Ethical Considerations in Closed Loop Deep Brain Stimulation

BackgroundClosed-loop deep brain stimulation (DBS) uses feedback to infer a clinical state and adjust stimulation accordingly. This novel mechanism has several potential advantages over conventional DBS including reducing stimulation-induced side effects, improving battery longevity, and alleviating symptoms not optimally treated with standard protocols. However, several ethical challenges may arise with the implementation of this technology, particularly with respect to clinical decision making.ObjectiveTo discuss potential ethical and clinical dilemmas encountered in using closed-loop DBS for neurological and psychiatric disorders.MethodsThe relevant literature is reviewed and supplemented with discussion of ethically challenging clinical scenarios. We outline an ethical framework for addressing these issues and provide practical recommendations for clinicians and researchers.ResultsEthical considerations in closed-loop DBS revolve around five key principles: 1) risk/benefit analysis; 2) inclusion and exclusion criteria; 3) respect for patient autonomy; 4) quality of life and patient benefit; and 5) concerns associated with recording neural activity.Conclusion(s)Developing and implementing a pragmatic framework for ethical considerations in closed-loop DBS will be critical as this technology is utilized in patients with both neurologic and psychiatric indications.