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Pease M, Gupta K, Moshé SL, Correa DJ, Galanopoulou AS, Okonkwo DO, Gonzalez-Martinez J, Shutter L, Diaz-Arrastia R, Castellano JF. Insights into epileptogenesis from post-traumatic epilepsy. Nat Rev Neurol 2024; 20:298-312. [PMID: 38570704 DOI: 10.1038/s41582-024-00954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
Post-traumatic epilepsy (PTE) accounts for 5% of all epilepsies. The incidence of PTE after traumatic brain injury (TBI) depends on the severity of injury, approaching one in three in groups with the most severe injuries. The repeated seizures that characterize PTE impair neurological recovery and increase the risk of poor outcomes after TBI. Given this high risk of recurrent seizures and the relatively short latency period for their development after injury, PTE serves as a model disease to understand human epileptogenesis and trial novel anti-epileptogenic therapies. Epileptogenesis is the process whereby previously normal brain tissue becomes prone to recurrent abnormal electrical activity, ultimately resulting in seizures. In this Review, we describe the clinical course of PTE and highlight promising research into epileptogenesis and treatment using animal models of PTE. Clinical, imaging, EEG and fluid biomarkers are being developed to aid the identification of patients at high risk of PTE who might benefit from anti-epileptogenic therapies. Studies in preclinical models of PTE have identified tractable pathways and novel therapeutic strategies that can potentially prevent epilepsy, which remain to be validated in humans. In addition to improving outcomes after TBI, advances in PTE research are likely to provide therapeutic insights that are relevant to all epilepsies.
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Affiliation(s)
- Matthew Pease
- Department of Neurosurgery, Indiana University, Bloomington, IN, USA.
| | - Kunal Gupta
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Solomon L Moshé
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
- Department of Paediatrics, Albert Einstein College of Medicine, New York, NY, USA
| | - Daniel J Correa
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Aristea S Galanopoulou
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lori Shutter
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
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John London A, Karlawish J, Largent EA, Phillips Hey S, McCarthy EP. Algorithmic identification of persons with dementia for research recruitment: ethical considerations. Inform Health Soc Care 2024; 49:28-41. [PMID: 38196387 PMCID: PMC11001531 DOI: 10.1080/17538157.2023.2299881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Underdiagnosis, misdiagnosis, and patterns of social inequality that translate into unequal access to health systems all pose barriers to identifying and recruiting diverse and representative populations into research on Alzheimer's disease and Alzheimer's disease related dementias. In response, some have turned to algorithms to identify patients living with dementia using information that is associated with this condition but that is not as specific as a diagnosis. This paper explains six ethical issues associated with the use of such algorithms including the generation of new, sensitive, identifiable medical information for research purposes without participant consent, issues of justice and equity, risk, and ethical communication. It concludes with a discussion of strategies for addressing these issues and prompting valuable research.
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Affiliation(s)
- Alex John London
- Center for Ethics and Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Jason Karlawish
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily A. Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Ellen P. McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Halley MC, Young JL, Tang C, Mintz KT, Lucas-Griffin S, Maghiro A, Ashley EA, Tabor HK. Genomics Research with Undiagnosed Children: Ethical Challenges at the Boundaries of Research and Clinical Care. J Pediatr 2023; 261:113537. [PMID: 37271495 PMCID: PMC10527480 DOI: 10.1016/j.jpeds.2023.113537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore the perspectives of parents of undiagnosed children enrolled in genomic diagnosis research regarding their motivations for enrolling their children, their understanding of the potential burdens and benefits, and the extent to which their experiences ultimately aligned with or diverged from their original expectations. STUDY DESIGN In-depth interviews were conducted with parents, audio-recorded and transcribed. A structured codebook was applied to each transcript, after which iterative memoing was used to identify themes. RESULTS Fifty-four parents participated, including 17 (31.5%) whose child received a diagnosis through research. Themes describing parents' expectations and experiences of genomic diagnosis research included (1) the extent to which parents' motivations for participation focused on their hope that it would directly benefit their child, (2) the ways in which parents' frustrations regarding the research process confused the dual clinical and research goals of their participation, and (3) the limited clinical benefits parents ultimately experienced for their children. CONCLUSIONS Our results suggest that parents of undiagnosed children seeking enrollment in genomic diagnosis research are at risk of a form of therapeutic misconception-in this case, diagnostic misconception. These findings indicate the need to examine the processes and procedures associated with this research to communicate appropriately and balance the potential burdens and benefits of study participation.
