1
|
Turk-Browne NB, Aslin RN. Infant neuroscience: how to measure brain activity in the youngest minds. Trends Neurosci 2024:S0166-2236(24)00019-5. [PMID: 38570212 DOI: 10.1016/j.tins.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/08/2024] [Accepted: 02/09/2024] [Indexed: 04/05/2024]
Abstract
The functional properties of the infant brain are poorly understood. Recent advances in cognitive neuroscience are opening new avenues for measuring brain activity in human infants. These include novel uses of existing technologies such as electroencephalography (EEG) and magnetoencephalography (MEG), the availability of newer technologies including functional near-infrared spectroscopy (fNIRS) and optically pumped magnetometry (OPM), and innovative applications of functional magnetic resonance imaging (fMRI) in awake infants during cognitive tasks. In this review article we catalog these available non-invasive methods, discuss the challenges and opportunities encountered when applying them to human infants, and highlight the potential they may ultimately hold for advancing our understanding of the youngest minds.
Collapse
Affiliation(s)
- Nicholas B Turk-Browne
- Department of Psychology, Yale University, New Haven, CT 06520, USA; Wu Tsai Institute, Yale University, New Haven, CT 06510, USA.
| | - Richard N Aslin
- Department of Psychology, Yale University, New Haven, CT 06520, USA; Child Study Center, Yale School of Medicine, New Haven, CT 06520, USA
| |
Collapse
|
2
|
Susser D, Cabrera LY. Brain Data in Context: Are New Rights the Way to Mental and Brain Privacy? AJOB Neurosci 2024; 15:122-133. [PMID: 37017379 DOI: 10.1080/21507740.2023.2188275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
The potential to collect brain data more directly, with higher resolution, and in greater amounts has heightened worries about mental and brain privacy. In order to manage the risks to individuals posed by these privacy challenges, some have suggested codifying new privacy rights, including a right to "mental privacy." In this paper, we consider these arguments and conclude that while neurotechnologies do raise significant privacy concerns, such concerns are-at least for now-no different from those raised by other well-understood data collection technologies, such as gene sequencing tools and online surveillance. To better understand the privacy stakes of brain data, we suggest the use of a conceptual framework from information ethics, Helen Nissenbaum's "contextual integrity" theory. To illustrate the importance of context, we examine neurotechnologies and the information flows they produce in three familiar contexts-healthcare and medical research, criminal justice, and consumer marketing. We argue that by emphasizing what is distinct about brain privacy issues, rather than what they share with other data privacy concerns, risks weakening broader efforts to enact more robust privacy law and policy.
Collapse
|
3
|
Toth J, Kurtin DL, Brosnan M, Arvaneh M. Opportunities and obstacles in non-invasive brain stimulation. Front Hum Neurosci 2024; 18:1385427. [PMID: 38562225 PMCID: PMC10982339 DOI: 10.3389/fnhum.2024.1385427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Non-invasive brain stimulation (NIBS) is a complex and multifaceted approach to modulating brain activity and holds the potential for broad accessibility. This work discusses the mechanisms of the four distinct approaches to modulating brain activity non-invasively: electrical currents, magnetic fields, light, and ultrasound. We examine the dual stochastic and deterministic nature of brain activity and its implications for NIBS, highlighting the challenges posed by inter-individual variability, nebulous dose-response relationships, potential biases and neuroanatomical heterogeneity. Looking forward, we propose five areas of opportunity for future research: closed-loop stimulation, consistent stimulation of the intended target region, reducing bias, multimodal approaches, and strategies to address low sample sizes.
Collapse
Affiliation(s)
- Jake Toth
- Automatic Control and Systems Engineering, Neuroscience Institute, Insigneo Institute, University of Sheffield, Sheffield, United Kingdom
| | | | - Méadhbh Brosnan
- School of Psychology, University College Dublin, Dublin, Ireland
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Mahnaz Arvaneh
- Automatic Control and Systems Engineering, Neuroscience Institute, Insigneo Institute, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
4
|
van der Grinten M, de Ruyter van Steveninck J, Lozano A, Pijnacker L, Rueckauer B, Roelfsema P, van Gerven M, van Wezel R, Güçlü U, Güçlütürk Y. Towards biologically plausible phosphene simulation for the differentiable optimization of visual cortical prostheses. eLife 2024; 13:e85812. [PMID: 38386406 PMCID: PMC10883675 DOI: 10.7554/elife.85812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
Blindness affects millions of people around the world. A promising solution to restoring a form of vision for some individuals are cortical visual prostheses, which bypass part of the impaired visual pathway by converting camera input to electrical stimulation of the visual system. The artificially induced visual percept (a pattern of localized light flashes, or 'phosphenes') has limited resolution, and a great portion of the field's research is devoted to optimizing the efficacy, efficiency, and practical usefulness of the encoding of visual information. A commonly exploited method is non-invasive functional evaluation in sighted subjects or with computational models by using simulated prosthetic vision (SPV) pipelines. An important challenge in this approach is to balance enhanced perceptual realism, biologically plausibility, and real-time performance in the simulation of cortical prosthetic vision. We present a biologically plausible, PyTorch-based phosphene simulator that can run in real-time and uses differentiable operations to allow for gradient-based computational optimization of phosphene encoding models. The simulator integrates a wide range of clinical results with neurophysiological evidence in humans and non-human primates. The pipeline includes a model of the retinotopic organization and cortical magnification of the visual cortex. Moreover, the quantitative effects of stimulation parameters and temporal dynamics on phosphene characteristics are incorporated. Our results demonstrate the simulator's suitability for both computational applications such as end-to-end deep learning-based prosthetic vision optimization as well as behavioral experiments. The modular and open-source software provides a flexible simulation framework for computational, clinical, and behavioral neuroscientists working on visual neuroprosthetics.
