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Schiff and colleagues’1 reply to criticism that deep brain stimulation (DBS) for the minimally conscious state is a “halfway” solution, whereby “progress in digestion and mobility” may ethically clash with a heightened awareness of disability on the part of the patient, a likely liability.
We encountered the same criticism when we announced in December 2008 that, following bifocal extradural cortical stimulation in the setting of a proof-of-principle study (Project Lazarus), a patient in a permanent vegetative state (19 months) became minimally conscious, with improved digestion and mobility.2
First, those who criticize such undertakings should tell us what they intend to do with these patients: leave them suspended until death arrives, which counters the basic foundations of medicine, ie, improving illness of whatever nature, or terminate them (eg, via high-dose opioid injection), which is also against the hippocratic tradition?
On the other end, Schiff and colleagues gloss over the fact that DBS is not a completely safe technique: hemorrhage-related mortality is a well-known complication of DBS. Bifocal extradural cortical stimulation is a noninvasive technique that can resynchronize wide swaths of cortical tissue and feed directly to the thalamus, with no mortality or disabling morbidity.3 Most importantly, cortical stimulation can be synergistic with neurorehabilitation interventions, and noninvasive cortical stimulation (eg, transcranial magnetic stimulation) can both refine surgical targeting and provide therapeutic benefit.3
I strongly urge those involved to consider the ease of the cortical stimulation approach over the resource-intensive non–risk-free DBS approach. Moreover, a synergistic effect with standard rehabilitation is demonstrated. This would make the procedure more ethical, at least under the safety, rationale, and efficacy profile.
To the critics, the words of Dr William Osler: “One thing is certain; it is not for you to don the black cap and, assuming the judicial function, take hope away from ANY patient . . . hope that comes to us all.”
Correspondence: Dr Canavero, Turin Advanced Neuromodulation Group, Corso Einaudi 2, 10128 Torino, Italy (solara@infinito.it).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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