Deep brain stimulation in the management of disorders of consciousness: a review of physiology, previous reports, and ethical considerations

2010 ◽  
Vol 29 (2) ◽  
pp. E14 ◽  
Author(s):  
Anish N. Sen ◽  
Peter G. Campbell ◽  
Sanjay Yadla ◽  
Jack Jallo ◽  
Ashwini D. Sharan
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Daily Practice ◽  
Disorders Of Consciousness ◽  
Ethical Considerations ◽  
Physiological Mechanisms ◽  
Future Directions ◽  
Ethical Concerns ◽  
Minimally Conscious ◽  
Deep Brain

Patients suffering from disorders of consciousness constitute a population that exists largely outside of the daily practice patterns of neurosurgeons. Historically, treatment has focused on nursing and custodial issues with limited neurosurgical intervention. Recently, however, deep brain stimulation has been explored to restore cognitive and physical function to patients in minimally conscious states. In this article, the authors characterize the physiological mechanisms for the use of deep brain stimulation in persistently vegetative and minimally conscious patients, review published cases and associated ethical concerns, and discuss future directions of this technology.

scholarly journals Deep Brain Stimulation for Tremor: Update on Long-Term Outcomes, Target Considerations and Future Directions

2021 ◽  
Vol 10 (16) ◽  
pp. 3468
Author(s):  
Naomi I. Kremer ◽  
Rik W. J. Pauwels ◽  
Nicolò G. Pozzi ◽  
Florian Lange ◽  
Jonas Roothans ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Focused Ultrasound ◽  
Neurosurgical Procedures ◽  
Drug Resistant ◽  
Long Term Outcomes ◽  
Future Directions ◽  
Ventral Intermediate Nucleus ◽  
Deep Brain

Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus is one of the main advanced neurosurgical treatments for drug-resistant tremor. However, not every patient may be eligible for this procedure. Nowadays, various other functional neurosurgical procedures are available. In particular cases, radiofrequency thalamotomy, focused ultrasound and radiosurgery are proven alternatives to DBS. Besides, other DBS targets, such as the posterior subthalamic area (PSA) or the dentato-rubro-thalamic tract (DRT), may be appraised as well. In this review, the clinical characteristics and pathophysiology of tremor syndromes, as well as long-term outcomes of DBS in different targets, will be summarized. The effectiveness and safety of lesioning procedures will be discussed, and an evidence-based clinical treatment approach for patients with drug-resistant tremor will be presented. Lastly, the future directions in the treatment of severe tremor syndromes will be elaborated.

Ethical considerations in deep brain stimulation for psychiatric illness

2020 ◽  
pp. 247-251
Author(s):  
Ryan A. Grant ◽  
Casey H. Halpern ◽  
Gordon H. Baltuch ◽  
John P. O’Reardon ◽  
Arthur L. Caplan
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Psychiatric Illness ◽  
Ethical Considerations ◽  
Deep Brain

scholarly journals Deep Brain Stimulation at End of Life: Clinical and Ethical Considerations

2020 ◽  
Vol 23 (4) ◽  
pp. 582-585
Author(s):  
Lauren R. Sankary ◽  
Paul J. Ford ◽  
Andre G. Machado ◽  
Laura J. Hoeksema ◽  
Renato V. Samala ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
End Of Life ◽  
Brain Stimulation ◽  
Ethical Considerations ◽  
Deep Brain

scholarly journals Deep-Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes

2020 ◽  
Vol 10 (12) ◽  
pp. 925
Author(s):  
Christian Iorio-Morin ◽  
Anton Fomenko ◽  
Suneil K. Kalia
Keyword(s):  
Multiple Sclerosis ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Zona Incerta ◽  
Future Directions ◽  
Ventral Intermediate Nucleus ◽  
Prevalent Symptom ◽  
Multiple Conditions ◽  
Deep Brain

Tremor is a prevalent symptom associated with multiple conditions, including essential tremor (ET), Parkinson’s disease (PD), multiple sclerosis (MS), stroke and trauma. The surgical management of tremor evolved from stereotactic lesions to deep-brain stimulation (DBS), which allowed safe and reversible interference with specific neural networks. This paper reviews the current literature on DBS for tremor, starting with a detailed discussion of current tremor targets (ventral intermediate nucleus of the thalamus (Vim), prelemniscal radiations (Raprl), caudal zona incerta (Zi), thalamus (Vo) and subthalamic nucleus (STN)) and continuing with a discussion of results obtained when performing DBS in the various aforementioned tremor syndromes. Future directions for DBS research are then briefly discussed.

Pediatric Deep Brain Stimulation for Dystonia: Current State and Ethical Considerations

2020 ◽  
Vol 29 (4) ◽  
pp. 557-573
Author(s):  
KATRINA A. MUÑOZ ◽  
JENNIFER BLUMENTHAL-BARBY ◽  
ERIC A. STORCH ◽  
LAURA TORGERSON ◽  
GABRIEL LÁZARO-MUÑOZ
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
The United States ◽  
Childhood Onset ◽  
Ethical Considerations ◽  
Current State ◽  
Limited Effectiveness ◽  
Deep Brain

AbstractDystonia is a movement disorder that can have a debilitating impact on motor functions and quality of life. There are 250,000 cases in the United States, most with childhood onset. Due to the limited effectiveness and side effects of available treatments, pediatric deep brain stimulation (pDBS) has emerged as an intervention for refractory dystonia. However, there is limited clinical and neuroethics research in this area of clinical practice. This paper examines whether it is ethically justified to offer pDBS to children with refractory dystonia. Given the favorable risk-benefit profile, it is concluded that offering pDBS is ethically justified for certain etiologies of dystonia, but it is less clear for others. In addition, various ethical and policy concerns are discussed, which need to be addressed to optimize the practice of offering pDBS for dystonia. Strategies are proposed to help address these concerns as pDBS continues to expand.

scholarly journals Researcher Perspectives on Ethical Considerations in Adaptive Deep Brain Stimulation Trials

2020 ◽  
Vol 14 ◽  
Author(s):  
Katrina A. Muñoz ◽  
Kristin Kostick ◽  
Clarissa Sanchez ◽  
Lavina Kalwani ◽  
Laura Torgerson ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Ethical Considerations ◽  
Deep Brain
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