Electrographic cue-reactivity co-localizes with accumbens deep brain stimulation in a case of opioid use disorder

Opioid use disorder (OUD) is a significant public health concern, with over 30% of the affected population not responding to available treatments. Severe OUD is characterized by drug-cue reactivity that has been reported to predict treatment failure. We leveraged this pathophysiological feature to optimize deep brain stimulation (DBS) of the nucleus accumbens region (NAc) in a male patient with OUD. A personalized drug-cue-reactivity task was administered while recording NAc electrophysiology from a lead externalized for clinical purposes. We identified a drug-cue-evoked electrophysiological signal in the ventral NAc that was associated with an elevated craving state and attenuated with stimulation delivered to the same area. This electrophysiological biomarker, along with behavioral assessments, informed the re-programming of DBS to a more focal and effective stimulation site. This resulted in sustained suppression of drug-related cravings. This study represents a proof-of-principle for a personalized, biomarker-informed neuromodulation strategy in OUD.