Collapse
Affiliation(s)
| | | | - Antonio Lozano
- Netherlands Institute for Neuroscience, Vrije Universiteit, Amsterdam, Netherlands
| | - Laura Pijnacker
- Donders Institute for Brain Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Bodo Rueckauer
- Donders Institute for Brain Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Pieter Roelfsema
- Netherlands Institute for Neuroscience, Vrije Universiteit, Amsterdam, Netherlands
| | - Marcel van Gerven
- Donders Institute for Brain Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Richard van Wezel
- Donders Institute for Brain Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Umut Güçlü
- Donders Institute for Brain Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Yağmur Güçlütürk
- Donders Institute for Brain Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| |
Collapse
|
5
|
Matta R, Moreau D, O’Connor R. Printable devices for neurotechnology. Front Neurosci 2024; 18:1332827. [PMID: 38440397 PMCID: PMC10909977 DOI: 10.3389/fnins.2024.1332827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
Printable electronics for neurotechnology is a rapidly emerging field that leverages various printing techniques to fabricate electronic devices, offering advantages in rapid prototyping, scalability, and cost-effectiveness. These devices have promising applications in neurobiology, enabling the recording of neuronal signals and controlled drug delivery. This review provides an overview of printing techniques, materials used in neural device fabrication, and their applications. The printing techniques discussed include inkjet, screen printing, flexographic printing, 3D printing, and more. Each method has its unique advantages and challenges, ranging from precise printing and high resolution to material compatibility and scalability. Selecting the right materials for printable devices is crucial, considering factors like biocompatibility, flexibility, electrical properties, and durability. Conductive materials such as metallic nanoparticles and conducting polymers are commonly used in neurotechnology. Dielectric materials, like polyimide and polycaprolactone, play a vital role in device fabrication. Applications of printable devices in neurotechnology encompass various neuroprobes, electrocorticography arrays, and microelectrode arrays. These devices offer flexibility, biocompatibility, and scalability, making them cost-effective and suitable for preclinical research. However, several challenges need to be addressed, including biocompatibility, precision, electrical performance, long-term stability, and regulatory hurdles. This review highlights the potential of printable electronics in advancing our understanding of the brain and treating neurological disorders while emphasizing the importance of overcoming these challenges.
Collapse
Affiliation(s)
- Rita Matta
- Mines Saint-Etienne, Centre CMP, Departement BEL, Gardanne, France
| | - David Moreau
- Mines Saint-Etienne, Centre CMP, Departement BEL, Gardanne, France
| | - Rodney O’Connor
- Mines Saint-Etienne, Centre CMP, Departement BEL, Gardanne, France
- Department of Chemical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| |
Collapse
|
6
|
Thota AK, Jung R. Accelerating neurotechnology development using an Agile methodology. Front Neurosci 2024; 18:1328540. [PMID: 38435056 PMCID: PMC10904481 DOI: 10.3389/fnins.2024.1328540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/18/2024] [Indexed: 03/05/2024] Open
Abstract
Novel bioelectronic medical devices that target neural control of visceral organs (e.g., liver, gut, spleen) or inflammatory reflex pathways are innovative class III medical devices like implantable cardiac pacemakers that are lifesaving and life-sustaining medical devices. Bringing innovative neurotechnologies early into the market and the hands of treatment providers would benefit a large population of patients inflicted with autonomic and chronic immune disorders. Medical device manufacturers and software developers widely use the Waterfall methodology to implement design controls through verification and validation. In the Waterfall methodology, after identifying user needs, a functional unit is fabricated following the verification loop (design, build, and verify) and then validated against user needs. Considerable time can lapse in building, verifying, and validating the product because this methodology has limitations for adjusting to unanticipated changes. The time lost in device development can cause significant delays in final production, increase costs, and may even result in the abandonment of the device development. Software developers have successfully implemented an Agile methodology that overcomes these limitations in developing medical software. However, Agile methodology is not routinely used to develop medical devices with implantable hardware because of the increased regulatory burden of the need to conduct animal and human studies. Here, we provide the pros and cons of the Waterfall methodology and make a case for adopting the Agile methodology in developing medical devices with physical components. We utilize a peripheral nerve interface as an example device to illustrate the use of the Agile approach to develop neurotechnologies.
