Download PDF
Psychiatr Prax 2014; 41(S 01): S38-S43
DOI: 10.1055/s-0034-1370015
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Tiefe Hirnstimulation in der Psychiatrie: Ethische Aspekte

Deep Brain Stimulation in Psychiatry: Ethical Aspects
Ulf J. Müller
1   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Magdeburg
,
Bernhard Bogerts
1   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Magdeburg
,
Jürgen Voges
2   Klinik für stereotaktische Neurochirurgie, Universitätsklinikum Magdeburg
,
Imke Galazky
3   Klinik für Neurologie, Universitätsklinikum Magdeburg
,
Sina Kohl
4   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln
,
Hans-Jochen Heinze
3   Klinik für Neurologie, Universitätsklinikum Magdeburg
,
Jens Kuhn
4   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln
,
Johann Steiner
1   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Magdeburg
› Author Affiliations
Further Information

Publication History

Publication Date:
01 July 2014 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Tiefe Hirnstimulation (THS) wurde bei zahlreichen neurologischen Erkrankungen erforscht. Zunehmend wird auch eine Bedeutung dieser Behandlungsmethode bei psychiatrischen Krankheiten gesehen. In dieser Übersichtsarbeit werden nach einer kurzen geschichtlichen Einleitung die derzeit am häufigsten diskutierten Punkte bezüglich des Einsatzes der THS in der Psychiatrie besprochen. Abschließend wird aufgezeigt, dass die derzeitige Diskussion über die Risiken oder den Nutzen der THS in der Psychiatrie vermutlich nicht nur auf wissenschaftlichen Überlegungen basiert, sondern auch die Krankheitswertigkeit einzelner psychiatrischer Störungsbilder infrage stellt.

Abstract

Deep brain stimulation (DBS) has been shown to be an efficacious treatment for many neurological conditions and has thus been expanded to psychiatric diseases as well. Following an introduction on the history of DBS in psychiatry, this review summarizes commonly raised ethical concerns and questions on clinical trial design, selection of patients, informed consent and concerns about the possible impact of DBS on an individual’s personality. Finally, it highlights the fact that critique on DBS in psychiatry is probably not selectively based on scientific concerns about potential risks; instead, the neurobiological origin of specific psychiatric disorders has been questioned.

