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Yadav H, Maini S. Electroencephalogram based brain-computer interface: Applications, challenges, and opportunities. MULTIMEDIA TOOLS AND APPLICATIONS 2023:1-45. [PMID: 37362726 PMCID: PMC10157593 DOI: 10.1007/s11042-023-15653-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/17/2022] [Accepted: 04/22/2023] [Indexed: 06/28/2023]
Abstract
Brain-Computer Interfaces (BCI) is an exciting and emerging research area for researchers and scientists. It is a suitable combination of software and hardware to operate any device mentally. This review emphasizes the significant stages in the BCI domain, current problems, and state-of-the-art findings. This article also covers how current results can contribute to new knowledge about BCI, an overview of BCI from its early developments to recent advancements, BCI applications, challenges, and future directions. The authors pointed to unresolved issues and expressed how BCI is valuable for analyzing the human brain. Humans' dependence on machines has led humankind into a new future where BCI can play an essential role in improving this modern world.
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Affiliation(s)
- Hitesh Yadav
- Department of Electrical and Instrumentation Engineering, Sant Longowal Institute of Engineering & Technology, Longowal, Punjab India
| | - Surita Maini
- Department of Electrical and Instrumentation Engineering, Sant Longowal Institute of Engineering & Technology, Longowal, Punjab India
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2
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Cabrera LY, Gilbert MMC, Achtyes ED, McCright AM, Bluhm R. Jumping through the hoops: Barriers and other ethical concerns regarding the use of psychiatric electroceutical interventions. Psychiatry Res 2022; 313:114612. [PMID: 35584563 PMCID: PMC10516532 DOI: 10.1016/j.psychres.2022.114612] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/19/2022]
Abstract
Stakeholders' perceptions of barriers to and other ethical concerns about using psychiatric electroceutical interventions (PEIs), interventions that use electrical or magnetic stimuli to treat psychiatric conditions like treatment-resistant depression (TRD), may influence the uptake of these interventions. This study examined such perceptions among psychiatrists, patients with depression, and members of the public. We conducted semi-structured qualitative interviews with 16 members of each group to examine their views on practical barriers and ethical concerns. We used qualitative content analysis to identify relevant themes, and compared findings across stakeholder groups. Access limitations to the interventions, including cost and availability of the interventions, cut across all PEIs-including those that are still experimental, and were raised by all groups. Most participants across all groups raised concerns about informed consent, in terms of receiving adequate, appropriate, and understandable information. Our results suggest that these three stakeholder groups perceive similar structural and attitudinal barriers to, and have similar ethical concerns about, using PEIs for TRD. These results identify key issues that must be addressed for the full potential of PEIs to be realized. Future research with larger samples will help to better understand how to address these barriers to treatment for individuals with TRD.
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Affiliation(s)
- Laura Y Cabrera
- Center for Neural Engineering, Department of Science and Mechanics and Rock Ethics Institute, Pennsylvania State University, University Park, W-316 Millennium Science Complex, PA 16802, United States.
| | - Maryssa M C Gilbert
- College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Eric D Achtyes
- Division of Psychiatry & Behavioral Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States; Pine Rest Christian Mental Health Services, Grand Rapids, MI, United States
| | - Aaron M McCright
- Department of Sociology, College of Social Science, Michigan State University, East Lansing, MI, United States
| | - Robyn Bluhm
- Department of Philosophy, College of Arts and Letters, and Lyman Briggs College, Michigan State University, East Lansing, MI, United States
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3
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Pardo M, Khizroev S. Where do we stand now regarding treatment of psychiatric and neurodegenerative disorders? Considerations in using magnetoelectric nanoparticles as an innovative approach. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2022; 14:e1781. [PMID: 35191206 DOI: 10.1002/wnan.1781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/27/2021] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
Almost 1000 million people have recently been diagnosed with a mental health or substance disorder (Ritchie & Roser, 2018). Psychiatric disorders, and their treatment, represent a big burden to the society worldwide, causing about 8 million deaths per year (Walker et al., 2015). Daily progress in science enables continuous advances in methods to treat patients; however, the brain remains to be the most unknown and complex organ of the body. There is a growing demand for innovative approaches to treat psychiatric as well as neurodegenerative disorders, disorders with unknown curability, and treatments mostly designed to slow disease progression. Based on that need and the peculiarity of the central nervous system, in the present review, we highlight the handicaps of the existing approaches as well as discuss the potential of the recently introduced magnetoelectric nanoparticles (MENPs) to become a game-changing tool in future applications for the treatment of brain alterations. Unlike other stimulation approaches, MENPs have the potential to enable a wirelessly controlled stimulation at a single-neuron level without requiring genetic modification of the neural tissue and no toxicity has yet been reported. Their potential as a new tool for targeting the brain is discussed. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease Therapeutic Approaches and Drug Discovery > Neurological Disease.
