Clinician Perspectives on the Potential of DBS for Pediatric Patients with Treatment-Resistant OCD
Saturday, October 14, 2023
10:30 AM – 11:45 AM ET
Location: Chasseur (Third Floor)
The World Society for Stereotactic and Functional Neurosurgery has argued that at least two successful randomized controlled trials should be available before deep brain stimulation (DBS) treatment for a psychiatric disorder is considered “established.” DBS is currently offered to children ages 7 and older with refractory dystonia under an FDA-humanitarian device exemption. No randomized control trials were conducted – practitioners relied on evidence from DBS use in adults. In addition, accumulated research supports the safety and effectiveness of DBS for obsessive-compulsive disorder (OCD) in adults (Wu et al. 2021). Approximately 10-20% of children with OCD have treatment-resistant presentations, so it is likely that there will be interest in offering DBS for some children (POTS 2004). Both ethical and empirical anticipatory work is needed to evaluate whether, and if so, under what conditions it might be appropriate to offer DBS in this context. To address this gap, we present qualitative data from semi-structured interviews with 24 clinicians with expertise in this area. First, we report clinician perspectives on what they take to be acceptable levels of evidence to offer DBS in this patient population and their reasons for why such levels are appropriate. Second, we share their perspectives on what sorts of institutional policies or protocols might be needed to effectively provide care for this patient population, including oversight mechanisms like ethics consults and review commitments, as well as candidacy assessments and the presence of a diverse team of experts.
Tiffany Campbell – Center for Bioethics – Harvard Medical School; Natalie Dorfman – Center for Medical Ethics and Health Policy – Baylor College of Medicine; Laura Torgerson – Center for Medical Ethics and Health Policy – Baylor College of Medicine; Kristin Kostick Quenet – Center for Medical Ethics and Health Policy – Baylor College of Medicine; Jennifer Blumenthal-Barby – Center for Medical Ethics and Health Policy – Baylor College of Medicine; Eric Storch – Department of Psychiatry & Behavioral Sciences – Baylor College of Medicine; Gabriel Lázaro-Muñoz – Center for Bioethics – Harvard Medical School