Neuroethical implications of deep brain stimulation in degenerative disorders

The use of deep brain stimulation (DBS) in degenerative diseases involving cognitive impairment raises important ethical issues. This review takes into account the previous publications on the ethical issues of DBS to re-evaluate this technique in the framework of cognitive degenerative diseases, especially Alzheimer's disease and dementia associated to Parkinson's disease.

The serendipitous discovery of the properties of DBS in memory enhancement fostered the expectations of the patients, the experts, and the industry involved in the production of the devices. Nonetheless, there is still a lack of evidence of its effectiveness in slowing or stopping the evolution of the initial cognitive decline into dementia, and a lack of a cognitive model to explain its effects on the memory circuit.

Applying the principles for the ethical assessment of new treatments in biomedicine to the use of DBS in cognitive impairment and especially in memory loss, we conclude that any use of this technique for this indication should be reserved to experimental settings, with clear protocols and strict inclusion criteria for the selection of the possible candidates for surgery.