Deep brain Stimulation for Addiction.

Addiction is a highly prevalent and chronic relapsing disease with severe negative consequences for patients, their environment and society. Not all patients respond to the currently available interventions and therefore additional treatments are needed to help those refractory patients.

Deep brain stimulation (DBS) has shown to be effective in different neurological and psychiatric diseases. Both animal research and observational human studies provide compelling evidence for the potential efficacy of DBS in patients with a substance disorder. DBS of the nucleus accumbens (NAc) is compatible with our neurobiological understanding of addiction based on extensive experimental animal and human research.
This research project aims to establish the feasibility, safety, and potential efficacy of NAc DBS in 8 patients with a chronic, treatment refractory heroin and/or cocaine addiction. Additionally the functional effects of DBS will be explored in several ways; by imaging methods such as fMRI and by neuropsychological testing. Changes found in these three areas will be associated with clinical outcome parameters.

Deep brain stimulation of the nucleus accumbens decreases drug use and craving in treatment refractory heroin and/or cocaine dependence.

1. Baseline (0);

2. After optimalization (1);

3. Phase 1 cross-over trail (2);

4. Phase 2 cross-over trail (3);

5. Maintanence phase (4).

Treatment by means of deep brain stimulation of the nucleus accumbens area. Deep brain stimulation (DBS) is a neurosurgical intervention in which implanted electrodes deliver electrical pulses to stereotactically targeted areas of
the brain. The treatment will be given as long as necessary, which might mean their whole lives.
For the research phase there will be a double blinded cross over phase once the DBS has been optimized (between 3-12 months after surgery). In this phase first the DBS will be stay ON or put OFF for 2-6 weeks after which the assessments will take place and secondly the setting of the DBS is reversed (ON/OFF) for 2-6 weeks and again followed by assessments. The order of ON/OFF or OFF/ON will be randomized. Patients will serve as their own controls: assessments of ON condition will be compared to assessments with OFF condition. Both researcher and patients are blind for DBS setting during trail.