Deep brain stimulation (DBS) is an effective neurosurgical treatment for patients with advanced Parkinson's disease (PD) suffering from motor complications that are refractory to further medication management. DBS requires an invasive procedure of implanting brain electrodes while awake, followed by implantation of neurostimulators under general anesthesia. The neurostimulator requires battery monitoring and replacement approximately every 3 to 5 years. These two elements of the technology provide numerous decision points about continuing therapies that can involve ethical choices. Although motor function can be improved with subthalamic nucleus (STN) DBS, the long-term risks of living with implanted hardware should be carefully evaluated for patients with diminishing cognitive capacity. We describe two cases where ethical dilemmas occurred postoperatively as a result of cognitive decline and describe salient ethical dimensions that illustrate the need for a proactive postoperative plan for supervision as a prerequisite for surgery to include neuropsychological testing to predict the likelihood of net benefit to the patient and family beyond just motor improvement.

译文

:深部脑刺激(DBS)是对患有帕金森氏病(PD),运动并发症且无法进一步药物治疗的晚期帕金森病(PD)患者的有效神经外科治疗。 DBS需要在清醒时植入脑电极的侵入性程序,然后在全身麻醉下植入神经刺激器。神经刺激器大约每3至5年需要对电池进行监视和更换。该技术的这两个要素为可能涉及伦理选择的持续疗法提供了众多决策点。尽管丘脑下丘脑核(STN)DBS可以改善运动功能,但对于认知能力下降的患者,应仔细评估使用植入式硬件生活的长期风险。我们描述了由于认知能力下降而导致术后出现道德困境的两种情况,并描述了突出的道德维度,这些维度说明了需要积极的术后监督计划作为进行手术的先决条件,以包括神经心理学测试以预测对患者净收益的可能性和家庭不只是运动改善。

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