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Concerns with the promotion of deep brain stimulation for obsessive–compulsive disorder

Nature Medicine volume 29, page 18 (2023)Cite this article

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We commend the aim of Visser-Vandewalle et al.1 to make medical devices accessible to everyone in need. We also wish to underline that articles 4 and 25 of the United Nations Convention on the Rights of Persons with Disabilities oblige states to promote research and development and availability of new technologies and devices2. The Convention applies to “long-term mental impairments” (article 1), which includes chronic obsessive–compulsive disorder (OCD). Although this is not definitely settled, we suggest that the obligations of states should extend to medical devices that alleviate OCD symptoms, such as deep brain stimulators. The purpose of the Convention is to promote and ensure the full and effective participation of persons with disabilities in society on an equal basis with others (article 1), and so demands the provision of such devices in the case of intractable OCD. The Convention may thus have a key role in addressing the crisis of access rightfully lamented by Visser-Vandewalle et al.1 and should be invoked to this end by stakeholders worldwide.

However, we also have three points of disagreement with Visser-Vandewalle et al.1. The first concerns their confidence in the safety and efficacy of the method, which is based on 7 studies with a total of 72 participants. In light of recent failures of deep brain stimulation (DBS) to alleviate symptoms of major depressive disorder, despite promising first results with small-scale studies3, a broader evidence base is required for widely rolling out a method that involves invasive brain surgery. Caution seems especially warranted given that noninvasive stimulation methods that come with considerably fewer risks are on the horizon4,5. In addition, closed-loop neural devices are increasingly replacing the traditional open-loop systems and may have a more favorable risk–benefit profile6,7.

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Acknowledgements

S.R.S. is funded by the European Research Council (ERC, NGBMI 759370) and Einstein Foundation Berlin. S.R.S. and C.B. are funded by the German Federal Ministry of Research and Education (BMBF, HYBRIDMIND 01GP2121A and -B). F.G. has received funding from the University of Tasmania Humanities Strategic Research Grant Scheme (Ethics Lab).

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Authors and Affiliations

  1. Faculty of Law, Universität Hamburg, Hamburg, Germany

    Christoph Bublitz

  2. Ethics Lab, School of Humanities, CALE, University of Tasmania, Hobart, Tasmania, Australia

    Frederic Gilbert

  3. Clinical Neurotechnology Laboratory, Dept. of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany

    Surjo R. Soekadar

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  1. Christoph Bublitz
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Correspondence to Christoph Bublitz.

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Bublitz, C., Gilbert, F. & Soekadar, S.R. Concerns with the promotion of deep brain stimulation for obsessive–compulsive disorder. Nat Med 29, 18 (2023). https://doi.org/10.1038/s41591-022-02087-5

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