Ethical Considerations in Deep Brain Stimulation for the Treatment of Addiction and Overeating Associated With Obesity.
Ethical Considerations in Deep Brain Stimulation for the Treatment of Addiction and Overeating Associated With Obesity.
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DOI：
10.1080/21507740.2013.770420
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发表时间：
2013-05
影响因子：
--
通讯作者：
Caplan AL
中科院分区：
文献类型：
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作者：
Pisapia JM;Halpern CH;Muller UJ;Vinai P;Wolf JA;Whiting DM;Wadden TA;Baltuch GH;Caplan AL
深部脑刺激(DBS)治疗运动障碍的成功，以及对精神疾病的神经生物学和神经解剖学基础的了解的提高，导致了扩大目前DBS应用的建议。例如，最近针对阿尔茨海默病和强迫症的临床前和临床研究支持了刺激人类下丘脑和伏隔核区域的安全性。众所周知，这些区域与肥胖相关的成瘾和暴饮暴食有关。然而，使用针对这些领域的DBS作为一种治疗方式会引发共同的伦理考虑，包括知情同意、胁迫、增强、对人格的威胁以及对奖励中心的操纵。针对这两种情况的试点研究目前都处于调查阶段。如果这些研究显示出希望，那么有必要解决与临床试验启动相关的伦理问题，包括临床前证据的可靠性、患者选择、研究设计、参与和伤害的补偿、成本效益以及长期随访的必要性。多学科团队对于这类研究的道德执行是必要的。除了确定安全性和有效性外，对这些伦理问题的考虑对于采用DBS作为治疗这些疾病的方法至关重要。我们对DBS未来治疗肥胖成瘾和暴饮暴食的临床试验提出了建议，并为解决与治疗相关的伦理问题提供了一个框架。
The success of deep brain stimulation (DBS) for movement disorders and the improved understanding of the neurobiologic and neuroanatomic bases of psychiatric diseases have led to proposals to expand current DBS applications. Recent preclinical and clinical work with Alzheimer’s disease and obsessive-compulsive disorder, for example, supports the safety of stimulating regions in the hypothalamus and nucleus accumbens in humans. These regions are known to be involved in addiction and overeating associated with obesity. However, the use of DBS targeting these areas as a treatment modality raises common ethical considerations, which include informed consent, coercion, enhancement, threat to personhood, and manipulation of the reward center. Pilot studies for both of these conditions are currently investigational. If these studies show promise, then there is a need to address the ethical concerns related to the initiation of clinical trials including the reliability of preclinical evidence, patient selection, study design, compensation for participation and injury, cost-effectiveness, and the need for long-term follow-up. Multidisciplinary teams are necessary for the ethical execution of such studies. In addition to establishing safety and efficacy, the consideration of these ethical issues is vital to the adoption of DBS as a treatment for these conditions. We offer suggestions about the pursuit of future clinical trials of DBS for the treatment of addiction and overeating associated with obesity and provide a framework for addressing ethical concerns related to treatment.