Posted by SLS on June 15, 2013, at 7:03:46
In reply to Lou's reply-dolanduzryet » SLS, posted by Lou Pilder on June 14, 2013, at 19:55:56
> Scott,
> The facts that Dr dolan stated in her video could be false, but if she was to cite facts that were incorrect, I think that there could be many articles on the net accusing her of being dishonest about what she says about DBS. I have not seen any articles accusing here of dishonesty. In fact, I have found articles testifying to what she said is true.
> Here is a link about suicide of people that undergo this operation of inserting a wire in the brain and hooking it up to a device that is surgically planted in the body.
> The warning is to those considering this operation to have a more-informed body of knowledge so that they can make a more-informed decision as to undergo this operation.
> LouWe are in agreement, Lou. Thanks for replying to my post in such a cogent manner.
> http://www.internalmedicinenews.com/fileadmin/content_pdf/fpn/archive_pdf/vol36iss11/73323_main.pdf
That's a good article. However, for me, it produces more questions than answers.
Depression often accompanies Parkinson's Disease, and appears to be a neuropsychiatric phenomenon rather than being exclusively psychological. If one were to combine this substrate with the desperation that one must reach to agree to DBS, one might expect a higher rate of suicidality, particularly if the treatment doesn't work.
"Preoperatively, three completed and three attempted
suicides were reported. These patients were on DBS wait
lists."This is not a direct quote of Dr. Voon. Nonetheless, it would be important to know what the reporting period was. Did it include one's life history or only the short period of time that they were observed in the study preoperatively. It would be meaningless to compare a period of a few months preoperatively to the subsequent 8 years that were observed postoperatively.
* This study was completed in 2006. If one subtracts 8 years, we see that the DBS procedure studied was that which existed in 1998. It would be informative to know how the procedure has evolved along with observational protocols by 2013.
I included the actual abstract of the Voon study at the end of this post. If you notice, Dr. Voon states that the neuropsychiatric complications are preventable postoperatively during DBS treatment.
* POSTOPERATIVELY
Clearly, Dr. Voon does not believe that suicide is an inevitable consequence of DBS.
From the article you cited:
"Suicide has significant implications and its potentially
quite preventable, said Dr. Voon, so patients and families
should be aware of this risk."Compare the preceding verbiage presented by the author of the article you cited to the wording of Dr. Voon in his study that I included below. I don't know about you, but reading the passage above, I came away with the impression that it meant that suicide was preventable by avoiding DBS.
Regarding DBS, Voon states:
"The majority of the observed neuropsychiatric symptoms are transient, treatable, and potentially preventable"
I have no reason to believe that it is impossible for DBS to produce changes in brain function that can lead to suicidality. In our present age of limited understanding of the brain, whenever one changes brain function through somatic interventions, they should be wary of unwanted collateral side effects. To say the least, I think there is more study to be done in this area. So, too, do scientists. Researchers like Helen Mayberg, one of the pioneers in the application of DBS for depressive disorders, make this very clear.
At this juncture, I do not question the fidelity of Dr. Voon. However, I do question the presentation of the author of the article.
- Scott-----------------------------------
Mov Disord. 2006 Jun;21 Suppl 14:S305-27.Deep brain stimulation: neuropsychological and neuropsychiatric issues.
Voon V, Kubu C, Krack P, Houeto JL, Tröster AI.
SourceDepartment of Psychiatry, Toronto Western Hospital, Toronto, Canada. voonv@ninds.nih.gov
AbstractParkinson's disease (PD) is a neurodegenerative disorder characterized by motor, cognitive, neuropsychiatric, autonomic, and other nonmotor symptoms. The efficacy of deep brain stimulation (DBS) for the motor symptoms of advanced PD is well established. However, the effects of DBS on the cognitive and neuropsychiatric symptoms are less clear. The neuropsychiatric aspects of DBS for PD have recently been of considerable clinical and pathophysiological interest. As a companion to the preoperative and postoperative sections of the DBS consensus articles, this article reviews the published literature on the cognitive and neuropsychiatric aspects of DBS for PD. The majority of the observed neuropsychiatric symptoms are transient, treatable, and potentially preventable. Outcome studies, methodological issues, pathophysiology, and preoperative and postoperative management of the cognitive and neuropsychiatric aspects and complications of DBS for PD are discussed.
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1045198
URL: http://www.dr-bob.org/babble/20130527/msgs/1045333.html