Early application of deep brain stimulation: clinical and ethical aspects

Abstract

Deep brain stimulation (DBS) has proven to be a successful therapeutic approach in several patients with movement disorders such as Parkinson's disease and dystonia. Hitherto its application was mainly restricted to advanced disease patients resistant to medication or with severe treatment side effects. However, there is now growing interest in earlier application of DBS, aimed at improving clinical outcomes, quality of life, and avoiding psychosocial consequences of chronic disease-related impairments. We address the clinical and ethical aspects of two "early" uses of DBS, (1) DBS early in the course of the disease, and (2) DBS early in life (i.e. in children). Possible benefits, risks and burdens are discussed and thoroughly considered. Further research is needed to obtain a careful balance between exposing vulnerable patients to potential severe surgical risks and excluding them from a potentially good outcome.

Keywords: CP; Children; DBS; Deep brain stimulation; Dystonia; ELSA-DBS; Ethics; GPi; Movement disorders; NBIA; PD; PED; PKAN; Parkinson's disease; STn; cerebral palsy; deep brain stimulation; ethical, legal and social aspects of deep brain stimulation; globus pallidus pars interna; neurodegeneration with brain iron accumulation; nucleus subthalamicus; pantothenate kinase associated neurodegeneration; paroxysmal exercise induced dystonia.