%0 Journal Article
%T A Review of Social and Relational Aspects of Deep Brain Stimulation in Parkinson's Disease Informed by Healthcare Provider Experiences
%A Emily Bell
%A Bruce Maxwell
%A Mary Pat McAndrews
%A Abbas F. Sadikot
%A Eric Racine
%J Parkinson's Disease
%D 2011
%I Hindawi Publishing Corporation
%R 10.4061/2011/871874
%X Background. Although the clinical effectiveness of deep brain stimulation (DBS) in Parkinson's disease is established, there has been less examination of its social aspects. Methods and Results. Building on qualitative comments provided by healthcare providers, we present four different social and relational issues (need for social support, changes in relationships (with self and partner) and challenges with regards to occupation and the social system). We review the literature from multiple disciplines on each issue. We comment on their ethical implications and conclude by establishing the future prospects for research with the possible expansion of DBS for psychiatric indications. Conclusions. Our review demonstrates that there are varied social issues involved in DBS. These issues may have significant impacts on the perceived outcome of DBS by patients. Moreover, the fact that the social impact of DBS is still not well understood in emerging psychiatric indications presents an important area for future examination. 1. Introduction There is evidence that deep brain stimulation (DBS) can improve both motor function and quality of life in patients suffering from inadequately controlled symptoms of Parkinson¡¯s disease (PD), when compared to patients on best medical therapy alone [1, 2]. In addition, DBS is a neurosurgical intervention utilized for the treatmentof patients with essential tremor and dystonia [3]. However, aside from the apparent efficacy of DBS, there are also data suggesting psychosocial adjustment difficulties in some patients with DBS which paint a more complex picture of patient outcomes. Powerful questions about whether ¡°the doctor is happy, the patient less so?¡± [4] and whether there might be a ¡°distressed mind in a repaired body?¡± [5] suggest that psychosocial factors after DBS may have a large impact on patients. The psychosocial challenges that may present after DBS have been explored by Agid and colleagues [4¨C6]. In their qualitative interview study of PD DBS patients, the authors observed that some patients faced a range of psychosocial challenges including what they interpret to be repercussions and difficulties for the ¡°self¡± (the patient), with ¡°the other¡± (the spouse) and with ¡°others¡± [4]. Additionally, a qualitative interview study of patients and healthcare providers performed by Gisquet demonstrated that some patients who have undergone DBS communicate ¡°a loss of control over managing their illness and over their life,¡± characterized by the fact that patients report being tied to the medical team to manage their
%U http://www.hindawi.com/journals/pd/2011/871874/