Scientific and ethical issues related to deep brain stimulation for disorders of mood, behavior, and thought.

CONTEXT A 2-day consensus conference was held to examine scientific and ethical issues in the application of deep brain stimulation for treating mood and behavioral disorders, such as major depression, obsessive-compulsive disorder, and Tourette syndrome. OBJECTIVES The primary objectives of the conference were to (1) establish consensus among participants about the design of future clinical trials of deep brain stimulation for disorders of mood, behavior, and thought and (2) develop standards for the protection of human subjects participating in such studies. RESULTS Conference participants identified 16 key points for guiding research in this growing field. CONCLUSIONS The adoption of the described guidelines would help to protect the safety and rights of research subjects who participate in clinical trials of deep brain stimulation for disorders of mood, behavior, and thought and have further potential to benefit other stakeholders in the research process, including clinical researchers and device manufactures. That said, the adoption of the guidelines will require broad and substantial commitment from many of these same stakeholders.

[1]  B. Greenberg,et al.  Anatomy and physiology of the basal ganglia: Implications for DBS in psychiatry , 2008, Neuroscience & Biobehavioral Reviews.

[2]  M R DeLong,et al.  The primate subthalamic nucleus. III. Changes in motor behavior and neuronal activity in the internal pallidum induced by subthalamic inactivation in the MPTP model of parkinsonism. , 1994, Journal of neurophysiology.

[3]  Thomas E Schlaepfer,et al.  Deep brain stimulation for treatment of refractory depression , 2005, The Lancet.

[4]  P. Appelbaum,et al.  The MacArthur Treatment Competence Study. III , 1995, Law and human behavior.

[5]  J. Gybels,et al.  Effects of electrical stimulation or lesion in nucleus accumbens on the behaviour of rats in a T-maze after administration of 8-OH-DPAT or vehicle , 2003, Behavioural Brain Research.

[6]  G. Friehs,et al.  Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience , 2010, Molecular Psychiatry.

[7]  P. Larson.  Deep brain stimulation for psychiatric disorders , 2011, Neurotherapeutics.

[8]  E. Brown.  Last resort: psychosurgery and the limits of medicine , 1999, Medical History.

[9]  B Bioulac,et al.  Reversal of Rigidity and Improvement in Motor Performance by Subthalamic High‐frequency Stimulation in MPTP‐treated Monkeys , 1993, The European journal of neuroscience.

[10]  A. Lozano,et al.  Deep Brain Stimulation for Treatment-Resistant Depression , 2005, Neuron.

[11]  J. Obeso,et al.  Subthalamotomy improves MPTP-induced parkinsonism in monkeys. , 1994, Stereotactic and functional neurosurgery.

[12]  A. Lozano,et al.  Subcallosal Cingulate Gyrus Deep Brain Stimulation for Treatment-Resistant Depression , 2008, Biological Psychiatry.

[13]  B. Greenberg,et al.  Psychosurgery: avoiding an ethical redux while advancing a therapeutic future. , 2006, Neurosurgery.

[14]  M. Jenike.  Neurosurgical treatment of obsessive-compulsive disorder , 1998, British Journal of Psychiatry.

[15]  Michael S Okun,et al.  Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder , 2006, Neuropsychopharmacology.

[16]  D J Kupfer,et al.  Competence of depressed patients for consent to research. , 1999, The American journal of psychiatry.

[17]  M. Kao.  A new mode of percutaneous upper thoracic phenol sympathicolysis: report of 50 cases. , 2002, Neurosurgery.

[18]  L. Price,et al.  A 40-year follow-up of patients with obsessive compulsive disorder , 2002, European Psychiatry.

[19]  Michael X. Cohen,et al.  Deep Brain Stimulation to Reward Circuitry Alleviates Anhedonia in Refractory Major Depression , 2008, Neuropsychopharmacology.

[20]  R. Alterman,et al.  Deep brain stimulation for torsion dystonia in children , 2007, Child's Nervous System.

[21]  V. Visser-Vandewalle,et al.  Surgery in Tourette syndrome , 2004, Movement disorders : official journal of the Movement Disorder Society.

[22]  Clement Hamani,et al.  Neural stimulation successfully treats depression in patients with prior ablative cingulotomy. , 2008, The American journal of psychiatry.

[23]  T. Rummans,et al.  Decisional Capacity of Severely Depressed Patients Requiring Electroconvulsive Therapy , 2003, The journal of ECT.

[24]  P. Rabins,et al.  Psychiatric and neuropsychiatric adverse events associated with deep brain stimulation: A meta‐analysis of ten years' experience , 2007, Movement disorders : official journal of the Movement Disorder Society.

[25]  B. Nuttin,et al.  Applicants for stereotactic neurosurgery for psychiatric disorders: role of the Flemish advisory board , 2008, Acta psychiatrica Scandinavica.

[26]  Bradley S. Peterson,et al.  Course of Tic Severity in Tourette Syndrome: The First Two Decades , 1998, Pediatrics.

[27]  R. Pinkerton,et al.  Willingness and competence of depressed and schizophrenic inpatients to consent to research. , 2004, The journal of the American Academy of Psychiatry and the Law.

[28]  D. Dunner,et al.  Clinical and differential diagnostic aspects of treatment-resistant depression. , 1995, Journal of psychiatric research.

[29]  H. Mayberg.  Modulating dysfunctional limbic-cortical circuits in depression: towards development of brain-based algorithms for diagnosis and optimised treatment. , 2003, British medical bulletin.

[30]  R. Maciunas,et al.  Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome , 2007, Movement disorders : official journal of the Movement Disorder Society.

[31]  E. Valenstein.  Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness , 1987, Psychological Medicine.

[32]  M. Robertson,et al.  Deep brain stimulation in 18 patients with severe Gilles de la Tourette syndrome refractory to treatment: the surgery and stimulation , 2007, Journal of Neurology, Neurosurgery, and Psychiatry.

[33]  J. Gybels,et al.  Deep brain stimulation for treatment‐refractory obsessive‐compulsive disorder: psychopathological and neuropsychological outcome in three cases , 2003, Acta psychiatrica Scandinavica.

[34]  G. Friehs,et al.  Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder , 2006, Neuropsychopharmacology.

[35]  Thomas Wichmann,et al.  Circuits and circuit disorders of the basal ganglia. , 2007, Archives of neurology.

[36]  Jeffrey M Albert,et al.  Prospective randomized double-blind trial of bilateral thalamic deep brain stimulation in adults with Tourette syndrome. , 2007, Journal of neurosurgery.

[37]  S. Rauch,et al.  Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues. , 2003, Neurosurgery clinics of North America.