A Commentary on: “Preserving cortico-striatal function: Deep Brain Stimulation in Huntington's disease”

摘要: I read Nagel et al. with interest (Nagel al., 2015). In theory, the potential to modify cognitive function in Huntington's disease (HD) electrical stimulation or specifically Deep Brain Stimulation (DBS) is exciting. HD a devastating and terminal need of better treatments, both symptomatic neuroprotective. Cognitive dysfunction itself becoming more recognized as severely disabling aspect well (Paulsen Long, 2014). outline an intriguing argument for pursuing globus pallidus externa DBS target improvement while also acknowledging that current evidence based on small number animal models very limited human (n = 2) experience. In actuality, practical nature pursing treatment cognition complicated. The ethics new indications hotly debated topic (Unterrainer Oduncu, We still do not yet fully understand mechanism treating disorders where its efficacy established. Trialing it other neurologic conditions without sound rational can be unnecessarily dangerous best those we are trying treat. While was relatively free complications trials chorea, benign procedure. It brain surgery known irreversible surgical including infection, stroke, intracranial bleeding even death (Bronstein 2011). Some authors cite complication rates Parkinson's high 10% hemorrhage, 2% 15% infection up 4.5% Hardware requiring repeat occur. Finally, behavior have been negatively impacted after surgery, albeit often cited subthalamic disease. Still, there accounts decline mania pallidal (Miyawaki 2000; Rothlind Considering these neuropsychiatric complications, would proceed cautiously given incidence pre-existing increased risk suicide. Lastly, caution against making any statements alluding slowing progression neuroprotection data, especially perspective future participants trials. This too premature. indeed desperate population ability identify subjects early prodromal stage increases inappropriate improper recruitment Any research using this needs done slowly highest ethical standards rigorous consenting protocols. Personally, commonly recommend my patients currently approved participate volume surgeries, am holding out hope medicinal, neuroprotective therapy reversible adverse effects carry surgery.