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Charles B. Mikell, Saurabh Sinha and Sameer A. Sheth

DBS of the VS modulates dopaminergic transmission at ~D m receptors. We have previously proposed that the effects of DBS of the VS are consistent with stabilization of dopamine transmission. 81 This mechanism could also account for its therapeutic effects in MDD 89 and addiction. 59 , 60 Moreover, error-related negativity, a marker of reward prediction error by the dopamine system, 45 is decreased by VS DBS in alcoholism. 59 Given these findings, VS would be a reasonable target for neuromodulation in schizophrenia; a possible mechanism of action would be

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Patrick J. Karas, Charles B. Mikell, Eisha Christian, Mark A. Liker and Sameer A. Sheth

reduction in drug-seeking behaviors following DBS. Müller and colleagues reported a pilot study of 5 patients who received bilateral nucleus accumbens DBS for chronic alcoholism. 142 Two of the 5 patients were abstinent for at least 5 years following DBS and the remaining 3 had marked decreases in their alcohol consumption. One patient had a 2-week hypomanic episode that resolved after changes in stimulation settings. Of note, they also reported that 1 patient agreed to additional studies; when the DBS was turned off, the patient experienced increased risky behavior