The Development Of Deep Brain Stimulation For Neurological And Psychiatric Disorders Clinical Societal And Ethical Issues

To date more than eighty thousand patients worldwide have received deep brain stimulation (DBS), mainly in order to alleviate symptoms of treatment-resistant disorders such as tremor associated with Parkinson’s disease, essential tremor, chronic pain, epilepsy, obsessive compulsive disorder, major depression and Tourette syndrome. The number of indications for neurological and psychiatric conditions using this technology is rapidly increasing, raising important societal and ethical issues that cannot be dealt with by scientists and clinicians on their own, but need discussions among all possible stakeholders on questions such as: what are the comprehensive risks and benefits of this technology? what is the real impact on patients’ life, in terms of health, quality of life and personal identity? This Research Topic provides an overview of potentials and limitations of deep brain stimulation as used to treat neurological and psychiatric conditions, bringing together Mini Reviews, Perspectives and Opinion papers from key stakeholders interested in the development and social impact of this technology. It is also a continuation of the debate that started among scientists, clinicians, patients, sociologists, journalists, philosophers and other experts during the “brains in dialogue on deep brain stimulation” workshop that was organized in September 2010 in Warsaw, Poland, by the FP7 project bid – brains in dialogue (www.neuromedia.eu) coordinated by the Interdisciplinary Laboratory of SISSA (Trieste, Italy).

This important book discusses today’s most current and cutting-edge applications of Deep Brain Stimulation (DBS). The book begins with reviews of the functional anatomy and physiology of motor and nonmotor aspects of the basal ganglia and their connections which underlie the application of DBS to neurological and psychiatric disorders. This is followed by proposed mechanisms of action of DBS based on functional neuroimaging and neurophysiologic studies in animals and man.

Neuromodulation is among the fastest-growing areas of medicine, involving many diverse specialties and affecting hundreds of thousands of patients with numerous disorders worldwide. It can briefly be described as the science of how electrical, chemical, and mechanical interventions can modulate the nervous system function. A prominent example of neuromodulation is deep brain stimulation (DBS), an intervention that reflects a fundamental shift in the understanding of neurological and psychiatric diseases: namely as resulting from a dysfunctional activity pattern in a defined neuronal network that can be normalized by targeted stimulation. The application of DBS has grown remarkably and more than 130,000 patients worldwide have obtained a DBS intervention in the past 30 years—most of them for treating movement disorders. This Frontiers Research Topics provides an overview on the current discussion beyond basic research in DBS and other brain stimulation technologies. Researchers from various disciplines, who are working on broader clinical, ethical and social issues related to DBS and related neuromodulation technologies, have contributed to this research topic.

The electrifying, forgotten history of Robert Heath's brain pacemaker, investigating the origins and ethics of one of today's most promising medical breakthroughs: deep brain stimulation The technology invented by psychiatrist Robert G. Heath in the 1950s and '60s has been described as among the most controversial experiments in US history. His work was alleged at the time to be part of MKUltra, the CIA's notorious "mind control" project. His research subjects included incarcerated convicts and gay men who wished to be "cured" of their sexual preference. Yet his cutting-edge research and legacy were quickly buried deep in Tulane University's archives. Investigative science journalist Lone Frank now tells the complete sage of this passionate, determined doctor and his groundbreaking neuroscience. More than fifty years after Heath's experiments, this very same treatment is becoming mainstream practice in modern psychiatry for everything from schizophrenia, anorexia, and compulsive behavior to depression, Parkinson's, and even substance addiction. Lone Frank uncovered lost documents and accounts of Heath's trailblazing work. She tracked down surviving colleagues and patients, and she delved into the current support for deep brain stimulation by scientists and patients alike. What has changed? Why do we today unquestioningly embrace this technology as a cure? How do we decide what is a disease of the brain to be cured and what should be allowed to remain unrobed and unprodded? And how do we weigh the decades of criticism against the promise of treatment that could be offered to millions of patients? Elegantly written and deeply fascinating, The Pleasure Shock weaves together biography, scientific history, and medical ethics. It is an adventure into our ever-shifting views of the mind and the fateful power we wield when we tinker with the self.

The consideration of ethical and social issues related to current uses of deep brain stimulation (DBS) as well as investigational uses should now be an integral part of contemporary DBS practice. Scholarship, interdisciplinary work groups, and peer processes have helped articulate standards that need to be respected and implemented in current DBS practice. Integrating new knowledge and interdisciplinary ethical perspectives could be considered a sign of the maturity and rigor of a DBS program. Still, investigational uses of DBS carry tremendous hope but also touch on sensitive and thorny ethical questions. These questions can benefit from the ethical wisdom generated for standard uses of DBS but also challenge current practices and professional conduct. Realizing this, interdisciplinary expert groups have been convened to identify and flesh out ethical guideposts for cutting-edge research in DBS. By implementing these ethical frameworks, DBS is an opportunity to develop promising treatments for a set of vulnerable and sometimes underserved patients while keeping their best interests in sight.

This book provides a state-of-the-art overview of our current understanding of deep brain stimulation (DBS) for the treatment of neurological and psychiatric disorders. With a broad multidisciplinary scope, it presents contributions from leading experts in the field from Europe and America, who share not only their knowledge, but their experience as well. The book focuses both on basic and theoretical aspects of DBS, as well as clinical and practical aspects. It follows an evidence-based approach, and where possible offers clinical recommendations based on published guidelines. It starts with a general section, which discusses basic principles and general considerations. This is followed a sections dedicated to neurological disorders, and psychiatric disorders, in which only accepted indications are discussed. All experimental indications are discussed in the final chapter. The text is supplemented with numerous illustrations. Intended for medical specialists and residents involved in the treatment of patients with DBS, it also appeals to other professionals working with DBS patients, such as psychologists, nurses, physiotherapists, as well as basic and clinical neuroscientists.

Deep Brain Stimulation: A New Frontier in Psychiatry provides an overview of current developments and the future possibilities of deep brain stimulation for patients with therapy-refractory psychiatric disorders. The side-by-side presentation of clinical applications and animal research provides a truly translational approach. Also included is a special chapter on the ethical issues involved in deep brain stimulation in psychiatry. Deep brain stimulation of selected brain areas has been shown to result in a substantial improvement of symptoms and quality of life in patients suffering from obsessive-compulsive disorder, major depressive disorder and drug addiction. Although it is still an experimental therapy and the number of psychiatric patients that are treated is low, its effectiveness and safety makes deep brain stimulation the most promising therapy for treating other serious and life-threatening psychiatric conditions.

Euromodulation is among the fastest-growing areas of medicine, involving many diverse specialties and affecting hundreds of thousands of patients with numerous disorders worldwide. It can briefly be described as the science of how electrical, chemical, and mechanical interventions can modulate the nervous system function. A prominent example of neuromodulation is deep brain stimulation (DBS), an intervention that reflects a fundamental shift in the understanding of neurological and psychiatric diseases: namely as resulting from a dysfunctional activity pattern in a defined neuronal network that can be normalized by targeted stimulation. The application of DBS has grown remarkably and more than 130,000 patients worldwide have obtained a DBS intervention in the past 30 years--most of them for treating movement disorders. This Frontiers Research Topics provides an overview on the current discussion beyond basic research in DBS and other brain stimulation technologies. Researchers from various disciplines, who are working on broader clinical, ethical and social issues related to DBS and related neuromodulation technologies, have contributed to this research topic.