A history of deep brain stimulation: Technological innovation and the role of clinical assessment tools

Abstract

Deep brain stimulation involves using a pacemaker-like device to deliver constant electrical stimulation to problematic areas within the brain. It has been used to treat over 40,000 people with Parkinson’s disease and essential tremor worldwide and is currently undergoing clinical trials as a treatment for depression and obsessive–compulsive disorder. This article will provide an historical account of deep brain stimulation in order to illustrate the plurality of interests involved in the development and stabilization of deep brain stimulation technology. Using Latour’s notion of immutable mobiles, this article will illustrate the importance of clinical assessment tools in shaping technological development in the era of medical device regulation. Given that such tools can serve commercial and professional interests, this article suggests that it is necessary to scrutinise their application in research contexts to ensure that they capture clinical changes that are meaningful for patients and their families. This is particularly important in relation to potentially ethically problematic therapies such as deep brain stimulation for psychiatric disorders.

Precision Medicine Informatics: Principles, Prospects, and Challenges

“…DBS is a neurosurgical procedure which uses a neurostimulator that delivers electrical stimulation, through implanted electrodes, to specific targets in the brain for the treatment of neuropsychiatric disorders [85].…”

N‐of‐1 Trials for Closed‐Loop Deep Brain Stimulation Devices

“…Yet an RCT may not be designed to assess how each participant interacts with an implanted neurological device, how it affects their phenomenal experience, or the risks associated with having a personalized algorithm guide medical treatments. As one commenter at a 1997 meeting of the U.S. Food and Drug Administration noted in evaluating an open‐loop DBS device to treat Parkinson's disease, “[U]nless that side effect [from DBS] slaps you in the face or is quite profound, you may not find subtle effects like the neurological changes.” 25 …”

What parents think and feel about deep brain stimulation in paediatric secondary dystonia including cerebral palsy: A qualitative study of parental decision-making

“…In order to help ensure that DBS is used responsibly, it is necessary that professionals are attentive to the perspectives of patients 16,17 . Given the gap between professional experience of DBS and public understanding of the advantages and limitations of DBS functional neurosurgery it is perhaps surprising that to date, the exploration of decision-making in DBS surgical options has been ignored.…”