Collapse
Affiliation(s)
- Anil Kumar Thota
- Adaptive Neural Systems Group, The Institute for Integrative and Innovative Research, University of Arkansas, Fayetteville, AR, United States
| | - Ranu Jung
- Adaptive Neural Systems Group, The Institute for Integrative and Innovative Research, University of Arkansas, Fayetteville, AR, United States
- Biomedical Engineering Department, University of Arkansas, Fayetteville, AR, United States
| |
Collapse
|
7
|
Lewis CM, Boehler C, Liljemalm R, Fries P, Stieglitz T, Asplund M. Recording Quality Is Systematically Related to Electrode Impedance. Adv Healthc Mater 2024:e2303401. [PMID: 38354063 DOI: 10.1002/adhm.202303401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/19/2024] [Indexed: 02/16/2024]
Abstract
Extracellular recordings with planar microelectrodes are the gold standard technique for recording the fast action potentials of neurons in the intact brain. The introduction of microfabrication techniques has revolutionized the in vivo recording of neuronal activity and introduced high-density, multi-electrode arrays that increase the spatial resolution of recordings and the number of neurons that can be simultaneously recorded. Despite these innovations, there is still debate about the ideal electrical transfer characteristics of extracellular electrodes. This uncertainty is partly due to the lack of systematic studies comparing electrodes with different characteristics, particularly for chronically implanted arrays over extended time periods. Here a high-density, flexible, and thin-film array is fabricated and tested, containing four distinct electrode types differing in surface material and surface topology and, thus, impedance. It is found that recording quality is strongly related to electrode impedance with signal amplitude and unit yield negatively correlated to impedance. Electrode impedances are stable for the duration of the experiment (up to 12 weeks) and recording quality does not deteriorate. The findings support the expectation from the theory that recording quality will increase as impedance decreases.
Collapse
Affiliation(s)
| | - Christian Boehler
- Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, 79110, Freiburg, Germany
| | - Rickard Liljemalm
- Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110, Freiburg, Germany
| | - Pascal Fries
- Ernst Strüngmann Institute (ESI) for Neuroscience in Cooperation with Max Planck Society, Deutschordenstraße 46, 60528, Frankfurt, Germany
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29, 6525 EN, Nijmegen, Netherland
| | - Thomas Stieglitz
- Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, 79110, Freiburg, Germany
| | - Maria Asplund
- Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, 79110, Freiburg, Germany
- Department of Microtechnology and Nanoscience, Chalmers University of Technology, Kemivägen 9, Gothenburg, 41258, Sweden
| |
Collapse
|
8
|
Duke G, Yotter CN, Sharifian B, Duke G, Petersen S. The effectiveness of microcurrent neurofeedback on depression, anxiety, post-traumatic stress disorder, and quality of life. J Am Assoc Nurse Pract 2024; 36:100-109. [PMID: 37682024 PMCID: PMC10836789 DOI: 10.1097/jxx.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The world faces a mental health crisis with elevated rates of depression, anxiety, and post-traumatic stress, leaving a profound impact on daily quality of life (QOL). Current treatments show varying degrees of efficacy and carry burdensome challenges. Evidence exists for use of an innovative neurotechnology to reduce symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), but the science is lacking for use in the general population. PURPOSES The purpose of this pilot study was to explore the effects of microcurrent neurofeedback on depression, anxiety, PTSD symptoms, and QOL in adults. METHODOLOGY This was a one-group, exploratory pilot study that tested outcomes of depression, anxiety, PTSD risk, suicide risk, and QOL in 20 adults using convenience sampling. IASIS microcurrent neurofeedback (I-MCN) was the intervention that was delivered twice a week for 10 weeks; data collection was baseline, 5 weeks, and 10 weeks. RESULTS Depression, anxiety, PTSD risk, and QOL improved significantly by the 10th and 20th session; suicidal risk showed nonsignificant reduction. Use of a more feasible interventional procedure established a foundation for use in clinical settings for the population. CONCLUSIONS Using a more simpler procedure than what was used in a previous study reflected positive outcomes earlier and sustained over 10 weeks. This safe and effective technology carries rare but easily overcome adverse effects and could be an alternative to existing treatments or treatment-resistant conditions. IMPLICATIONS Advanced practice nurses can apply the evidence to reduce symptoms of depression, anxiety, and PTSD. Randomized controlled trials and testing on diverse populations are needed.