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Affiliation(s)
- Marta Pardo
- Miller School of Medicine, Department of Neurology and Molecular and Cellular Pharmacology, University of Miami, Miami, Florida, USA
| | - Sakhrat Khizroev
- Department of Electrical and Computer Engineering, University of Miami, Coral Gables, Florida, USA
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Bluhm R, Castillo E, Achtyes ED, McCright AM, Cabrera LY. They Affect the Person, but for Better or Worse? Perceptions of Electroceutical Interventions for Depression Among Psychiatrists, Patients, and the Public. QUALITATIVE HEALTH RESEARCH 2021; 31:2542-2553. [PMID: 34672815 PMCID: PMC8579329 DOI: 10.1177/10497323211037642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Responding to reports of cases of personality change following deep brain stimulation, neuroethicists have debated the nature and ethical implications of these changes. Recently, this literature has been challenged as being overblown and therefore potentially an impediment to patients accessing needed treatment. We interviewed 16 psychiatrists, 16 patients with depression, and 16 members of the public without depression, all from the Midwestern United States, about their views on how three electroceutical interventions (deep brain stimulation, electroconvulsive therapy, and transcranial magnetic stimulation) used to treat depression might affect the self. Participants were also asked to compare the electroceuticals' effects on the self with the effects of commonly used depression treatments (psychotherapy and pharmaceuticals). Using qualitative content analysis, we found that participants' views on electroceuticals' potential effects on the self mainly focused on treatment effectiveness and side effects. Our results have implications for both theoretical discussions in neuroethics and clinical practice in psychiatry.
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Affiliation(s)
- Robyn Bluhm
- Michigan State University, East Lansing, Michigan, USA
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Portillo-Lara R, Tahirbegi B, Chapman CAR, Goding JA, Green RA. Mind the gap: State-of-the-art technologies and applications for EEG-based brain-computer interfaces. APL Bioeng 2021; 5:031507. [PMID: 34327294 PMCID: PMC8294859 DOI: 10.1063/5.0047237] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
Brain-computer interfaces (BCIs) provide bidirectional communication between the brain and output devices that translate user intent into function. Among the different brain imaging techniques used to operate BCIs, electroencephalography (EEG) constitutes the preferred method of choice, owing to its relative low cost, ease of use, high temporal resolution, and noninvasiveness. In recent years, significant progress in wearable technologies and computational intelligence has greatly enhanced the performance and capabilities of EEG-based BCIs (eBCIs) and propelled their migration out of the laboratory and into real-world environments. This rapid translation constitutes a paradigm shift in human-machine interaction that will deeply transform different industries in the near future, including healthcare and wellbeing, entertainment, security, education, and marketing. In this contribution, the state-of-the-art in wearable biosensing is reviewed, focusing on the development of novel electrode interfaces for long term and noninvasive EEG monitoring. Commercially available EEG platforms are surveyed, and a comparative analysis is presented based on the benefits and limitations they provide for eBCI development. Emerging applications in neuroscientific research and future trends related to the widespread implementation of eBCIs for medical and nonmedical uses are discussed. Finally, a commentary on the ethical, social, and legal concerns associated with this increasingly ubiquitous technology is provided, as well as general recommendations to address key issues related to mainstream consumer adoption.
