Nucleus accumbens: a systematic review of neural circuitry and clinical studies in healthy and pathological states.
Level 3 - non-randomized controlled study
Systematic review synthesizing heterogeneous human neuroimaging studies and small interventional neuromodulation cohorts (not limited to randomized trials).
PubMed 35901682 · doi:10.3171/2022.5.JNS212548
What was done
Authors searched PubMed, Embase, and Scopus for human studies evaluating nucleus accumbens (NAcc) neural circuitry or neuromodulation with sample sizes greater than 5 patients. Extracted variables included study aims, designs, durations, participant demographics, neurocircuitry characteristics, and clinical outcomes.
What was found
Across 3,591 retrieved articles, 123 were included. Qualitative synthesis showed that NAcc corticolimbic connections (notably with the prefrontal cortex) mediate reward and pain processing, with distinct functional circuitry between core and shell subregions. Neuromodulation studies reported favorable outcomes in addiction/substance misuse, obsessive-compulsive disorder, and mood disorders. The most common complications were impaired memory or concentration, alongside hypomania as a notable serious adverse event. No pooled quantitative effect sizes, response rates, or statistical estimates were reported in the abstract. Clinical studies exhibited substantial heterogeneity in stereotactic coordinates, postoperative confirmation techniques, and blinded trial designs.
Why it matters
This review maps human NAcc connectivity and summarizes clinical neuromodulation outcomes, highlighting both therapeutic promise in refractory psychiatric disorders and the need for standardized stereotactic targeting and safety monitoring.
Limits
The abstract reports no numerical outcome data, pooled effect sizes, or confidence intervals. Included studies were marked by significant methodological heterogeneity, variable indirect targeting coordinates, and potential risk of bias from very small cohort sizes (minimum inclusion threshold was n > 5).
Cited by
- partial Addiction leads to disconnection or severing of large neuronal pathways between deep limbic structures (like the nucleus accumbens and ventral tegmental area) and the prefrontal cortex.