Collapse
Affiliation(s)
- Gloria Duke
- School of Nursing, The University of Texas at Tyler, Tyler, Texas
| | | | | | - Gary Duke
- Trinity Integrative Care, LLC, Tyler, Texas
| | - Sandra Petersen
- School of Nursing, The University of Texas at Tyler, Tyler, Texas
| |
Collapse
|
9
|
Bhidayasiri R. The grand challenge at the frontiers of neurotechnology and its emerging clinical applications. Front Neurol 2024; 15:1314477. [PMID: 38299015 PMCID: PMC10827995 DOI: 10.3389/fneur.2024.1314477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Affiliation(s)
- Roongroj Bhidayasiri
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| |
Collapse
|
10
|
Geukes SH, Bijlsma J, Meynen G, Raemaekers MAH, Ramsey NF, Simon Thomas MA, van Toor DAG, Vansteensel MJ. Neurotechnology in criminal justice: key points for neuroscientists and engineers. J Neural Eng 2024; 21:013001. [PMID: 38193322 DOI: 10.1088/1741-2552/ad1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Affiliation(s)
- S H Geukes
- University Medical Center Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Bijlsma
- Willem Pompe Institute for Criminal Law and Criminology, Department of Law, Faculty of Law, Economics, Governance and Organization, Utrecht University, Utrecht, The Netherlands
- Utrecht Centre for Accountability and Liability Law, Department of Law, Faculty of Law, Economics, Governance and Organization, Utrecht University, Utrecht, The Netherlands
| | - G Meynen
- Willem Pompe Institute for Criminal Law and Criminology, Department of Law, Faculty of Law, Economics, Governance and Organization, Utrecht University, Utrecht, The Netherlands
- Utrecht Centre for Accountability and Liability Law, Department of Law, Faculty of Law, Economics, Governance and Organization, Utrecht University, Utrecht, The Netherlands
- Department of Philosophy, Faculty of Humanities, VU Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest, Amsterdam, The Netherlands
| | - M A H Raemaekers
- University Medical Center Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N F Ramsey
- University Medical Center Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M A Simon Thomas
- Institute of Jurisprudence, Constitutional and Administrative Law, Department of Law, Faculty of Law, Economics, Governance and Organization, Utrecht University, Utrecht, The Netherlands
- Montaigne Centre for the Rule of Law and Administration of Justice, Department of Law, Faculty of Law, Economics, Governance and Organization, Utrecht University, Utrecht, The Netherlands
| | - D A G van Toor
- Willem Pompe Institute for Criminal Law and Criminology, Department of Law, Faculty of Law, Economics, Governance and Organization, Utrecht University, Utrecht, The Netherlands
- Montaigne Centre for the Rule of Law and Administration of Justice, Department of Law, Faculty of Law, Economics, Governance and Organization, Utrecht University, Utrecht, The Netherlands
| | - M J Vansteensel
- University Medical Center Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
11
|
Huang S, Paul U, Gupta S, Desai K, Guo M, Jung J, Capestany B, Krenzer WD, Stonecipher D, Farahany N. U.S. public perceptions of the sensitivity of brain data. J Law Biosci 2024; 11:lsad032. [PMID: 38259629 PMCID: PMC10800024 DOI: 10.1093/jlb/lsad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
As we approach an era of potentially widespread consumer neurotechnology, scholars and organizations worldwide have started to raise concerns about the data privacy issues these devices will present. Notably absent in these discussions is empirical evidence about how the public perceives that same information. This article presents the results of a nationwide survey on public perceptions of brain data, to inform discussions of law and policy regarding brain data governance. The survey reveals that the public may perceive certain brain data as less sensitive than other 'private' information, like social security numbers, but more sensitive than some 'public' information, like media preferences. The findings also reveal that not all inferences about mental experiences may be perceived as equally sensitive, and perhaps not all data should be treated alike in ethical and policy discussions. An enhanced understanding of public perceptions of brain data could advance the development of ethical and legal norms concerning consumer neurotechnology.
Collapse
Affiliation(s)
- Shenyang Huang
- Center for Cognitive Neuroscience, Duke University, Durham, North Carolina, USA
- Duke Initiative for Science & Society, Durham, North Carolina, USA
| | - Umika Paul
- Duke Initiative for Science & Society, Durham, North Carolina, USA
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Shikhar Gupta
- Duke Initiative for Science & Society, Durham, North Carolina, USA
| | - Karen Desai
- Duke Initiative for Science & Society, Durham, North Carolina, USA
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Melinda Guo
- Duke Initiative for Science & Society, Durham, North Carolina, USA
| | - Jennifer Jung
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | | | - Dylan Stonecipher
- Duke Initiative for Science & Society, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Nita Farahany
- Duke Initiative for Science & Society, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| |
Collapse
|
12
|
Goering S, Brown AI, Klein E. Brain Pioneers and Moral Entanglement: An Argument for Post-trial Responsibilities in Neural-Device Trials. Hastings Cent Rep 2024; 54:24-33. [PMID: 38390679 PMCID: PMC11060429 DOI: 10.1002/hast.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
We argue that in implanted neurotechnology research, participants and researchers experience what Henry Richardson has called "moral entanglement." Participants partially entrust researchers with access to their brains and thus to information that would otherwise be private, leading to created intimacies and special obligations of beneficence for researchers and research funding agencies. One of these obligations, we argue, is about continued access to beneficial technology once a trial ends. We make the case for moral entanglement in this context through exploration of participants' vulnerability, uncompensated risks and burdens, depth of relationship with the research team, and dependence on researchers in implanted neurotechnology trials.
