天博体育

A paper published in the February issue of 鈥攄iscussed at length in an article in the 鈥攃ontains the sort of blunt, plain-spoken language you seldom read in academic journals. The authors, who include some of the most prominent neuroscientists and ethicists in the world, warn that manufacturers are misusing the FDA鈥檚 to promote deep brain stimulation as a 鈥渢reatment鈥� for (OCD).

In fact, they make clear that deep brain stimulation is very much an experimental procedure. Research is still at an early stage, and the risks to patients are not well defined. When suffering is severe and no other treatment has provided relief, there is value in making available an intervention like deep brain stimulation. But misleading or biased information, no matter where it comes from, certainly undermines patients鈥� ability to calculate benefits and risks.

To , a surgeon must first implant electrodes in the brain and connect them to a pair of small electrical generators underneath the collarbone. Deep brain stimulation uses electricity to affect how brain signals are transmitted in particular areas of the brain. The image to the right, from the , shows how deep brain stimulation depends on the implantation of pulse generators below the collarbone and electrodes in the brain.

Among the concerns raised by the article in Health Affairs (and in our own article on this topic last year in the Harvard Mental Health Letter):

• Inadequate research. Although deep brain stimulation is sometimes described as a 鈥減acemaker for the brain,鈥� that is an oversimplification. Cardiac pacemakers monitor heart rhythm and trigger a heartbeat when necessary. While cardiac pacemakers have an established track record of success and clear guidelines for use, deep brain stimulation does not. (Among other things, when OCD symptoms do improve after deep brain stimulation, we still don鈥檛 know exactly how or why the electrical stimulation helps.) Only about 100 people in the world have undergone deep brain stimulation for OCD鈥攐nly some of the results have been published鈥攁ltogether too small a number to standardize the procedure.

• Safety. Implantation of a deep brain stimulation device involves boring small holes into the skull (for the electrodes) and surgery on the chest (for the battery). Possible complications鈥攁s for any surgery鈥攁re infection and bleeding. The wires may break. And the device鈥檚 batteries can run out, sometimes without warning鈥攃ausing rapid mood deterioration or behavior changes.

Furthermore, many alternatives exist. Deep brain stimulation is only appropriate for people who suffer severe and incapacitating symptoms and have exhausted every other treatment alternative. Fortunately, most people with OCD have other鈥攁nd more proven鈥攐ptions. These include behavioral treatments, drug treatment, or some combination of the two. You can read more about treatment options in an article in the March 2009 Harvard Mental Health Letter.