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Paediatric deep brain stimulation: ethical considerations in malignant Tourette syndrome
  1. Rosemary T. Behmer Hansen1,
  2. Arjun Dubey2,
  3. Cynthia Smith1,
  4. Patrick J. Henry1,
  5. Antonios Mammis1
  1. 1Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  2. 2School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
  1. Correspondence to Dr Antonios Mammis, Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; mammisan{at}njms.rutgers.edu

Abstract

Gilles de la Tourette syndrome (TS) is a childhood neuropsychiatric disorder characterised by the presence of motor and vocal tics. Patients with malignant TS experience severe disease sequelae; risking morbidity and mortality due to tics, self-harm, psychiatric comorbidities and suicide. By definition, those cases termed ‘malignant’ are refractory to all conventional psychiatric and pharmacological regimens. In these instances, deep brain stimulation (DBS) may be efficacious. Current 2015 guidelines recommend a 6-month period absent of suicidal ideation before DBS is offered to patients with TS. We therefore wondered whether it may be ethically justifiable to offer DBS to a minor with malignant TS. We begin with a discussion of non-maleficence and beneficence. New evidence suggests that suicide risk in young patients with TS has been underestimated. In turn, DBS may represent an invaluable opportunity for children with malignant TS to secure future safety, independence and fulfilment. Postponing treatment is associated with additional risks. Ultimately, we assert this unique risk-benefit calculus justifies offering DBS to paediatric patients with malignant TS. A multidisciplinary team of clinicians must determine whether DBS is in the best interest of their individual patients. We conclude with a suggestion for future TS-DBS guidelines regarding suicidal ideation. The importance of informed consent and assent is underscored.

  • deep brain stimulation
  • clinical ethics
  • minors/parental consent
  • surgery
  • informed consent
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Footnotes

  • Contributors AM and RTBH had the idea for the article. RTBH, AD, CS and PJH performed the literature search. RTBH, AD, CS and PJH wrote the article. AM and RTBH are the guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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