Informed Consent Decision-Making in Deep Brain Stimulation

Abstract

Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson’s disease, essential tremor, dystonia), in which first and/or second line pharmacological treatments were inefficacious. Initial evidence of DBS efficacy exists for refractory obsessive-compulsive disorder, treatment-resistant major depressive disorder, and impulse control disorders. Ethical concerns have been raised about the use of an invasive surgical approach involving the central nervous system in patients with possible impairment in cognitive functioning and decision-making capacity. Most of the disorders in which DBS has been used might present with alterations in memory, attention, and executive functioning, which may have an impact on the mental capacity to give informed consent to neurosurgery. Depression, anxiety, and compulsivity are also common in DBS candidate disorders, and could also be associated with an impaired capacity to consent to treatment or clinical research. Despite these issues, there is limited empirical knowledge on the decision-making levels of these patients. The possible informed consent issues of DBS will be discussed by focusing on the specific treatable diseases.

The Patient's Perspective on Shared Decision-Making in Advanced Parkinson's Disease: A Cross-Sectional Survey Study

“…The latter applies to our population of people with advanced PD, of whom 72% had a disease duration of more than 10 years. One of the reasons for a less active role when disease progresses is that patients develop cognitive impairments which would limit their decision-making capacities (5, 18, 19). It is possible that, due to selection bias in our population, our respondents did not have cognitive deficits.…”

Trading Vulnerabilities: Living with Parkinson’s Disease before and after Deep Brain Stimulation

“…26 Patients receiving DBS for PD are informed about risks directly related to the surgery (infection and bleeding) or to potential device difficulties (malfunction, shifting wire leads, etc.). Attention has also been given to concerns about potential difficulties in understanding, appreciating, and retaining complicated medical information for people with a progressive neurological disorder like PD, 27 although we recognize dangers in labeling particular patient groups as "vulnerable" 28 . To the best our knowledge, relatively few DBS consent forms or processes include robust discussions regarding what are sometimes called psychosocial side effects, 29 although presurgical screening for personality or psychiatric conditions has become more common.…”

Deep brain stimulation and suicide attempts in treatment-resistant patients: a case report and neuroethical analysis

“…It underscores the imperative of meticulously apprising patients about this potential hazard. Moreover, there’s a need to recognize that informed consent may be susceptible to neurobiological biases, particularly in patients whose basal ganglia are altered because of neurodegenerative pathology, even before the permanent neuroanatomical implants of the DBS electrodes ( 9 ).…”