Please select the eligibility criteria that correspond to the clinical trial below.
Title: Deep Brain Stimulation of the Nucleus Accumbens as a Novel Treatment in Severe Opioid Addiction
Brief Summary: The main objective of this study is to assess the efficacy of bilateral deep brain stimulation (DBS) of the Nucleus accumbens (NAc) as a novel treatment in severe opioid addiction. The included patients have been treated so far with a substitute in form of methadone.

Our hypothesis is that bilateral DBS of the NAc will significantly reduce the craving for heroin and thus enable the patients to decrease their Levomethadone-dosage substantially.


Options:
A: Inclusion Criteria:

* German speaking male/female subjects
* age:60-80
* AD assessed by DSM-IV, ICD-10 and NINCDS-ADRDA-Scale
* no Lewy-Body-dementia or other form of dementia
* MMST \>18 and \<26
* stable psychopharmacological medication
* no psychotic symptoms, no suicidal tendency
* education for at least 8 years
* written informed consent of the patient
* consent of at least two family members
* no contraindication regarding PET-examination
* no contraindication regarding anesthesia or stereotactic operation

Exclusion Criteria:

* legal accommodation
* clinical co-morbidity
* contraindication of MRT examination
* psychotic symptoms last six months
* aggressive behavior or suicidal tendency
* verbal IQ \<85
* stereotactic operation in previous history
* neoplastic neurological diseases
* serious organic disease
B: Inclusion Criteria:

* Age \> 18 years
* Proficiency in the German language
* Long lasting heroin addiction (fulfilled diagnostic-criteria according to DSM-IV,ICD-10)
* At least one detoxication-treatment without a long-term period of abstinence has already taken place
* Long-term inpatient treatment to support abstinence have occurred
* Free patient's decision / Informed Consent (existing comprehensive ability in meaning, methodology and execution of the study and ability of acceptance)
* If prior medication, stable dosage of psychopharmacological drugs over the last three months, which shall, after checking be retained during the study
* Substitution treatment with constant dose within the last three months before study inclusion

Exclusion Criteria:

* Hospitalization by PsychKG
* Clinical relevant psychiatric comorbidity (schizophrenic psychoses, bipolar affective diseases, severe personality disorder)
* Contraindications of a MRI-examination, e.g. implanted cardiac pacemaker/ heart defibrillator
* Current and in the last six months existent paranoid-hallucinated symptomatology
* Foreign aggressiveness in the last six months
* Verbal IQ \< 85 (evaluated with the German Mehrfachauswahl-Intelligenz-Test (MWT-A/B))
* Stereotactic respectively neurosurgical intervention in the past
* Neoplastical neurological diseases
* Contraindications of a stereotactic operation, e.g. increased bleeding-disposition, cerebrovascular diseases (e.g. arteriovenous malfunction, aneurysms, systemic vascular diseases)
* Serious and instable organic diseases (e.g. instable coronal heart disease)
* tested positively for HIV
* pregnancy and/or lactation
C: Inclusion Criteria:

* Must be 21+ years of age
* Diagnosis of Tourette Syndrome (TS) in accordance to the Diagnostic and Statistical Manual of Mental DIsorders (DSM-V) criteria
* Yale Global Tic Severity Scale (YGTSS) must be ≥35/50 for at least 12 months; Motor Tic subscore must be ≥15
* TS must be causing incapacitation with severe distress, self-injurious behavior, and/or quality of life disruption
* TS must be medication refractory. Criteria to determine if medication refractory is the exact criteria stated by Mink et. al TSA DBS Guidelines published in 2006: Subjects must have been treated by a psychiatrist or neurologist experienced in TS with therapeutic doses of either 1-4 mg/day of haloperidol or 2-8 mg/day of pimozide, risperidone (1-3 mg/day), and aripiprazole (2.5-5 mg/day). Must be at minimum a single trial with an alpha-2 adrenergic agonist (0.1-0.3 mg/day)
* Clinically relevant depression must be pharmacologically treated and deemed stable
* Must have been stabilized for 1 month on TS medication without a dose change prior to surgical intervention. If medication trials resulted in discontinuation of TS medications, the subject must be stabilized for 3 months off TS medicines
* Must be willing to keep TS related medications stable and unchanged throughout the trial
* Must have been offered habit reversal therapy/cognitive behavioral intervention therapy (HRT) if subject did not have it prior to enrollment. (Subjects not required to participate in HRT but it will be highly encouraged, and must be completed prior to start of this study's protocol. Those who improve significantly will be excluded from receiving DBS surgery)
* If tic is focal or addressable by botulinum toxin treatment, the study neurologist will offer to administer a trial of botulinum toxin prior to consideration of surgical therapy. (If the subject chooses not to have the treatment, they cannot participate in the study. If the patient responds satisfactorily and their quality of life significantly improves, they will be excluded)

