Center for Ethics Assistant Professor Dr. Laura Cabrera and Associate Professor Dr. Karen Kelly-Blake, along with Dr. Christos Sidiropoulos of the Department of Neurology & Ophthalmology, are co-authors of a new article in Brain Sciences. Their article “Perspectives on Deep Brain Stimulation and Its Earlier Use for Parkinson’s Disease: A Qualitative Study of US Patients” appears in a special issue on “Brain Stimulation and Parkinson’s Disease.”
Background: Deep brain stimulation (DBS) is being used earlier than was previously the case in the disease progression in people with Parkinson’s disease (PD). To explore preferences about the timing of DBS, we asked PD patients with DBS whether they would have preferred the implantation procedure to have occurred earlier after diagnosis. Methods: Twenty Michigan-based patients were interviewed about both their experiences with DBS as well as their attitudes regarding the possible earlier use of DBS. We used a structured interview, with both closed and open-ended questions. Interviews were transcribed verbatim and analyzed using a mixed-methods approach. Results: We found that the majority of our participants (72%) had high overall satisfaction with DBS in addressing motor symptoms (mean of 7.5/10) and quality of life (mean of 8.25/10). Participants were mixed about whether they would have undergone DBS earlier than they did, with five participants being unsure and the remaining nearly equally divided between yes and no. Conclusion: Patient attitudes on the early use of DBS were mixed. Our results suggest that while patients were grateful for improvements experienced with DBS, they would not necessarily have endorsed its implementation earlier in their disease progression. Larger studies are needed to further examine our findings.
The full text is available online via MDPI.
Center Assistant Professor Dr. Laura Cabrera is co-author of an article in the August 2019 issue of World Neurosurgery. In “Perspectives on the Earlier Use of Deep Brain Stimulation for Parkinson Disease from a Qualitative Study of U.S. Clinicians,” authors Dr. Cabrera, Dr. Harini Sarva (Weill Cornell Medical College), and Dr. Christos Sidiropoulos (Michigan State University Department of Neurology & Ophthalmology) share the results of Michigan-based clinician interviews about the use of deep brain stimulation (DBS) therapy in people with Parkinson’s disease. They conclude that there is a wide variation in clinicians’ parameters for when they suggest DBS as a treatment option for their patients.
The full text is available online via Science Direct (MSU Library or other institutional access may be required to view this article).
Center Assistant Professor Dr. Marleen Eijkholt and Assistant Professor Dr. Laura Cabrera are co-authors of a new article in Neuromodulation: Technology at the Neural Interface. The article, “Shaking Up the Debate: Ensuring the Ethical Use of DBS Intervention Criteria for Mid-Stage Parkinson’s Patients,” was written by Dr. Eijkholt, Dr. Cabrera, Adolfo Ramirez-Zamora, MD (University of Florida), and Julie G. Pilitsis MD, PhD (Albany Medical Center).
Deep brain stimulation (DBS) is a well-established treatment for the management of severe motor fluctuations in advanced Parkinson’s disease (PD). Until recently, device regulation, medical, and insurance practices limited DBS to patients with advanced stages of PD. In February 2016 this changed, however, when the US Food and Drug Administration (FDA) granted formal approval for the use of brain stimulator in mid-stage PD patients. In this article, we examine whether DBS in mid-stage PD can be ethically justified beyond the FDA approval.
Materials and Methods
We scrutinize the current risk-benefit profile, the costs-benefit profile, and the capacity for informed consent requirement, to ask if use of subthalamic nucleus (STN) in mid-stage DBS is ethically appropriate.
We propose that mid-stage DBS decisions could be appropriate under a shared decision-making model, which embraces a broad quality of life perspective.
Although it might be too premature to know how the FDA decision will affect medical and insurance practices, we conclude by arguing that revisions to persisting guidelines seems justified both on scientific and ethical grounds.
The full text is available through Wiley Online Library (MSU Library or other institutional access may be required to view this article).