Pressing ethical issues in considering pediatric deep brain stimulation for obsessive-compulsive disorder.
Pressing ethical issues in considering pediatric deep brain stimulation for obsessive-compulsive disorder.
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DOI：
10.1016/j.brs.2021.10.388
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发表时间：
2021-11
影响因子：
7.7
通讯作者：
Lázaro-Muñoz G
中科院分区：
文献类型：
--
作者：
Muñoz KA;Kostick K;Torgerson L;Zuk P;Kalwani L;Sanchez C;Blumenthal-Barby J;Storch EA;Lázaro-Muñoz G
成人难治性强迫症（OCD）是首个获得FDA人道主义器械豁免（HDE）的脑深部电刺激（DBS）精神适应症。鉴于HDE的批准和令人鼓舞的证据，DBS治疗强迫症的探索可能会在未来扩展到青少年。美国有超过100，000名青少年患有难治性强迫症，在肌张力障碍的情况下，成人DBS过渡到儿童已经有先例。然而，与用于肌张力障碍的小儿DBS相比，用于OCD的小儿DBS的风险-受益分析可能更复杂，并提出不同的伦理问题。本研究旨在深入了解与在患有强迫症的青少年中使用DBS相关的紧迫伦理问题。半结构化的采访进行了临床医生（n=25）照顾难治性强迫症的儿科患者。访谈记录使用MAXQDA 2018软件进行编码，并使用主题内容分析进行分析，以确定新兴主题。在临床医生的反应中确定了五个中心主题，其中三个在儿科DBS环境中加重。临床医生表达了与决策条件相关的担忧，包括青少年的同意能力（80%），缺乏关于在患有强迫症的青少年中使用DBS的结局和潜在未知影响的证据（68%），以及在考虑DBS之前用尽其他治疗选择的重要性（20%）。解决临床医生问题的策略包括实施经验证的决策支持工具，并进一步研究儿童DBS治疗OCD的结局，以建立明确的患者选择指南。
Refractory obsessive-compulsive disorder (OCD) among adults is the first psychiatric indication of deep brain stimulation (DBS) to receive an FDA Humanitarian Device Exemption (HDE). Given the HDE approval and encouraging evidence that has since emerged, exploration of DBS for OCD may expand to adolescents in the future. More than 100,000 adolescents in the U.S. suffer from refractory OCD, and there is already a precedent for the transition of DBS in adults to children in the case of dystonia. However, the risk-benefit analysis of pediatric DBS for OCD may be more complex and raise different ethical questions compared to pediatric DBS for dystonia. This study aimed to gain insight into pressing ethical issues related to using DBS in adolescents with OCD. Semi-structured interviews were conducted with clinicians (n=25) caring for pediatric patients with refractory OCD. Interview transcripts were coded with MAXQDA 2018 software and analyzed using thematic content analysis to identify emergent themes. Five central themes were identified in clinician responses, three of which were exacerbated in the pediatric DBS setting. Clinicians expressed concerns related to conditions of decision-making including adolescents' capacity to assent (80%), the lack of evidence about the outcomes and potential unknown effects of using DBS in adolescents with OCD (68%), and the importance of exhausting other treatment options before considering DBS (20%). Strategies to address clinician concerns include implementation of validated decision support tools and further research into the outcomes of pediatric DBS for OCD to establish clear guidelines for patient selection.
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