A Complex Intervention with Striking Results – A Word from the Chair of Hinnovic
While few of us may be aware of what Deep Brain Stimulation (DBS) is, its description can only strike everyone’s imagination, provoking either enthusiasm or suspicion. Why? Perhaps because like other medical interventions that are technologically as well as clinically impressive, DBS affects what one may see in it.
While searching for images for this dossier, Patrick Vachon, our technician, found a website that is, I have to admit, somewhat surprising because it simulates through an interactive computer animation a surgery during which the visitor ‘assists’ a neurosurgeon in the implementation of a brain stimulator. The website hence displays in a bizarrely playful format an intervention that is neither mundane, nor accessible to everyone. The site is managed by Edheads, a not-for-profit American organization whose mission is to develop pedagogical web-based contents and tools for teachers and their students. Sara Widing, from the Department of Neurosurgery of the Ohio State University Medical Center, acted as the scientific director of this project, which was partly funded by Medtronic Inc. This American company is specialized in the development and commercialization of medical devices and is currently the only supplier of the electrodes required to perform DBS.
Despite those caveats, the website is worth a visit, because it shows very clearly the complexity of the intervention and how it builds on an unprecedented accumulation of high tech devices (such as GPS, medical imaging, sterilization procedures, electrophysiological techniques). Furthermore, one can notice with the naked eye that, for certain medical conditions, impressive results may be achieved by comparing the patient symptoms before and after the surgery. This kind of images thus bring forward the likely gains in quality of life for patients.
One may also better understand the strong conviction with which some researchers and clinicians are promoting DBS; it is under their own eyes that such progress is taking place, progress they might not have had hoped to see happened in the course of their own career. In fact, while some patients may experience physically and morally demanding situations that affect their relatives as well, for a number of clinical conditions, the clinician’s therapeutic arsenal may be limited.
Hence, in front of such striking demonstrations, is it possible not to be moved and amazed? Isn’t it legitimate to seek to discover other applications for which DBS could generate outcomes that would be potentially as dramatic?
Reacting to such enthusiasm and aiming to ensure the quality and long-term safety of treatments, several researchers ask for prudence, insist for gathering more evidence (going beyond what isolated clinical cases make visible) and suggest to closely monitor the frenetic search for new therapeutic indications (in the domain of mental health for instance). Furthermore, when such an impressive technological arsenal is required to treat one patient at a time, clarifying who can access the treatment, at what cost and with what impact on other health care services becomes paramount.
|Author :||Pascale Lehoux, Ph.D.|