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Affiliation(s)
- Roberto Portillo-Lara
- Department of Bioengineering, Imperial College London, Royal School of Mines, London SW7 2AZ, United Kingdom
| | - Bogachan Tahirbegi
- Department of Bioengineering, Imperial College London, Royal School of Mines, London SW7 2AZ, United Kingdom
| | - Christopher A. R. Chapman
- Department of Bioengineering, Imperial College London, Royal School of Mines, London SW7 2AZ, United Kingdom
| | - Josef A. Goding
- Department of Bioengineering, Imperial College London, Royal School of Mines, London SW7 2AZ, United Kingdom
| | - Rylie A. Green
- Department of Bioengineering, Imperial College London, Royal School of Mines, London SW7 2AZ, United Kingdom
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6
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Gordon G, Williamson G, Gkofa V, Schmidt U, Brockmeyer T, Campbell I. Participants' experience of approach bias modification training with transcranial Direct Current Stimulation as a combination treatment for binge eating disorder. EUROPEAN EATING DISORDERS REVIEW 2021; 29:969-984. [PMID: 34460140 DOI: 10.1002/erv.2859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/25/2021] [Accepted: 08/09/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study explored participants' experience of approach bias modification training (ABM) with transcranial Direct Current Stimulation (tDCS) for binge eating disorder (BED) within a randomised controlled trial (RCT). A subset of participants who completed the RCT were interviewed to attain feedback on treatment experience and outcomes. METHOD 15 participants with BED who completed the RCT were recruited, using purposive sampling. Participants received six sessions of concurrent ABM training with either real or sham tDCS. Semi-structured interviews relating to study experience and treatment outcomes were conducted and data were analysed thematically. RESULTS The combined ABM and tDCS intervention was deemed acceptable and worthwhile by participants interviewed across both intervention groups. Negative preconceptions of tDCS were an initial deterrent to study participation for some, yet the brain stimulation experience was found to be tolerable. Minor and transient sensations and side effects attributed to tDCS were reported by most participants during and after stimulation, in addition to less pleasant aspects of ABM training, with no significant adverse effects reported by interviewees. Positive outcomes were described by participants across both intervention groups, relating to changes in BED symptoms and to broader beneficial effects on associated cognitive and emotional factors. Two participants experienced a shift in autonomy, attributed to tDCS and the combined intervention respectively. CONCLUSIONS Adults with symptoms of BED found concurrent ABM and tDCS sessions to be acceptable, despite initial apprehension about the safety of tDCS. Findings are relevant to the neuroethics literature and may inform science communication strategies on neuromodulation treatments.
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Affiliation(s)
- Gemma Gordon
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Grace Williamson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vasiliki Gkofa
- Division of Psychiatry, University College London, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Gottingen, Goettingen, Germany
| | - Iain Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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7
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Saha S, Mamun KA, Ahmed K, Mostafa R, Naik GR, Darvishi S, Khandoker AH, Baumert M. Progress in Brain Computer Interface: Challenges and Opportunities. Front Syst Neurosci 2021; 15:578875. [PMID: 33716680 PMCID: PMC7947348 DOI: 10.3389/fnsys.2021.578875] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022] Open
Abstract
Brain computer interfaces (BCI) provide a direct communication link between the brain and a computer or other external devices. They offer an extended degree of freedom either by strengthening or by substituting human peripheral working capacity and have potential applications in various fields such as rehabilitation, affective computing, robotics, gaming, and neuroscience. Significant research efforts on a global scale have delivered common platforms for technology standardization and help tackle highly complex and non-linear brain dynamics and related feature extraction and classification challenges. Time-variant psycho-neurophysiological fluctuations and their impact on brain signals impose another challenge for BCI researchers to transform the technology from laboratory experiments to plug-and-play daily life. This review summarizes state-of-the-art progress in the BCI field over the last decades and highlights critical challenges.
