Ethical Focal Points in the International Practice of Deep Brain Stimulation

摘要

Deep brain stimulation (DBS) is a standard therapy for several movement disorders, and the list of further indications that are investigated is growing rapidly. We performed two surveys among DBS experts (n1 D 113) and centers (n2 D 135) to identify ethical focal points in the current global practice of DBS. The data indicate a mismatch between the patients' fears and the frequencies of the suspected side effects, a significant "satisfaction gap," signs of improvements of outcome, habituation effects in terms of involved disciplines, a growing spectrum of novel indications that partly conflicts with the experts' success probability ratings, and differences in the density of supply between countries that might affect the future development of DBS. We formulate ethical recommendations with regard both to patient-related practices (e.g., recruitment, assurance of alternatives) and to institutional development (e.g., measures for quality assurance and for the development of novel DBS indications).