Deep Brain Stimulation

Deep Brain Stimulation – it sounds like something sinister out of a horror film; but this little-known about therapeutic technique is more widely used than you might think. Deep Brain Simulation is a method that has been used to successfully treat a number of conditions including Parkinson’s, depression and Obsessive Compulsive Disorder (OCD). The mechanisms of its work are not very well understood, but despite this it has been approved for the treatment of a variety of conditions since 1997. By sending electrical impulses via implanted electrodes to specific regions of the brain, it has shown to be effective in treating a number of disorders.

Perhaps the most well characterised and treated condition is Parkinson’s disease, a neurodegerative disorder that results in loss of muscular control, uncontrolled tremors and a general loss of body movement. Whilst not able to completely cure Parkinson’s, Deep Brain Stimulation has been used to effectively manage many of the symptoms, improving the patients overall quality of life.

Elsewhere, Deep Brain Stimulation has been used in the treatment of Tourette’s syndrome – characterised for its “tic” behaviour and obsessive compulsive behaviours. Despite early success, Deep Brain Stimulation has as yet proved to be only partially successful – a lack of experimental evidence means that whilst trials are ongoing, we cannot be sure that it will be a viable and worthwhile treatment method.

Perhaps most controversially, Deep Brain Stimulation has been proposed for the treatment of mental illness. For many people, this is where the ethical controversy begins. For others, this is a natural extension of the treatments already on offer.

What exactly is the big issue? For one thing, Deep Brain Stimulation has the potential to dramatically alter a person’s state of mind – side effects can include temporary depression, hallucinations and dizziness amongst other conditions. Whilst these may all be temporary, the treatment, though somewhat destructive, is potentially acceptable if successful; yet a major issue arises when you consider Deep Brain Stimulation for treating mental illness for a whole host of reasons.

Firstly, many people with mental illnesses will understandably be unable to make a logical and informed choice about the treatment. Does this mean that we should treat people even if they cannot give informed consent? A traditional example might be medical treatment for someone who is unconscious – whilst they cannot give an indication as to whether they would like treatment, it is generally accepted practice by medical practitioners to help them anyway. If you have a mentally ill patient who cannot think for themselves, would it be ethically correct to treat them? This would obviously depend on a number of factors; chiefly the effectiveness of the treatment and its possible side-effects. But this raises an important question: is it right to fundamentally take away someone’s autonomy?

Another key consideration is whether or not the treatment can be considered to be safe. The use of Deep Brain Stimulation has proved effective for many disorders including Parkinson’s, but it comes with a very serious health risk. A recent study put the risk of infection between 2-8%, haemorrhaging at 2%, and numerous psychological problems such as memory impairment and depression at anywhere from 2-25%! For many, such as Maartje Schemer of the University of Rotterdam, Netherlands, this risk is sufficiently high that it should only be used when all other options have been exhausted. An incredibly invasive procedure, the use of Deep Brain Stimulation should be considered a last resort – other treatment methods: drugs, psychotherapy, etc., should all be used as a first measure.

Perhaps most pressing is the issue of personal identity. Though rather difficult to explain as a concept, a useful definition of personal identity, according to Schetchtman, is a person’s “self-perception, biography, values and sense of self.” Essentially: “Who Am I?” In the last few years, a number of psychological tests have been developed to try and understand and measure changes in people’s personal identity, yet it is for obvious reasons incredibly difficult to quantify. How for example, can you determine if a change in someone’s political opinion has been triggered by a neurological event resulting from Deep Brain Stimulation, or a news broadcast that they have watched?

Finally, whilst not much discussed, an important topic is access. Who decides whether a patient with Parkinson’s is more deserving of treatment over someone with severe depression, or OCD? With the cost of treatment very high, how can fair and the most helpful decisions be made? From a perspective of justice, it might be argued that priority be given to those who have the most severe ailment – but that might be of little solace to someone ignored but suffering of depression who has tried everything else, found no effective treatment, and is desperate for help.

Overall, Deep Brain Stimulation provides an interesting ethical conundrum. On the one hand, it has the potential to successfully treat many patients suffering from particular neurological and mental problems, but with the associated risks and sketchy ethics, is it a risk worth taking?

#JonathanJames #Health #DeepBrainStimulation