These uncertainties about factors that contribute to occurrences of behavioural, cognitive and psychiatric complications after DBS may impede a full risk assessment of the procedure and create challenges for the selection of patients and the management of their expectations.
There have also been observations of patients facing social adaptation challenges after DBS surgery. Difficulties in accepting the fact that they have lost years of their lives to illness or in living with their new selves have been reported. One study showed that 65% of married patients who had undergone surgery experienced a conjugal crisis after DBS (Agid et al, 2006) and another one demonstrated that 33% of spouses had depression following their partner’s surgery (Schupbach et al, 2006).
This goes to show how mixed the success of DBS can be. Little attention has been devoted to these issues. Yet they are not negligible and even less so if DBS is extended to neuropsychiatric disorders where serious consequences may be anticipated in the psychosocial adjustment of patients over the long term. That is why, it becomes urgent “(…) to more systematically characterize cognitive and behavioural changes after DBS and its social impacts” (Bell, 2009: 584).
This text summarises the ethical issues related to deep brain stimulation, developed and discussed in an excellent publication by Emily Bell, Ghislaine Mathieu and Eric Racine. (2009). Preparing the ethical future of deep brain stimulation. Surgical Neurology, 72: 577-586. The summary has been approved by the first author.
Adapted by :Myriam Hivon, Ph.D.
REFERENCES
Bell E, Mathieu G, Racine E (2009). Preparing the ethical future of deep brain stimulation. Surgical Neurology, 72: 577-586.
Agid Y, Schupbach M, Gargiulo M, et al. (2006). Neurosurgery in Parkinson’s disease: the doctor is happy, the patient less so? J Neural Transm Suppl. 70: 409-14.
Schupbach M, Gargiulo M, Welter ML, et al. (2006) Neurosurgery in Parkinson disease: a distressed mind in a repaired body? Neurology 66:1811-6.