Exclusion Criteria:

* Any previous neurological intervention including DBS or ablative brain lesions, any metal in the head, and any type of implanted stimulator
* Untreated or unstable anxiety, depression, bipolar disorder, or other Axis I psychiatric disorder
* Presence of psychotic features
* Significant psychosocial factors that can cause increased risk
* The presence of only simple motor tics, a movement disorder other than TS, or medication related movement disorders from TS medications
* Severe medical co-morbidity including cardiovascular disorder, lung disorder, kidney disease, chronic neurological disease, hematological disease, or frailty that impacts tolerability of the surgery as judged by the screening physicians
* Abnormal brain magnetic resonance imaging (MRI) scan, including severe atrophy, hydrocephalus, stroke, structural lesions, demyelinating lesions, or infectious lesions that would potentially confound the outcome or safety of the surgery as judged by the study neurosurgeon
* Dementia or cognitive dysfunction that will place the subject at risk for worsening cognition, and/or may impact the ability to cooperate with tasks involved in the study
* Any attempt or intent of suicide in the last 6 months
* Significant substance abuse or dependence within the last 6 months
* Multiple failed medication treatments of inadequate dose or duration
* History of noncompliance with previous medical and psychosocial treatment efforts
* Severe head banging tics
* Women of child-bearing potential who are pregnant or planning pregnancy (urine pregnancy test required)
* Positive urine drug screen for illicit substances (urine drug screen required)
* History of multiple surgical procedures with poor outcomes
* Unexplained gaps in medical history
* Pending lawsuits or other legal action
D: Inclusion Criteria:

* Patients must have a clinical diagnosis of probable idiopathic PD.
* Demonstrated response to dopaminergic therapy, defined as demonstrating at least 30% improvement in parkinsonian motor signs, based upon the UPDRS motor examination subscore, following the administration of their dopamine agonist (DA) drug(s) during the screening neurological examination.
* Hoehn and Yahr (H\&Y) stage II when OFF medication.
* No contraindications to surgery.
* Age between 50 and 75 years old.
* Available for follow-up for four years.
* Informed Consent: The subject understands the risks, benefits, and alternatives to the study procedures and participation in the study.
* MRI within normal range for age.
* Levodopa or dopamine agonist therapy for greater than six months but less than or equal to four years.

Exclusion Criteria:

* Evidence of an alternative diagnosis or secondary parkinsonism, as suggested by features unusual early in the clinical course: Prominent postural instability, freezing phenomena, or hallucinations unrelated to medications in the first 3 years after symptom onset; dementia preceding motor symptoms; supranuclear gaze palsy (other than restriction of upward gaze) or slowing of vertical saccades in the first year; severe, symptomatic dysautonomia unrelated to medications; documentation of a condition known to produce parkinsonism and plausibly connected to the subject's symptoms (such as suitably located focal brain lesions or neuroleptic use within the past 6 months)
* Uncontrolled medical condition or clinically significant medical disease that would increase the risk of developing pre- or postoperative complications (e.g., significant cardiac or pulmonary disease, uncontrolled hypertension).
* Evidence of dementia
* Major psychiatric disorder
* Previous brain operation or injury.
* Active participation in another clinical trial for the treatment of PD.
* Patients who have demand cardiac pacemakers or implantable cardioverter defibrillators (ICD's).
* Patients who have medical conditions that require repeat MRI scans or diathermy treatments.
* Evidence of existing dyskinesias or motor fluctuations.

Answer: B