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Affiliation(s)
- Meghan C Halley
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA.
| | - Jennifer L Young
- Center for Genetic Medicine, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Charis Tang
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA
| | - Kevin T Mintz
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA
| | - Sawyer Lucas-Griffin
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA
| | | | - Euan A Ashley
- Department of Genetics, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Holly K Tabor
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine; Stanford, CA
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Richardson HS. More-Than-Partial Entrustment in Pragmatic Clinical Trials. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:42-45. [PMID: 37450525 DOI: 10.1080/15265161.2023.2217125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Foss K, Henderson GE, Kuczynski K, Roberts MC. A Paradigm of Investigator Duty to Multiple Stakeholder Participants. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:58-60. [PMID: 37450534 DOI: 10.1080/15265161.2023.2217115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Kimberly Foss
- The University of North Carolina at Chapel Hill School of Medicine
| | - Gail E Henderson
- The University of North Carolina at Chapel Hill School of Medicine
| | - Kriste Kuczynski
- The University of North Carolina at Chapel Hill School of Medicine
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Friedman E, Baumann MJ, Sehgal S, Starren J, Steans R, Venables A, Michelson K. Pragmatic Research and Clinical Duties: Solutions Through Precision AI-Enabled Clinically Embedded Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:50-52. [PMID: 37450520 PMCID: PMC10493857 DOI: 10.1080/15265161.2023.2217126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
| | | | | | | | | | | | - Kelly Michelson
- Northwestern University Feinberg School of Medicine
- Ann & Robert H. Lurie Children's Hospital of Chicago
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Wilfond BS, Toraman Turk S, Kraft SA, Weiss EM, Tarr PI, Schnadower D, Freedman SB. Distinguishing Clinical and Research Risks in Pragmatic Clinical Trials: The Need for Further Stakeholder Engagement. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:39-42. [PMID: 37450523 PMCID: PMC11104017 DOI: 10.1080/15265161.2023.2217146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Califf RM, Faden R, Kass N, Morain S, Crane M. Challenges in the Ethics and Implementation of Learning Health Care Systems. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:1-4. [PMID: 37450514 DOI: 10.1080/15265161.2023.2223033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Menikoff J. Canceling Tuskegee. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:53-55. [PMID: 37450531 DOI: 10.1080/15265161.2023.2217133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Greene SM. End-to-End Integration of Pragmatic Trials Into Health Care Settings. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:45-47. [PMID: 37450522 DOI: 10.1080/15265161.2023.2217149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Neuhaus C, Crane J, Pacia D. Special Considerations When Research is Embedded within Community Health Centers. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:55-58. [PMID: 37450533 PMCID: PMC10542914 DOI: 10.1080/15265161.2023.2217112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Chen D, Shepherd L. Is There a Doctor in the House? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:47-50. [PMID: 37450521 PMCID: PMC10494221 DOI: 10.1080/15265161.2023.2217148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Donna Chen
- Center for Health Humanities and Ethics, University of Virginia School of Medicine
| | - Lois Shepherd
- Center for Health Humanities and Ethics, University of Virginia School of Medicine
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Halley MC, Olson NW. Blurred Boundaries: Toward an Expanded Ethics of Research and Clinical Care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:5-9. [PMID: 38410998 DOI: 10.1080/15265161.2023.2224148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
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Casey JD, Rice TW, Semler MW. Progressing from "Whether to" to "How to" Conduct Pragmatic Trials. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:33-36. [PMID: 37450516 PMCID: PMC10445643 DOI: 10.1080/15265161.2023.2217123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
| | - Todd W Rice
- Vanderbilt University Medical Center
- Vanderbilt Institute for Clinical and Translational Research (VICTR)
| | - Matthew W Semler
- Vanderbilt University Medical Center
- Vanderbilt Institute for Clinical and Translational Research (VICTR)
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Borgerson K. Seizing the Opportunity to Improve Ethical Oversight of Clinical Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:63-65. [PMID: 37450517 DOI: 10.1080/15265161.2023.2217120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Tumilty E, Smith E. "A Community-Engaged Approach to Address Collateral Findings in Embedded Research". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:61-63. [PMID: 37450538 PMCID: PMC10361628 DOI: 10.1080/15265161.2023.2217113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Emma Tumilty
- Department of Bioethics and Health Humanities, School of Public Health, University of Texas Medical Branch
| | - Elise Smith
- Department of Bioethics and Health Humanities, School of Public Health, University of Texas Medical Branch
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Morain SR, Largent EA. Response to Open Peer Commentaries on "Think Pragmatically: Investigators' Obligations to Patient-Subjects When Research is Embedded into Care". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:W1-W3. [PMID: 38410993 DOI: 10.1080/15265161.2023.2224269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
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Wilets I, Martin G, Bania T. Pragmatic Research and Quality Assessment/Improvement Initiatives: Kindred Spirits. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:69-70. [PMID: 37450540 DOI: 10.1080/15265161.2023.2217118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Afolabi MOS, Afolabi IO. A Neuroethical Analysis of Pragmatic Clinical Trials: Balancing Diverse Interests associated with Collateral Findings. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:66-68. [PMID: 37450527 DOI: 10.1080/15265161.2023.2217128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Abstract
Many large research initiatives have cumulatively enrolled thousands of patients with a range of complex medical issues but no clear genetic etiology. However, it is unclear how researchers, institutions, and funders should manage the data and relationships with those participants who remain undiagnosed when these studies end. In this comment, we outline the current literature relevant to post-study obligations in clinical genomics research and discuss the application of current guidelines to research with undiagnosed participants.
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