Collapse
|
13
|
González-Márquez C. Neuromodulation and memory: exploring ethical ramifications in memory modification treatment via implantable neurotechnologies. Front Psychol 2023; 14:1282634. [PMID: 38179489 PMCID: PMC10764565 DOI: 10.3389/fpsyg.2023.1282634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024] Open
Abstract
Invasive implantable neurotechnologies capable of simultaneously altering and recording neural activity are no longer the exclusive province of science fiction but a looming reality that will revolutionize medical practice. These advancements, particularly in their memory-altering capabilities, herald a vast array of opportunities for addressing the complex landscape of neurodegenerative and psychiatric conditions linked to memory impairments. However, the panoply of ethical implications arising from such a novel neurotechnology remains relatively unexplored by the neuroethics literature. This study examines and contrasts the potential ethical implications of memory modification treatment via implantable neurotechnologies. The study contends that undesired side effects resulting from memory modulation can lead to significant identity harms, disrupting the coherence of self-narratives and impinging on our authenticity. To evince the practical impact of this moral argument, the study conducts a practical ethical assessment of how employing implantable neurotechnologies to modulate memory may jeopardize (i) our moral responsiveness to events and core system of values and (ii) the emotional component associated with the altered memory. From a first-person standpoint, changes to the way we reasonably feel and react to past events and future intentions may be deemed ethically problematic as these profound changes can yield significant moral disruptions and negatively impact our personal lives and interpersonal relationships. In addition, the study discusses further ethical conundrums from a third-person perspective as these disruptions can inhibit social activism against structural injustices, thereby hindering societal progress. Thus, taking into account this societal dimension is paramount when evaluating the ethical permissibility of memory modification procedures.
Collapse
|
14
|
Schalk G, Shao S, Xiao K, Wu Z. Detection of common EEG phenomena using individual electrodes placed outside the hair. Biomed Phys Eng Express 2023; 10:015015. [PMID: 38055994 DOI: 10.1088/2057-1976/ad12f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/06/2023] [Indexed: 12/08/2023]
Abstract
Many studies over the past decades have provided exciting evidence that electrical signals recorded from the scalp (electroencephalogram, EEG) hold meaningful information about the brain's function or dysfunction. This information is used routinely in research laboratories to test specific hypotheses and in clinical settings to aid in diagnoses (such as during polysomnography evaluations). Unfortunately, with very few exceptions, such meaningful information about brain function has not yet led to valuable solutions that can address the needs of many people outside such research laboratories or clinics. One of the major hurdles to practical application of EEG-based neurotechnologies is the current predominant requirement to use electrodes that are placed in the hair, which greatly reduces practicality and cosmesis. While several studies reported results using one specific combination of signal/reference electrode outside the hair in one specific context (such as a brain-computer interface experiment), it has been unclear what information about brain function can be acquired using different signal/referencing locations placed outside the hair. To address this issue, in this study, we set out to determine to what extent EEG phenomena related to auditory, visual, cognitive, motor, and sleep function can be detected from different combinations of individual signal/referencing electrodes that are placed outside the hair. The results of our study from 15 subjects suggest that only a few EEG electrodes placed in locations on the forehead or around the ear can provide substantial task-related information in 6 of 7 tasks. Thus, the results of our study provide encouraging evidence and guidance that should invigorate and facilitate the translation of laboratory experiments into practical, useful, and valuable EEG-based neurotechnology solutions.
Collapse
Affiliation(s)
- Gerwin Schalk
- Chen Frontier Lab for Applied Neurotechnology, Tianqiao and Chrissy Chen Institute, Shanghai, People's Republic of China
- Department of Neurosurgery, Huashan Hospital / Fudan University, Shanghai, People's Republic of China
| | - Shiyun Shao
- Chen Frontier Lab for Applied Neurotechnology, Tianqiao and Chrissy Chen Institute, Shanghai, People's Republic of China
| | - Kewei Xiao
- Chen Frontier Lab for Applied Neurotechnology, Tianqiao and Chrissy Chen Institute, Shanghai, People's Republic of China
| | - Zehan Wu
- Chen Frontier Lab for Applied Neurotechnology, Tianqiao and Chrissy Chen Institute, Shanghai, People's Republic of China
- Department of Neurosurgery, Huashan Hospital / Fudan University, Shanghai, People's Republic of China
| |
Collapse
|
15
|
Seyfried G, Youssef S, Schmidt M. Pioneering neurohackers: between egocentric human enhancement and altruistic sacrifice. Front Neurosci 2023; 17:1188066. [PMID: 37946729 PMCID: PMC10631784 DOI: 10.3389/fnins.2023.1188066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023] Open
Abstract
The growing field of neurotechnology (NT) is becoming more and more accessible in terms of reduced costs, increasing availability and reliability of materials, and ways to implant devices. As in other engineering fields such as bio-or information technology, there is a growing community of pioneering hackers who (self-)experiment with NT and develop novel applications. While most debates about NT, its goals and ethical ramifications are usually conducted by professionals in the field (neuroscientists, -engineers, -ethicists), little is known within these institutional frameworks about the motivations, goals and visions of neurohackers and how they view ethical ramifications of NT therapeutics vs. human enhancement. In this study we draw on qualitative interviews with 13 of these neurohacking pioneers, who are interacting with NT from a grassroots perspective (i.e., a bottom-up and community/subculture-oriented approach), and shed light on: how they understand themselves in the context of human enhancement; what the role of invasive NTs is when it comes to identifying as a cyborg; if their practices show a clear distinction between therapy and enhancement; whether human enhancement is always about performance, optimization and functionality; and to which extent neurohackers contribute to "mainstreaming" NT.