Schlüsselwörter

tiefe Hirnstimulation - THS - Psychiatrie - Ethik

Keywords

deep brain stimulation - dbs - psychiatry - ethics
 

  • Literatur

  • 1 Benabid AL, Pollak P, Louveau A et al. Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl neurophysiol 1987; 50: 344-346
    PubMedGoogle Scholar
  • 2 Deuschl G, Schade-Brittinger C, Krack P et al. A randomized trial of deep-brain stimulation for Parkinson's disease. N Engl J Med 2006; 355: 896-908
    CrossrefPubMedGoogle Scholar
  • 3 Kupsch A, Benecke R, Muller J et al. Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med 2006; 355: 1978-1990
    CrossrefPubMedGoogle Scholar
  • 4 Limousin P, Speelman JD, Gielen F et al. Multicentre European study of thalamic stimulation in parkinsonian and essential tremor. J Neurol Neurosurg Psychiatry 1999; 66: 289-296
    CrossrefPubMedGoogle Scholar
  • 5 Voges J, Waerzeggers Y, Maarouf M et al. Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery – experiences from a single centre. J Neurol Neurosurg Psychiatry 2006; 77: 868-872
    CrossrefPubMedGoogle Scholar
  • 6 Voges J, Hilker R, Botzel K et al. Thirty days complication rate following surgery performed for deep-brain-stimulation. Mov Disord 2007; 22: 1486-1489
    CrossrefPubMedGoogle Scholar
  • 7 Blomstedt P, Sjoberg RL, Hansson M et al. Deep brain stimulation in the treatment of obsessive-compulsive disorder. World Neurosurg 2013; 80: e245-253
    CrossrefPubMedGoogle Scholar
  • 8 Fisher R, Salanova V, Witt T et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia 2010; 51: 899-908
    CrossrefPubMedGoogle Scholar
  • 9 Schmetz MK, Heinemann T. Ethische Aspekte der tiefen Hirnstimulation in der Therapie psychiatrischer Erkrankungen. Fortschr Neurol Psychiatr 2010; 78: 269-278
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Witt K, Kuhn J, Timmermann L et al. Deep brain stimulation and the search for identity. Neuroethics 2013; 6: 499-511
    CrossrefPubMedGoogle Scholar
  • 11 Witt K, Kuhn J, Timmermann L et al. Tiefe Hirnstimulation und personale Identität: Was sollten wir messen?. Nervenheilkunde 2012; 31: 221-225
    PubMedGoogle Scholar
  • 12 Arends M, Fangerau H, Winterer G. „Psychochirurgie“ und tiefe Hirnstimulation mit psychiatrischer Indikation. Nervenarzt 2009; 80: 781-788
    CrossrefPubMedGoogle Scholar
  • 13 Hariz MI, Blomstedt P, Zrinzo L. Deep brain stimulation between 1947 and 1987: the untold story. Neurosurg Focus 2010; 29: E1
    PubMedGoogle Scholar
  • 14 Baumeister AA. The Tulane Electrical Brain Stimulation Program a historical case study in medical ethics. J Hist Neurosci 2000; 9: 262-278
    CrossrefPubMedGoogle Scholar
  • 15 Hausner H, Cording C, Hajak G et al. Aufklärung und Einwilligung in Psychiatrie und Psychotherapie. Psychiat Prax 2008; 35: 163-169
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Grant RA, Halpern CH, Baltuch GH et al. Ethical considerations in deep brain stimulation for psychiatric illness. J Clin Neurosci 2014; 21: 1-5
    CrossrefPubMedGoogle Scholar
  • 17 Rabins P, Appleby BS, Brandt J et al. Scientific and ethical issues related to deep brain stimulation for disorders of mood, behavior, and thought. Arch Gen Psychiatry 2009; 66: 931-937
    CrossrefPubMedGoogle Scholar
  • 18 Belzung C. Innovative drugs to treat depression: Did animal models fail to be predictive or did clinical trials fail to detect effects?. Neuropsychopharmacol DOI: 10.1038/npp.2013.342.
    PubMedGoogle Scholar
  • 19 Pisapia JM, Halpern CH, Müller UJ et al. Ethical considerations in deep brain stimulation for the treatment of addiction and overeating associated with obesity. AJOB Neuroscience 2013; 4: 35-46
    PubMedGoogle Scholar
  • 20 Kuhn J, Gaebel W, Klosterkoetter J et al. Deep brain stimulation as a new therapeutic approach in therapy-resistant mental disorders: ethical aspects of investigational treatment. Eur Arch Psychiatry Clin Neurosci 2009; 259 (Suppl. 02) S135-141
    CrossrefPubMedGoogle Scholar
  • 21 Hall W. Stereotactic neurosurgical treatment of addiction: minimizing the chances of another “great and desperate cure”. Addiction 2006; 101: 1-3
    PubMedGoogle Scholar
  • 22 Skuban T, Hardenacke K, Woopen C et al. Informed consent in deep brain stimulation – ethical considerations in a stress field of pride and prejudice. Front Integr Neurosci 2011; 5: 7
    PubMedGoogle Scholar
  • 23 Lipsman N, Giacobbe P, Bernstein M et al. Informed consent for clinical trials of deep brain stimulation in psychiatric disease: challenges and implications for trial design. J Med Ethics 2012; 38: 107-111
    CrossrefPubMedGoogle Scholar
  • 24 Schmitz-Luhn B, Katzenmeier C, Woopen C. Law and ethics of deep brain stimulation. Int J Law psychiatry 2012; 35: 130-136
    CrossrefPubMedGoogle Scholar
  • 25 Müller UJ, Voges J, Steiner J et al. Deep brain stimulation of the nucleus accumbens for the treatment of addiction. Ann N Y Acad Sci 2013; 1282: 119-128
    CrossrefPubMedGoogle Scholar
  • 26 Synofzik M. Neue Indikationen für die tiefe Hirnstimulation. Ethische Kriterien für Forschung und Therapie. Nervenarzt 2013; 84: 1175-1182
    CrossrefPubMedGoogle Scholar
  • 27 Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 6th. Aufl. Oxford, UK: Oxford University Press; 2008
    Google Scholar
  • 28 Kopell BH, Greenberg BD. Anatomy and physiology of the basal ganglia: implications for DBS in psychiatry. Neurosci Biobehav Rev 2008; 32: 408-422
