados ao grupo de diagnósticos clínicos 340-349, com 55 (11,2 por cento) e 12 (2.4 por cento) casos, respectivamente e o 305.0 teve o grupo 800-859 com 10 (2 por cento) casos, como o mais frequente.