Collapse
|
16
|
Hendriks S, Hsu N, Beckel-Mitchener AC, Ngai J, Grady C. Continuing trial responsibilities for implantable neural devices. Neuron 2023; 111:3143-3149. [PMID: 37582365 DOI: 10.1016/j.neuron.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 08/17/2023]
Abstract
Participants of neural implant studies have research-related posttrial care needs (e.g., hardware replacements). Gaps in plans for posttrial care are currently common, which can have major consequences for patients. Professionals and organizations involved should address important unmet posttrial needs.
Collapse
Affiliation(s)
- Saskia Hendriks
- Office of Neuroscience Communications and Engagement, NINDS, NIH, Bethesda, MD, USA; Department of Bioethics, NIH Clinical Center, Bethesda, MD, USA.
| | - Nina Hsu
- Office of Neuroscience Communications and Engagement, NINDS, NIH, Bethesda, MD, USA
| | | | - John Ngai
- NIH BRAIN Initiative, NIH, Bethesda, MD, USA
| | - Christine Grady
- Department of Bioethics, NIH Clinical Center, Bethesda, MD, USA
| |
Collapse
|
17
|
Abstract
Optogenetics, the use of microbial rhodopsins to make the electrical activity of targeted neurons controllable by light, has swept through neuroscience, enabling thousands of scientists to study how specific neuron types contribute to behaviors and pathologies, and how they might serve as novel therapeutic targets. By activating a set of neurons, one can probe what functions they can initiate or sustain, and by silencing a set of neurons, one can probe the functions they are necessary for. We here review the biophysics of these molecules, asking why they became so useful in neuroscience for the study of brain circuitry. We review the history of the field, including early thinking, early experiments, applications of optogenetics, pre-optogenetics targeted neural control tools, and the history of discovering and characterizing microbial rhodopsins. We then review the biophysical attributes of rhodopsins that make them so useful to neuroscience - their classes and structure, their photocycles, their photocurrent magnitudes and kinetics, their action spectra, and their ion selectivity. Our hope is to convey to the reader how specific biophysical properties of these molecules made them especially useful to neuroscientists for a difficult problem - the control of high-speed electrical activity, with great precision and ease, in the brain.
Collapse
Affiliation(s)
- Kiryl D Piatkevich
- School of Life Sciences, Westlake University, Hangzhou, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Edward S Boyden
- McGovern Institute and Koch Institute, Departments of Brain and Cognitive Sciences, Media Arts and Sciences, and Biological Engineering, K. Lisa Yang Center for Bionics and Center for Neurobiological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Howard Hughes Medical Institute, Cambridge, MA, USA
| |
Collapse
|
18
|
Herrera-Ferrá K, Muñoz JM, Nicolini H, Saruwatari Zavala G, Martínez Bullé Goyri VM. Contextual and Cultural Perspectives on Neurorights: Reflections Toward an International Consensus. AJOB Neurosci 2023; 14:360-368. [PMID: 35341473 DOI: 10.1080/21507740.2022.2048722] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The development and use of advanced and innovative neuroscience, neurotechnology and some forms of artificial intelligence have exposed potential threats to the human condition, including human rights. As a result, reconceptualizing or creating human rights (i.e. neurorights) has been proposed to address specific brain and mind issues like free will, personal identity and cognitive liberty. However, perceptions, interpretations and meanings of these issues-and of neurorights-may vary between countries, contexts and cultures, all relevant for an international-consensus definition and implementation of neurorights. Thus, we encourage reflecting on the proactive inclusion of transnational, cross-cultural and contextual considerations and concerns to contribute to the global discourse. This inclusion does not mean endorsing ethical relativism but rather a call to foster a universal understanding of key concepts and concerns. Including contextual and cultural perspectives may truly anticipate global concerns which could be addressed while developing and implementing neurorights. Consequently, any ethical and/or legal regulatory framework(s) for the translational and transnational use of advanced neuroscience, neurotechnology and some forms of artificial intelligence intended to protect and safeguard human dignity should be contextually and culturally mindful, responsible, respectful and inclusive of not only human rights and fundamental freedoms but also of neurocognitive cultural diversity.
