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) 是一种有效的神经外科治疗方法,用于患有运动并发症的晚期帕金森氏病 (PD) 患者,这些并发症难以进一步治疗药物。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。神经刺激器需要大约每3至5年进行一次电池监测和更换。该技术的这两个要素提供了许多有关可能涉及道德选择的持续疗法的决策点。尽管丘脑底核 (STN) DBS可以改善运动功能,但对于认知能力下降的患者,应仔细评估植入硬件的长期风险。我们描述了两种情况,其中由于认知能力下降而在术后发生伦理困境,并描述了突出的伦理维度,这些维度说明了需要积极的术后监督计划作为手术的先决条件,包括神经心理学测试,以预测对患者和家庭的净收益的可能性,而不仅仅是运动改善。

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