Center for Medical Ethics and Health Policy Staff Publications
Publication Date
10-1-2023
Journal
Journal of Obsessive-Compulsive and Related Disorders
DOI
10.1016/j.jocrd.2023.100830
PMID
37781644
PMCID
PMC10538479
PubMedCentral® Posted Date
10-1-2024
PubMedCentral® Full Text Version
Author MSS
Published Open-Access
yes
Keywords
deep brain stimulation; treatment-resistance; obsessive-compulsive disorder, children; ethics; qualitative; interview
Abstract
Approximately 10-20% of children with obsessive-compulsive disorder (OCD) have treatment-resistant presentations, and there is likely interest in developing interventions for this patient group, which may include deep brain stimulation (DBS). The World Society for Stereotactic and Functional Neurosurgery has argued that at least two successful randomized controlled trials should be available before DBS treatment for a psychiatric disorder is considered "established." The FDA approved DBS for adults with treatment-resistant OCD under a humanitarian device exemption (HDE) in 2009, which requires that a device be used to manage or treat a condition impacting 8,000 or fewer patients annually in the United States. DBS is currently offered to children ages 7 and older with treatment-resistant dystonia under an HDE. Ethical and empirical work are needed to evaluate whether and under what conditions it might be appropriate to offer DBS for treatment-resistant childhood OCD. To address this gap, we report qualitative data from semi-structured interviews with 25 clinicians with expertise in this area. First, we report clinician perspectives on acceptable levels of evidence to offer DBS in this patient population. Second, we describe their perspectives on institutional policies or protocols that might be needed to effectively provide care for this patient population.