Consent to deep brain stimulation for neurological and psychiatric disorders.
Identifieur interne : 000D45 ( PubMed/Checkpoint ); précédent : 000D44; suivant : 000D46Consent to deep brain stimulation for neurological and psychiatric disorders.
Auteurs : Walter Glannon [Canada]Source :
- The Journal of clinical ethics [ 1046-7890 ] ; 2010.
English descriptors
- KwdEn :
- Affect, Cognition, Cognition Disorders (etiology), Commitment of Mentally Ill, Decision Making (ethics), Deep Brain Stimulation (adverse effects), Deep Brain Stimulation (ethics), Hospitals, Psychiatric, Humans, Informed Consent (ethics), Informed Consent (psychology), Male, Mental Competency, Mental Disorders (therapy), Middle Aged, Narration, Nervous System Diseases (therapy), Obsessive-Compulsive Disorder (psychology), Obsessive-Compulsive Disorder (therapy), Parkinson Disease (physiopathology), Parkinson Disease (psychology), Parkinson Disease (therapy), Psychomotor Performance, Quality of Life, Withholding Treatment (ethics).
- MESH :
- adverse effects : Deep Brain Stimulation.
- ethics : Decision Making, Deep Brain Stimulation, Informed Consent, Withholding Treatment.
- etiology : Cognition Disorders.
- physiopathology : Parkinson Disease.
- psychology : Informed Consent, Obsessive-Compulsive Disorder, Parkinson Disease.
- therapy : Mental Disorders, Nervous System Diseases, Obsessive-Compulsive Disorder, Parkinson Disease.
- Affect, Cognition, Commitment of Mentally Ill, Hospitals, Psychiatric, Humans, Male, Mental Competency, Middle Aged, Narration, Psychomotor Performance, Quality of Life.
Abstract
Deep brain stimulation (DBS) of the globus pallidus interna and subthalamic nucleus has restored some degree of motor control in many patients in advanced stages of Parkinson's disease. DBS has also been used to treat dystonia, essential tremor (progressive neurological condition causing trembling), chronic pain, obsessive-compulsive disorder, Tourette's syndrome, major depressive disorder, obesity, cerebral palsy, and the minimally conscious state. Although the underlying mechanisms of the technique are still not clear, DBS can modulate underactive or overactive neural circuits and restore disrupted communication between and among groups of neurons in interacting regions of the brain.This can control and relieve many symptoms associated with a range of neurological and psychiatric disorders. But the procedures of implanting and stimulating the electrodes are brain-invasive and entail significant risks. Some patients receiving DBS have experienced intracerebral hemorrhage, infection, cognitive disturbances such as impulsive behavior, and affective disturbances such as mania. It is not known whether continuous electrical stimulation of the brain would reshape synaptic connectivity and permanently alter neural circuits in ways that may not be salutary. The risk of these effects indicates that DBS should be used only when a patient's condition is refractory to all other interventions and when there is a high probability that the technique will benefit the patient and improve his or her quality of life. If a patient's quality of life is poor and all other treatment options have been exhausted, then the likelihood of benefit can justify physicians' exposing patients to some risk. The clinical and ethical significance of the risk in DBS underscores the obligation of physicians to obtain fully informed consent from patients undergoing the procedure.
