Ethical considerations in closed loop deep brain stimulation

Deep Brain Stimulation Pub Date : 2023-10-01 DOI:10.1016/j.jdbs.2023.11.001

Sunderland Baker , Eliz Fenstermacher , Rachel A. Davis , Drew S. Kern , John A. Thompson , Gidon Felsen , Alexander J. Baumgartner

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Abstract

Background

Closed-loop deep brain stimulation (DBS) uses feedback to infer a clinical state and adjust stimulation accordingly. This novel mechanism has several potential advantages over conventional DBS including reducing stimulation-induced side effects, improving battery longevity, and alleviating symptoms not optimally treated with standard protocols. However, several ethical challenges may arise with the implementation of this technology, particularly with respect to clinical decision making.

Objective

To discuss potential ethical and clinical dilemmas encountered in using closed-loop DBS for neurological and psychiatric disorders.

Methods

The relevant literature is reviewed and supplemented with discussion of ethically challenging clinical scenarios. We outline an ethical framework for addressing these issues and provide practical recommendations for clinicians and researchers.

Results

Ethical considerations in closed-loop DBS revolve around five key principles: 1) risk/benefit analysis; 2) inclusion and exclusion criteria; 3) respect for patient autonomy; 4) quality of life and patient benefit; and 5) concerns associated with recording neural activity.

Conclusion(s)

Developing and implementing a pragmatic framework for ethical considerations in closed-loop DBS will be critical as this technology is utilized in patients with both neurologic and psychiatric indications.

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闭环深部脑刺激的伦理考虑

闭环脑深部刺激(DBS)利用反馈来推断临床状态并相应地调整刺激。与传统的DBS相比，这种新机制有几个潜在的优势，包括减少刺激引起的副作用，延长电池寿命，减轻标准方案无法最佳治疗的症状。然而，随着这项技术的实施，特别是在临床决策方面，可能会出现一些伦理挑战。目的探讨应用闭环DBS治疗神经和精神疾病可能遇到的伦理和临床困境。方法回顾相关文献，并对具有伦理挑战性的临床场景进行讨论。我们概述了解决这些问题的伦理框架，并为临床医生和研究人员提供实用的建议。结果闭环星展银行的伦理考虑围绕五个关键原则展开:1)风险/收益分析;2)纳入和排除标准;3)尊重病人的自主权;4)生活质量和患者获益;开发和实施一个实用的框架来考虑闭环DBS的伦理问题将是至关重要的，因为这项技术将被用于有神经和精神适应症的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Deep Brain Stimulation

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