Collapse
Affiliation(s)
| | - José M Muñoz
- Asociación Mexicana de Neuroética
- Institute for Culture and Society, University of Navarra
- Tatiana Foundation
| | - Humberto Nicolini
- Asociación Mexicana de Neuroética
- National Institute of Genomic Medicine (INMEGEN)
| | | | | |
Collapse
|
19
|
Alonso-Valerdi LM. Editorial: Improving decoding of neuroinformation: towards the diversity of neural engineering applications. Front Hum Neurosci 2023; 17:1270696. [PMID: 37711224 PMCID: PMC10497864 DOI: 10.3389/fnhum.2023.1270696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
|
20
|
Erden YJ, Brey P. Neurotechnology and ethics guidelines for human enhancement: The case of the hippocampal cognitive prosthesis. Artif Organs 2023; 47:1235-1241. [PMID: 37533179 DOI: 10.1111/aor.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Neurotechnologies offer both therapeutic and enhancement potential. In this article, we demonstrate how ethics guidelines can help with critical reflection on their potential for enhancement. We do this through the case of the hippocampal cognitive prosthesis. This prothesis developed in the US, has primarily therapeutic ends, with scope for enhancement. This technology raises several ethical issues, including as related to identity and memory, autonomy and authenticity. In the first section, we outline what we mean by enhancement, and introduce neurotechnologies generally and the hippocampal cognitive prosthesis specifically, with an introduction to generally relevant ethical issues. In the second section, we outline ethical issues pertinent to the hippocampal cognitive prosthesis and explore how ethics guidelines can help to promote essential critical reflection on a technology like this. Through all this, our emphasis is to balance between technological optimism and caution, especially where technologies have enhancement potential.
Collapse
Affiliation(s)
- Yasemin J Erden
- Philosophy Section, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Philip Brey
- Philosophy Section, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| |
Collapse
|
21
|
O’Shaughnessy MR, Johnson WG, Tournas LN, Rozell CJ, Rommelfanger KS. Neuroethics guidance documents: principles, analysis, and implementation strategies. J Law Biosci 2023; 10:lsad025. [PMID: 37901886 PMCID: PMC10602660 DOI: 10.1093/jlb/lsad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/17/2023] [Indexed: 10/31/2023]
Abstract
Innovations in neurotechnologies have ignited conversations about ethics around the world, with implications for researchers, policymakers, and the private sector. The human rights impacts of neurotechnologies have drawn the attention of United Nations bodies; nearly 40 states are tasked with implementing the Organization for Economic Co-operation and Development's principles for responsible innovation in neurotechnology; and the United States is considering placing export controls on brain-computer interfaces. Against this backdrop, we offer the first review and analysis of neuroethics guidance documents recently issued by prominent government, private, and academic groups, focusing on commonalities and divergences in articulated goals; envisioned roles and responsibilities of different stakeholder groups; and the suggested role of the public. Drawing on lessons from the governance of other emerging technologies, we suggest implementation and evaluation strategies to guide practitioners and policymakers in operationalizing these ethical norms in research, business, and policy settings.
Collapse
Affiliation(s)
- Matthew R O’Shaughnessy
- School of Electrical & Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Walter G Johnson
- School of Regulation and Global Governance (RegNet), Australian National University, Acton, ACT, Australia
| | | | - Christopher J Rozell
- School of Electrical & Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Karen S Rommelfanger
- Emory Center for Ethics Neuroethics Program, Emory University, Atlanta, GA, USA
- School of Medicine Departments of Neurology and Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA
- Institute of Neuroethics, Atlanta, GA, USA
| |
Collapse
|
22
|
López-Larraz E, Escolano C, Robledo-Menéndez A, Morlas L, Alda A, Minguez J. A garment that measures brain activity: proof of concept of an EEG sensor layer fully implemented with smart textiles. Front Hum Neurosci 2023; 17:1135153. [PMID: 37305362 PMCID: PMC10250743 DOI: 10.3389/fnhum.2023.1135153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/20/2023] [Indexed: 06/13/2023] Open
Abstract
This paper presents the first garment capable of measuring brain activity with accuracy comparable to that of state-of-the art dry electroencephalogram (EEG) systems. The main innovation is an EEG sensor layer (i.e., the electrodes, the signal transmission, and the cap support) made entirely of threads, fabrics, and smart textiles, eliminating the need for metal or plastic materials. The garment is connected to a mobile EEG amplifier to complete the measurement system. As a first proof of concept, the new EEG system (Garment-EEG) was characterized with respect to a state-of-the-art Ag/AgCl dry-EEG system (Dry-EEG) over the forehead area of healthy participants in terms of: (1) skin-electrode impedance; (2) EEG activity; (3) artifacts; and (4) user ergonomics and comfort. The results show that the Garment-EEG system provides comparable recordings to Dry-EEG, but it is more susceptible to artifacts under adverse recording conditions due to poorer contact impedances. The textile-based sensor layer offers superior ergonomics and comfort compared to its metal-based counterpart. We provide the datasets recorded with Garment-EEG and Dry-EEG systems, making available the first open-access dataset of an EEG sensor layer built exclusively with textile materials. Achieving user acceptance is an obstacle in the field of neurotechnology. The introduction of EEG systems encapsulated in wearables has the potential to democratize neurotechnology and non-invasive brain-computer interfaces, as they are naturally accepted by people in their daily lives. Furthermore, supporting the EEG implementation in the textile industry may result in lower cost and less-polluting manufacturing processes compared to metal and plastic industries.