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Affiliation(s)
- Simanto Saha
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
- Department of Electrical and Electronic Engineering, United International University, Dhaka, Bangladesh
| | - Khondaker A. Mamun
- Advanced Intelligent Multidisciplinary Systems (AIMS) Lab, Department of Computer Science and Engineering, United International University, Dhaka, Bangladesh
| | - Khawza Ahmed
- Department of Electrical and Electronic Engineering, United International University, Dhaka, Bangladesh
| | - Raqibul Mostafa
- Department of Electrical and Electronic Engineering, United International University, Dhaka, Bangladesh
| | - Ganesh R. Naik
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Sam Darvishi
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Ahsan H. Khandoker
- Healthcare Engineering Innovation Center, Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
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Jotterand F, Bosco C. Keeping the "Human in the Loop" in the Age of Artificial Intelligence : Accompanying Commentary for "Correcting the Brain?" by Rainey and Erden. SCIENCE AND ENGINEERING ETHICS 2020; 26:2455-2460. [PMID: 32643058 DOI: 10.1007/s11948-020-00241-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The benefits of Artificial Intelligence (AI) in medicine are unquestionable and it is unlikely that the pace of its development will slow down. From better diagnosis, prognosis, and prevention to more precise surgical procedures, AI has the potential to offer unique opportunities to enhance patient care and improve clinical practice overall. However, at this stage of AI technology development it is unclear whether it will de-humanize or re-humanize medicine. Will AI allow clinicians to spend less time on administrative tasks and technology related procedures and more time being present in person to attend to the needs of their patients? Or will AI dramatically increase the presence of smart technology in the clinical context to a point of undermining the humane dimension of the patient-physician relationship? In this brief commentary, we argue that technological solutions should be only integrated into clinical medicine if they fulfill the following three conditions: (1) they serve human ends; (2) they respect personal identity; and (3) they promote human interaction. These three conditions form the moral imperative of humanity.
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Affiliation(s)
- Fabrice Jotterand
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Clara Bosco
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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Ramirez-Zamora A, Giordano J, Boyden ES, Gradinaru V, Gunduz A, Starr PA, Sheth SA, McIntyre CC, Fox MD, Vitek J, Vedam-Mai V, Akbar U, Almeida L, Bronte-Stewart HM, Mayberg HS, Pouratian N, Gittis AH, Singer AC, Creed MC, Lazaro-Munoz G, Richardson M, Rossi MA, Cendejas-Zaragoza L, D'Haese PF, Chiong W, Gilron R, Chizeck H, Ko A, Baker KB, Wagenaar J, Harel N, Deeb W, Foote KD, Okun MS. Proceedings of the Sixth Deep Brain Stimulation Think Tank Modulation of Brain Networks and Application of Advanced Neuroimaging, Neurophysiology, and Optogenetics. Front Neurosci 2019; 13:936. [PMID: 31572109 PMCID: PMC6751331 DOI: 10.3389/fnins.2019.00936] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/21/2019] [Indexed: 02/05/2023] Open
Abstract
The annual deep brain stimulation (DBS) Think Tank aims to create an opportunity for a multidisciplinary discussion in the field of neuromodulation to examine developments, opportunities and challenges in the field. The proceedings of the Sixth Annual Think Tank recapitulate progress in applications of neurotechnology, neurophysiology, and emerging techniques for the treatment of a range of psychiatric and neurological conditions including Parkinson’s disease, essential tremor, Tourette syndrome, epilepsy, cognitive disorders, and addiction. Each section of this overview provides insight about the understanding of neuromodulation for specific disease and discusses current challenges and future directions. This year’s report addresses key issues in implementing advanced neurophysiological techniques, evolving use of novel modulation techniques to deliver DBS, ans improved neuroimaging techniques. The proceedings also offer insights into the new era of brain network neuromodulation and connectomic DBS to define and target dysfunctional brain networks. The proceedings also focused on innovations in applications and understanding of adaptive DBS (closed-loop systems), the use and applications of optogenetics in the field of neurostimulation and the need to develop databases for DBS indications. Finally, updates on neuroethical, legal, social, and policy issues relevant to DBS research are discussed.
