Cenolli Ilona, Campbell Tiffany A, Dorfman Natalie, Hurley Meghan, Smith Jared N, Kostick-Quenet Kristin, Storch Eric A, Blumenthal-Barby Jennifer, Lázaro-Muñoz Gabriel
Harvard Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA.
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA.
AJOB Empir Bioeth. 2025 Jan-Mar;16(1):32-41. doi: 10.1080/23294515.2024.2399519. Epub 2024 Sep 9.
Deep brain stimulation (DBS) is approved under a humanitarian device exemption to manage treatment-resistant obsessive-compulsive disorder (TR-OCD) in adults. It is possible that DBS may be trialed or used clinically off-label in children and adolescents with TR-OCD in the future. DBS is already used to manage treatment-resistant childhood dystonia. Evidence suggests it is a safe and effective intervention for certain types of dystonia. Important questions remain unanswered about the use of DBS in children and adolescents with TR-OCD, including whether mental health clinicians would refer pediatric patients for DBS, and who would be a good candidate for DBS.
To explore mental health clinicians' views on what clinical and psychosocial factors they would consider when determining which children with OCD would be good DBS candidates.
In depth, semi-structured interviews were conducted with = 25 mental health clinicians who treat pediatric patients with OCD. The interviews were transcribed, coded, and analyzed using thematic content analysis. Three questions focused on key, clinical, and psychosocial factors for assessing candidacy were analyzed to explore respondent views on candidacy factors. Our analysis details nine overarching themes expressed by clinicians, namely the patient's previous OCD treatment, OCD severity, motivation to commit to treatment, presence of comorbid conditions, family environment, education on DBS, quality of life, accessibility to treatment, and patient age and maturity.
Clinicians generally saw considering DBS treatment in youth as a last resort and only for very specific cases. DBS referral was predominantly viewed as acceptable for children with severe TR-OCD who have undertaken intensive, appropriate treatment without success, whose OCD has significantly reduced their quality of life, and who exhibit strong motivation to continue treatment given the right environment. Appropriate safeguards, eligibility criteria, and procedures should be discussed and identified before DBS for childhood TR-OCD becomes practice.
深部脑刺激（DBS）已根据人道主义器械豁免获得批准，用于治疗成人难治性强迫症（TR - OCD）。未来，DBS有可能在患有TR - OCD的儿童和青少年中进行临床试验或超说明书使用。DBS已被用于治疗难治性儿童肌张力障碍。有证据表明，它对某些类型的肌张力障碍是一种安全有效的干预措施。关于DBS在患有TR - OCD的儿童和青少年中的使用，仍有一些重要问题未得到解答，包括心理健康临床医生是否会将儿科患者转诊接受DBS治疗，以及谁会是DBS的合适候选人。
探讨心理健康临床医生对于在确定哪些患有强迫症的儿童是DBS的合适候选人时会考虑哪些临床和心理社会因素的看法。
对25名治疗患有强迫症的儿科患者的心理健康临床医生进行了深入的半结构化访谈。访谈内容被转录、编码，并使用主题内容分析法进行分析。分析了三个关注评估候选人资格的关键、临床和心理社会因素的问题，以探讨受访者对候选人资格因素的看法。我们的分析详细阐述了临床医生表达的九个总体主题，即患者先前的强迫症治疗情况、强迫症严重程度、接受治疗的动机、共病情况、家庭环境、DBS相关教育、生活质量、治疗可及性以及患者年龄和成熟度。
临床医生普遍认为，将DBS治疗用于青少年是最后的手段，且仅适用于非常特殊的情况。对于患有严重TR - OCD且经过强化、适当治疗但未成功、其强迫症已显著降低生活质量且在合适环境下表现出强烈继续治疗动机的儿童，DBS转诊主要被视为可接受的。在儿童TR - OCD的DBS治疗成为常规做法之前，应讨论并确定适当的保障措施、资格标准和程序。
