Ineichen Christian, Baumann-Vogel Heide, Christen Markus
Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, Zurich 8006, Switzerland.
Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland.
Brain Sci. 2016 Sep 7;6(3):40. doi: 10.3390/brainsci6030040.
During the last 25 years, more than 100,000 patients have been treated with Deep Brain Stimulation (DBS). While human clinical and animal preclinical research has shed light on the complex brain-signaling disturbances that underpin e.g., Parkinson's disease (PD), less information is available when it comes to complex psychosocial changes following DBS interventions. In this contribution, we propose to more thoroughly investigate complex personality-related changes following deep brain stimulation through refined and reliable instruments in order to help patients and their relatives in the post-surgery phase. By pursuing this goal, we first outline the clinical importance DBS has attained followed by discussing problematic and undesired non-motor problems that accompany some DBS interventions. After providing a brief definition of complex changes, we move on by outlining the measurement problem complex changes relating to non-motor symptoms currently are associated with. The latter circumstance substantiates the need for refined instruments that are able to validly assess personality-related changes. After providing a brief paragraph with regard to conceptions of personality, we argue that the latter is significantly influenced by certain competencies which themselves currently play only a tangential role in the clinical DBS-discourse. Increasing awareness of the latter circumstance is crucial in the context of DBS because it could illuminate a link between competencies and the emergence of personality-related changes, such as new-onset impulse control disorders that have relevance for patients and their relatives. Finally, we elaborate on the field of application of instruments that are able to measure personality-related changes.
在过去25年里，超过10万名患者接受了深部脑刺激（DBS）治疗。尽管人类临床研究和动物临床前研究已经揭示了诸如帕金森病（PD）等疾病背后复杂的脑信号紊乱，但对于DBS干预后复杂的社会心理变化，我们了解得还比较少。在本论文中，我们建议通过更精细、可靠的工具，更全面地研究深部脑刺激后与人格相关的复杂变化，以帮助患者及其亲属度过术后阶段。为实现这一目标，我们首先概述了DBS所具有的临床重要性，接着讨论了一些DBS干预伴随的有问题的、不良的非运动问题。在简要定义了复杂变化之后，我们继续概述目前与非运动症状相关的复杂变化所涉及的测量问题。后一种情况证实了需要能够有效评估与人格相关变化的精细工具。在简要介绍了人格概念之后，我们认为人格受到某些能力的显著影响，而这些能力目前在DBS临床讨论中仅处于边缘地位。在DBS背景下，提高对后一种情况的认识至关重要，因为这可能揭示能力与人格相关变化的出现之间的联系，比如新出现的对患者及其亲属有影响的冲动控制障碍。最后，我们详细阐述了能够测量与人格相关变化的工具的应用领域。
