DBS Draws Consensus Nod for Parkinson’s, But Not Other Conditions

Because snaking tiny stimulating wires into the brain has helped many people with Parkinson’s disease (see ARF related news series), scientists are now considering the same treatment for conditions ranging from Alzheimer’s (see ARF related news story on Laxton et al., 2010) to obesity to obsessive-compulsive disorder (OCD) (see ARF related news story). But while PD claims are well substantiated, other uses require much more careful study before both doctors and patients should rush to adopt DBS, this month’s literature suggests.

In the February 2011 Archives of Neurology, an international panel of research leaders presents its conclusions on deep-brain stimulation (DBS) for PD. In a consensus paper, they write that DBS is an appropriate treatment for people who lack significant cognitive or psychiatric problems but have motor problems that respond poorly to medication. The panel notes that DBS often provides long-lasting relief of dyskinesia and tremor.

At the same time, scientists exploring DBS for other conditions sounded a note of caution in Health Affairs. In 2009, the Food and Drug Administration (FDA) had granted a humanitarian exemption allowing doctors to use DBS to treat obsessive-compulsive disorder. The article’s authors, led by Thomas Schlaepfer at the University of Bonn, Germany, argue that without rigorous clinical trials, the long-term outcomes and side effects of this treatment remain unknown, making it too early for such approval.

Researchers are also arguing the relative merits of single case studies, which some say overhype DBS’s potential (see ARF related news story on Schlaepfer and Fins, 2010 and Hubbeling, 2010). The authors of the current article suggest the FDA revoke the OCD exemption, as scientists continue to examine the therapy in careful trials. In The New York Times, researchers note that practitioners of psychosurgery, burdened by a legacy of lobotomies, must tread especially carefully with new treatments. Other doctors counter that people with severe OCD may contemplate suicide, and it is important to be able to offer DBS as a last-resort treatment.

Bronstein JM, Tagliati M, Alterman RL, Lozano AM, Volkmann J, Stefani A, Horak FB, Okun MS, Foote KD, Krack P, Pahwa R, Henderson JM, Hariz MI, Bakay RA, Rezai A, Marks WJ Jr, Moro E, Vitek JL, Weaver FM, Gross RE, Delong MR. Deep-brain stimulation for Parkinson disease: an expert consensus and review of key issues. Arch Neurol. 2011 Feb;68(2):165. Epub 2010 Oct 11. Abstract

Fins JJ, Mayberg HS, Nuttin B, Kubu CS, Galert T, Sturm V, Stoppenbrink K, Merkel R, Schlaepfer TE. Misuse of the FDA’s humanitarian device exemption in deep-brain stimulation for obsessive-compulsive disorder. Health Aff (Millwood). 2011 Feb;30(2):302-11. Abstract

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