Glannon Walter
Department of Philosophy, University of Calgary, Calgary, Alberta.
J Clin Ethics. 2010 Summer;21(2):104-11.
Deep brain stimulation (DBS) of the globus pallidus interna and subthalamic nucleus has restored some degree of motor control in many patients in advanced stages of Parkinson's disease. DBS has also been used to treat dystonia, essential tremor (progressive neurological condition causing trembling), chronic pain, obsessive-compulsive disorder, Tourette's syndrome, major depressive disorder, obesity, cerebral palsy, and the minimally conscious state. Although the underlying mechanisms of the technique are still not clear, DBS can modulate underactive or overactive neural circuits and restore disrupted communication between and among groups of neurons in interacting regions of the brain.This can control and relieve many symptoms associated with a range of neurological and psychiatric disorders. But the procedures of implanting and stimulating the electrodes are brain-invasive and entail significant risks. Some patients receiving DBS have experienced intracerebral hemorrhage, infection, cognitive disturbances such as impulsive behavior, and affective disturbances such as mania. It is not known whether continuous electrical stimulation of the brain would reshape synaptic connectivity and permanently alter neural circuits in ways that may not be salutary. The risk of these effects indicates that DBS should be used only when a patient's condition is refractory to all other interventions and when there is a high probability that the technique will benefit the patient and improve his or her quality of life. If a patient's quality of life is poor and all other treatment options have been exhausted, then the likelihood of benefit can justify physicians' exposing patients to some risk. The clinical and ethical significance of the risk in DBS underscores the obligation of physicians to obtain fully informed consent from patients undergoing the procedure.
对内侧苍白球和丘脑底核进行深部脑刺激（DBS）已使许多帕金森病晚期患者恢复了一定程度的运动控制。DBS还被用于治疗肌张力障碍、特发性震颤（一种导致颤抖的进行性神经疾病）、慢性疼痛、强迫症、妥瑞氏综合征、重度抑郁症、肥胖症、脑瘫以及最低意识状态。尽管该技术的潜在机制仍不清楚，但DBS可以调节活跃不足或过度活跃的神经回路，并恢复大脑相互作用区域神经元群之间被破坏的通信。这可以控制和缓解与一系列神经和精神疾病相关的许多症状。但是植入和刺激电极的过程具有脑部侵入性，且存在重大风险。一些接受DBS治疗的患者出现了脑出血、感染、诸如冲动行为等认知障碍以及诸如躁狂等情感障碍。尚不清楚对大脑的持续电刺激是否会重塑突触连接并以可能无益的方式永久改变神经回路。这些影响的风险表明，只有当患者的病情对所有其他干预措施均无效，且该技术极有可能使患者受益并改善其生活质量时，才应使用DBS。如果患者的生活质量很差且所有其他治疗选择均已用尽，那么受益的可能性可以证明医生让患者承担一定风险是合理的。DBS风险的临床和伦理意义强调了医生有义务从接受该手术的患者那里获得充分知情同意。
