Pediatric Deep Brain Stimulation: A Cautionary Approach

criteria exist for a given disorder, then surely it is unethical to categorically exclude children and adolescent patients from receiving the only treatment available that could dramatically increase their quality of life. Experts that oppose the use of DBS for pediatric TS (Mink et al., 2006; Porta et al., 2009) defend their position based upon the nature of childhood TS. According to a recent review, by early adulthood, approximately three quarters of children with TS will have greatly diminished tics and more than one-third will be tic free (Bloch and Leckman, 2009). A recent follow-up study on childhood and adolescent OCD found that 60% of children and adolescents did not have a full clinical disorder at followup, and two-thirds of participants rated themselves as much improved (Micali et al., 2010). According to the authors, many young people adapt to their illness and can lead a fairly normal life despite their symptoms. These are indeed important findings that highlight the exceptional caution that is needed when considering pediatric DBS for disorders that may spontaneously disappear or become subclinical over time. However, do they warrant the categorical exclusion of child patients? As Mink et al. (2006) themselves put forward: “Remission of tics may occur in the third decade of life in up to 50% of patients, but to date, there are no prognostic features that predict which patients will have a remission in their symptoms”(p.1832), and according to experts, the situation remains the same today. Which means that we do not possess clear scientific criteria to warrant the categorical exclusion of all child patients. Children with severe treatmentrefractory diseases are an extremely vulnerable group, and they should not be exposed to an invasive intervention like DBS unless successful treatment outcomes have been established in adults. However, if treatment success for neurological or psychiatric disorders is established in adults, and provided no clear scientific criteria exist to categorically exclude minors, then children and adolescents can be involved Pediatric deep brain stimulation: a cautionary approach