PubMed: 20866016
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DBS has also been used to treat dystonia, essential tremor (progressive neurological condition causing trembling), chronic pain, obsessive-compulsive disorder, Tourette's syndrome, major depressive disorder, obesity, cerebral palsy, and the minimally conscious state. Although the underlying mechanisms of the technique are still not clear, DBS can modulate underactive or overactive neural circuits and restore disrupted communication between and among groups of neurons in interacting regions of the brain.This can control and relieve many symptoms associated with a range of neurological and psychiatric disorders. But the procedures of implanting and stimulating the electrodes are brain-invasive and entail significant risks. Some patients receiving DBS have experienced intracerebral hemorrhage, infection, cognitive disturbances such as impulsive behavior, and affective disturbances such as mania. It is not known whether continuous electrical stimulation of the brain would reshape synaptic connectivity and permanently alter neural circuits in ways that may not be salutary. The risk of these effects indicates that DBS should be used only when a patient's condition is refractory to all other interventions and when there is a high probability that the technique will benefit the patient and improve his or her quality of life. If a patient's quality of life is poor and all other treatment options have been exhausted, then the likelihood of benefit can justify physicians' exposing patients to some risk. The clinical and ethical significance of the risk in DBS underscores the obligation of physicians to obtain fully informed consent from patients undergoing the procedure.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">20866016</PMID><DateCreated><Year>2010</Year><Month>09</Month><Day>27</Day></DateCreated><DateCompleted><Year>2010</Year><Month>10</Month><Day>20</Day></DateCompleted><DateRevised><Year>2010</Year><Month>09</Month><Day>27</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">1046-7890</ISSN><JournalIssue CitedMedium="Print"><Volume>21</Volume><Issue>2</Issue><PubDate><Year>2010</Year><Season>Summer</Season></PubDate></JournalIssue><Title>The Journal of clinical ethics</Title><ISOAbbreviation>J Clin Ethics</ISOAbbreviation></Journal><ArticleTitle>Consent to deep brain stimulation for neurological and psychiatric disorders.</ArticleTitle><Pagination><MedlinePgn>104-11</MedlinePgn></Pagination><Abstract><AbstractText>Deep brain stimulation (DBS) of the globus pallidus interna and subthalamic nucleus has restored some degree of motor control in many patients in advanced stages of Parkinson's disease. DBS has also been used to treat dystonia, essential tremor (progressive neurological condition causing trembling), chronic pain, obsessive-compulsive disorder, Tourette's syndrome, major depressive disorder, obesity, cerebral palsy, and the minimally conscious state. Although the underlying mechanisms of the technique are still not clear, DBS can modulate underactive or overactive neural circuits and restore disrupted communication between and among groups of neurons in interacting regions of the brain.This can control and relieve many symptoms associated with a range of neurological and psychiatric disorders. But the procedures of implanting and stimulating the electrodes are brain-invasive and entail significant risks. Some patients receiving DBS have experienced intracerebral hemorrhage, infection, cognitive disturbances such as impulsive behavior, and affective disturbances such as mania. It is not known whether continuous electrical stimulation of the brain would reshape synaptic connectivity and permanently alter neural circuits in ways that may not be salutary. The risk of these effects indicates that DBS should be used only when a patient's condition is refractory to all other interventions and when there is a high probability that the technique will benefit the patient and improve his or her quality of life. If a patient's quality of life is poor and all other treatment options have been exhausted, then the likelihood of benefit can justify physicians' exposing patients to some risk. The clinical and ethical significance of the risk in DBS underscores the obligation of physicians to obtain fully informed consent from patients undergoing the procedure.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Glannon</LastName><ForeName>Walter</ForeName><Initials>W</Initials><AffiliationInfo><Affiliation>Department of Philosophy, University of Calgary, Calgary, Alberta. wglannon@ucalgary.ca</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><Agency>Canadian Institutes of Health Research</Agency><Country>Canada</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Clin Ethics</MedlineTA><NlmUniqueID>9114645</NlmUniqueID><ISSNLinking>1046-7890</ISSNLinking></MedlineJournalInfo><CitationSubset>E</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000339" MajorTopicYN="N">Affect</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003071" MajorTopicYN="N">Cognition</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003072" MajorTopicYN="N">Cognition Disorders</DescriptorName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003134" MajorTopicYN="N">Commitment of Mentally Ill</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003657" MajorTopicYN="Y">Decision Making</DescriptorName><QualifierName UI="Q000941" MajorTopicYN="N">ethics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D046690" MajorTopicYN="Y">Deep Brain Stimulation</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000941" MajorTopicYN="N">ethics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006778" MajorTopicYN="N">Hospitals, Psychiatric</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007258" MajorTopicYN="Y">Informed Consent</DescriptorName><QualifierName UI="Q000941" MajorTopicYN="N">ethics</QualifierName><QualifierName UI="Q000523" MajorTopicYN="N">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016743" MajorTopicYN="Y">Mental Competency</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001523" MajorTopicYN="N">Mental Disorders</DescriptorName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D033262" MajorTopicYN="N">Narration</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009422" MajorTopicYN="N">Nervous System Diseases</DescriptorName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009771" MajorTopicYN="N">Obsessive-Compulsive Disorder</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="N">psychology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D010300" MajorTopicYN="N">Parkinson Disease</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName><QualifierName UI="Q000523" MajorTopicYN="N">psychology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011597" MajorTopicYN="Y">Psychomotor Performance</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011788" MajorTopicYN="N">Quality of Life</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D028761" MajorTopicYN="N">Withholding Treatment</DescriptorName><QualifierName UI="Q000941" MajorTopicYN="N">ethics</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2010</Year><Month>9</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2010</Year><Month>9</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2010</Year><Month>10</Month><Day>21</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">20866016</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Canada</li></country></list><tree><country 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