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Affiliation(s)
- Adolfo Ramirez-Zamora
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - James Giordano
- Neuroethics Studies Program, Department of Neurology and Department of Biochemistry, Georgetown University Medical Center, Washington, DC, United States
| | - Edward S Boyden
- Media Laboratory, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Center for Neurobiological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Viviana Gradinaru
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, United States
| | - Aysegul Gunduz
- Department of Neuroscience and Department of Biomedical Engineering and Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Philip A Starr
- Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Michael D Fox
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jerrold Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Vinata Vedam-Mai
- Department of Neurosurgery, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Umer Akbar
- Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Veterans Affairs Medical Center, Brown Institute for Brain Science, Brown University, Providence, RI, United States
| | - Leonardo Almeida
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Helen M Bronte-Stewart
- Department of Neurology and Department of Neurological Sciences and Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Helen S Mayberg
- Department of Neurology and Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nader Pouratian
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Aryn H Gittis
- Biological Sciences and Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Annabelle C Singer
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University School of Medicine, Atlanta, GA, United States
| | - Meaghan C Creed
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Gabriel Lazaro-Munoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Mark Richardson
- Center for the Neural Basis of Cognition, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Marvin A Rossi
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, United States
| | | | | | - Winston Chiong
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Ro'ee Gilron
- Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Howard Chizeck
- Graduate Program in Neuroscience, Department of Electrical Engineering, University of Washington, Seattle, WA, United States
| | - Andrew Ko
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Kenneth B Baker
- Movement Disorders Program, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Joost Wagenaar
- Department of Neurology, Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, United States
| | - Noam Harel
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Wissam Deeb
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kelly D Foote
- Department of Neurosurgery, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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Commentary: The Value of Patient Benefit: Consideration of Framing Contingencies to Guide the Ethical Use of DBS-a Case Analysis. Camb Q Healthc Ethics 2019; 25:755-8. [PMID: 27634728 DOI: 10.1017/s0963180116000530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Here we have a case in which (1) the outcome(s) for the patient do not comport with the projected-or initially defined-outcomes of the research study, and (2) these outcomes represent cognitive and behavioral effects that are positively interpreted by the patient, but not by the patient's immediate family. The 6Cs approach, which frames the technique or technology-and its effects-within defined considerations of domains and dimensions, can be used as part of a multistep approach to addressing issues arising from the use of neurotechnology. 1 The approach recommends that the medical team consider the following domains and dimensions when engaging neuroethical analyses: • The capacities and limitations of current neuroscience and technology (neuroS/T), and the capacity of the patient • The consequences incurred by neuroS/T on recipients, families, and society in the short, intermediate, and long term • The character of the recipient (e.g., patterns of cognition, emotion, and behavior) affected by neuroS/T • The continuity of research and clinical care • The contexts of need and value that influence the use or nonuse of neuroS/T • Consent through provision of the most information possible 2.
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11
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Cabrera LY, Brandt M, McKenzie R, Bluhm R. Comparison of philosophical concerns between professionals and the public regarding two psychiatric treatments. AJOB Empir Bioeth 2018; 9:252-266. [PMID: 30398397 DOI: 10.1080/23294515.2018.1512534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Psychiatric interventions are a contested area in medicine, not only because of their history of abuses, but also because their therapeutic goal is to affect emotions, thoughts, beliefs, and behaviors that are regarded as pathological. Because psychiatric interventions affect characteristics that seem central to who we are, they raise issues regarding identity, autonomy, and personal responsibility for one's own well-being. Our study addresses two questions: (1) Do the public and academic researchers understand the philosophical stakes of these technologies in the same way? Following from this, (2) to what extent does the specific type of psychiatric technology affect the issues these two groups raise? This study compares how ethical issues regarding neurosurgical and pharmaceutical psychiatric interventions are discussed among the public and in the professional community of academic medicine and bioethics. METHODS We analyzed (1) online public comments and (2) the medical and bioethics literature, comparing the discussions of pharmacological and neurosurgical interventions in psychiatry in each source. RESULTS Overall, the public discussed philosophical issues less frequently than academics. For the two types of psychiatric interventions, we found differences between the academic literature and public comments among all themes, except for personal responsibility. CONCLUSIONS These findings reveal some of the similarities and discrepancies in how philosophical issues associated with psychiatric treatments are discussed in professional circles and among the public. Further research into what causes these discrepancies is crucial.