    CrossrefPubMedGoogle Scholar
  • 29 Klaming L, Haselager P. Did my brain implant make me do it? Questions raised by DBS regarding psychological continuity, responsibility for action and mental competence. Neuroethics 2013; 6: 527-539
    CrossrefPubMedGoogle Scholar
  • 30 Lipsman N, Woodside DB, Giacobbe P et al. Neurosurgical treatment of anorexia nervosa: review of the literature from leucotomy to deep brain stimulation. Eur Eat Disord Rev 2013; 21: 428-435
    CrossrefPubMedGoogle Scholar
  • 31 Lipsman N, Mendelsohn D, Taira T et al. The contemporary practice of psychiatric surgery: results from a survey of North American functional neurosurgeons. Stereotact Func Neurosurg 2011; 89: 103-110
    CrossrefPubMedGoogle Scholar
  • 32 Mendelsohn D, Lipsman N, Bernstein M. Neurosurgeons’ perspectives on psychosurgery and neuroenhancement: a qualitative study at one center. J Neurosurg 2010; 113: 1212-1218
    CrossrefPubMedGoogle Scholar
  • 33 Burkhard PR, Vingerhoets FJ, Berney A et al. Suicide after successful deep brain stimulation for movement disorders. Neurology 2004; 63: 2170-2172
    CrossrefPubMedGoogle Scholar
  • 34 Appleby BS, Duggan PS, Regenberg A et al. Psychiatric and neuropsychiatric adverse events associated with deep brain stimulation: A meta-analysis of ten years’ experience. Mov Disord 2007; 22: 1722-1728
    CrossrefPubMedGoogle Scholar
  • 35 Juurlink DN, Herrmann N, Szalai JP et al. Medical illness and the risk of suicide in the elderly. Arch Intern Med 2004; 164: 1179-1184
    CrossrefPubMedGoogle Scholar
  • 36 Witt K, Daniels C, Reiff J et al. Neuropsychological and psychiatric changes after deep brain stimulation for Parkinson's disease: a randomised, multicentre study. Lancet Neurol 2008; 7: 605-614
    CrossrefPubMedGoogle Scholar
  • 37 Skuban T, Flohrer J, Klosterkoetter J et al. Nebenwirkungen der Tiefen Hirnstimulation bei idiopathischem Parkinsonsyndrom. Fortschr Neurol Psychiatr 2011; 79: 703-710
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Baylis F. “I am who I am”: On the perceived threats to personal identity from deep brain stimulation. Neuroethics 2013; 6: 513-526
    CrossrefPubMedGoogle Scholar
  • 39 Volkmann J. Update on surgery for Parkinson’s disease. Curr Opin Neurol 2007; 20: 465-469
    PubMedGoogle Scholar
  • 40 Gilbert F. The burden of normality: from “chronically ill” to “symptom free”. New ethical challenges for deep brain stimulation postoperative treatment. J Med Ethics 2012; 38: 408-412
    CrossrefPubMedGoogle Scholar
  • 41 Synofzik M, Schlaepfer TE. Stimulating personality: ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes. Biotechnol J 2008; 3: 1511-1520
    CrossrefPubMedGoogle Scholar
  • 42 Kuhn J, Lenartz D, Mai JK et al. Deep brain stimulation of the nucleus accumbens and the internal capsule in therapeutically refractory Tourette-syndrome. J Neurol 2007; 254: 963-965
    CrossrefPubMedGoogle Scholar
  • 43 Müller UJ, Sturm V, Voges J et al. Successful treatment of chronic resistant alcoholism by deep brain stimulation of nucleus accumbens: first experience with three cases. Pharmacopsychiatry 2009; 42: 288-291
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Torres CV, Sola RG, Pastor J et al. Long-term results of posteromedial hypothalamic deep brain stimulation for patients with resistant aggressiveness. J Neurosurg 2013; 119: 277-287
    CrossrefPubMedGoogle Scholar
  • 45 Lipsman N, Woodside DB, Giacobbe P et al. Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial. Lancet 2013; 381: 1361-1370
    CrossrefPubMedGoogle Scholar
  • 46 Volkow ND, O’Brien CP. Issues for DSM-V: should obesity be included as a brain disorder?. Am J Psychiatry 2007; 164: 708-710
    CrossrefPubMedGoogle Scholar
  • 47 Smith DG, Robbins TW. The neurobiological underpinnings of obesity and binge eating: a rationale for adopting the food addiction model. Biol Psychiatry 2013; 73: 804-810
    CrossrefPubMedGoogle Scholar
  • 48 Pisapia JM, Halpern CH, Williams NN et al. Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study. Neurosurg Focus 2010; 29: E15
    PubMedGoogle Scholar
  • 49 Halpern CH, Tekriwal A, Santollo J et al. Amelioration of binge eating by nucleus accumbens shell deep brain stimulation in mice involves D2 receptor modulation. J Neurosci 2013; 33: 7122-7129
    CrossrefPubMedGoogle Scholar
  • 50 Brooks SJ, Rask-Andersen M, Benedict C et al. A debate on current eating disorder diagnoses in light of neurobiological findings: is it time for a spectrum model?. BMC Psychiatry 2012; 12: 76
    CrossrefPubMedGoogle Scholar
  • 51 Fumagalli M, Priori A. Functional and clinical neuroanatomy of morality. Brain 2012; 135: 2006-2021
    CrossrefPubMedGoogle Scholar
  • 52 Hariz M. Deep brain stimulation for antisocial behavior?. World Society for stereotactic and functional neurosurgery 2012. Newsletter Summer. Im Internet: http://neurosurgery.utoronto.ca/Assets/Neuro+Digital+Assets/ALL/In+the+Media/WSSFNNewsletter_Summer2012.pdf (Stand: 10.02.2014)
    Google Scholar
  • 53 Jordan W, Bleich S, Cohrs S et al. Definition des Kernbereichs ärztlicher Tätigkeit im psychiatrisch-psychotherapeutischen Fachgebiet – Voraussetzung für jede Delegation. Psychiat Prax 2011; 38 (Suppl. 02) S8-15
    Article in Thieme ConnectPubMedGoogle Scholar