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Affiliation(s)
- Laura Yenisa Cabrera
- a Center of Ethics and Humanities in the Life Sciences , Michigan State University , East Lansing , Michigan , USA
| | - Marisa Brandt
- b Lyman Briggs College , Michigan State University , East Lansing , Michigan , USA
| | - Rachel McKenzie
- b Lyman Briggs College , Michigan State University , East Lansing , Michigan , USA
| | - Robyn Bluhm
- b Lyman Briggs College , Michigan State University , East Lansing , Michigan , USA.,c Philosophy Department , Michigan State University , East Lansing , Michigan , USA
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12
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Lewis CJ, Maier F, Horstkötter N, Zywczok A, Witt K, Eggers C, Meyer TD, Dembek TA, Maarouf M, Moro E, Zurowski M, Woopen C, Kuhn J, Timmermann L. Subjectively perceived personality and mood changes associated with subthalamic stimulation in patients with Parkinson's disease. Psychol Med 2015; 45:73-85. [PMID: 25066623 DOI: 10.1017/s0033291714001081] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Clinical and ethical implications of personality and mood changes in Parkinson's disease (PD) patients treated with subthalamic deep brain stimulation (STN-DBS) are under debate. Although subjectively perceived personality changes are often mentioned by patients and caregivers, few empirical studies concerning these changes exist. Therefore, we analysed subjectively perceived personality and mood changes in STN-DBS PD patients. METHOD In this prospective study of the ELSA-DBS group, 27 PD patients were assessed preoperatively and 1 year after STN-DBS surgery. Two categories, personality and mood changes, were analysed with semi-structured interviews. Patients were grouped into personality change yes/no, as well as positive/negative mood change groups. Caregivers were additionally interviewed about patients' personality changes. Characteristics of each group were assessed with standard neurological and psychiatric measurements. Predictors for changes were analysed. RESULTS Personality changes were perceived by six of 27 (22%) patients and by 10 of 23 caregivers (44%). The preoperative hypomania trait was a significant predictor for personality change perceived by patients. Of 21 patients, 12 (57%) perceived mood as positively changed. Higher apathy and anxiety ratings were found in the negative change group. CONCLUSIONS Our results show that a high proportion of PD patients and caregivers perceived personality changes under STN-DBS, emphasizing the relevance of this topic. Mood changed in positive and negative directions. Standard measurement scales failed to adequately reflect personality or mood changes subjectively perceived by patients. A more individualized preoperative screening and preparation for patients and caregivers, as well as postoperative support, could therefore be useful.
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Affiliation(s)
- C J Lewis
- Department of Neurology,University of Cologne,Cologne,Germany
| | - F Maier
- Department of Neurology,University of Cologne,Cologne,Germany
| | - N Horstkötter
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - A Zywczok
- Department of Neurology,University of Cologne,Cologne,Germany
| | - K Witt
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - C Eggers
- Department of Neurology,University of Cologne,Cologne,Germany
| | - T D Meyer
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - T A Dembek
- Department of Neurology,University of Cologne,Cologne,Germany
| | - M Maarouf
- Department of Stereotaxy and Functional Neurosurgery,University of Cologne,Cologne,Germany
| | - E Moro
- Movement Disorders Unit, Department of Psychiatry and Neurology,University Hospital Center (CHU) of Grenoble,Grenoble,France
| | - M Zurowski
- Department of Psychiatry,University of Toronto, University Health Network,Toronto,Canada
| | - C Woopen
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - J Kuhn
- Department of Psychiatry and Psychotherapy,University of Cologne,Cologne,Germany
| | - L Timmermann
- Department of Neurology,University of Cologne,Cologne,Germany
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Ethics of the electrified mind: defining issues and perspectives on the principled use of brain stimulation in medical research and clinical care. Brain Topogr 2013; 27:33-45. [PMID: 23733209 DOI: 10.1007/s10548-013-0296-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/15/2013] [Indexed: 12/19/2022]
Abstract
In recent years, non-pharmacologic approaches to modifying human neural activity have gained increasing attention. One of these approaches is brain stimulation, which involves either the direct application of electrical current to structures in the nervous system or the indirect application of current by means of electromagnetic induction. Interventions that manipulate the brain have generally been regarded as having both the potential to alleviate devastating brain-related conditions and the capacity to create unforeseen and unwanted consequences. Hence, although brain stimulation techniques offer considerable benefits to society, they also raise a number of ethical concerns. In this paper we will address various dilemmas related to brain stimulation in the context of clinical practice and biomedical research. We will survey current work involving deep brain stimulation, transcranial magnetic stimulation and transcranial direct current stimulation. We will reflect upon relevant similarities and differences between them, and consider some potentially problematic issues that may arise within the framework of established principles of medical ethics: nonmaleficence and beneficence, autonomy, and justice.
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