Collapse
|
23
|
Bosch V, Mecacci G. Eyes on the road: brain computer interfaces and cognitive distraction in traffic. Front Neurogenom 2023; 4:1171910. [PMID: 38234470 PMCID: PMC10790900 DOI: 10.3389/fnrgo.2023.1171910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/11/2023] [Indexed: 01/19/2024]
Abstract
Novel wearable neurotechnology is able to provide insight into its wearer's cognitive processes and offers ways to change or enhance their capacities. Moreover, it offers the promise of hands-free device control. These brain-computer interfaces are likely to become an everyday technology in the near future, due to their increasing accessibility and affordability. We, therefore, must anticipate their impact, not only on society and individuals broadly but also more specifically on sectors such as traffic and transport. In an economy where attention is increasingly becoming a scarce good, these innovations may present both opportunities and challenges for daily activities that require focus, such as driving and cycling. Here, we argue that their development carries a dual risk. Firstly, BCI-based devices may match or further increase the intensity of cognitive human-technology interaction over the current hands-free communication devices which, despite being widely accepted, are well-known for introducing a significant amount of cognitive load and distraction. Secondly, BCI-based devices will be typically harder than hands-free devices to both visually detect (e.g., how can law enforcement check when these extremely small and well-integrated devices are used?) and restrain in their use (e.g., how do we prevent users from using such neurotechnologies without breaching personal integrity and privacy?). Their use in traffic should be anticipated by researchers, engineers, and policymakers, in order to ensure the safety of all road users.
Collapse
Affiliation(s)
- Victoria Bosch
- Machine Learning, Institute of Cognitive Science, Osnabrück University, Osnabrück, Germany
| | - Giulio Mecacci
- Department of Artificial Intelligence, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| |
Collapse
|
24
|
Ligthart S, Ienca M, Meynen G, Molnar-Gabor F, Andorno R, Bublitz C, Catley P, Claydon L, Douglas T, Farahany N, Fins JJ, Goering S, Haselager P, Jotterand F, Lavazza A, McCay A, Wajnerman Paz A, Rainey S, Ryberg J, Kellmeyer P. Minding Rights: Mapping Ethical and Legal Foundations of 'Neurorights'. Camb Q Healthc Ethics 2023:1-21. [PMID: 37183686 DOI: 10.1017/s0963180123000245] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The rise of neurotechnologies, especially in combination with artificial intelligence (AI)-based methods for brain data analytics, has given rise to concerns around the protection of mental privacy, mental integrity and cognitive liberty - often framed as "neurorights" in ethical, legal, and policy discussions. Several states are now looking at including neurorights into their constitutional legal frameworks, and international institutions and organizations, such as UNESCO and the Council of Europe, are taking an active interest in developing international policy and governance guidelines on this issue. However, in many discussions of neurorights the philosophical assumptions, ethical frames of reference and legal interpretation are either not made explicit or conflict with each other. The aim of this multidisciplinary work is to provide conceptual, ethical, and legal foundations that allow for facilitating a common minimalist conceptual understanding of mental privacy, mental integrity, and cognitive liberty to facilitate scholarly, legal, and policy discussions.
Collapse
Affiliation(s)
- Sjors Ligthart
- Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, Denmark; Department of Criminal Law, Tilburg University, Tilberg, The Netherlands
| | - Marcello Ienca
- School of Medicine, Technical University of Munich (TUM), Germany & College of Humanities, Swiss Federal Institute of Technology in Lausanne (EPFL), Lausanne, Switzerland
| | - Gerben Meynen
- Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, Denmark; Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Roberto Andorno
- Institute for Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland
| | | | - Paul Catley
- School of Law, The Open University, Milton Keynes, UK
| | - Lisa Claydon
- School of Law, The Open University, Milton Keynes, UK
| | | | | | - Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY, USA
| | - Sara Goering
- Department of Philosophy, University of Washington, Seattle, WA, USA
| | - Pim Haselager
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Fabrice Jotterand
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Allan McCay
- The University of Sydney Law School, Sydney, NSW, Australia
| | - Abel Wajnerman Paz
- Instituto de Éticas Aplicadas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Stephen Rainey
- Ethics and Philosophy of Technology Section, Delft University, Delft, The Netherlands
| | - Jesper Ryberg
- Department of Philosophy, Roskilde University, Roskilde, Denmark
| | - Philipp Kellmeyer
- Department of Neurosurgery, University of Freiburg - Medical Center, Freiburg im Breisgau, Germany
| |
Collapse
|
25
|
Eisenkolb VM, Held LM, Utzschmid A, Lin XX, Krieg SM, Meyer B, Gempt J, Jacob SN. Human acute microelectrode array recordings with broad cortical access, single-unit resolution, and parallel behavioral monitoring. Cell Rep 2023; 42:112467. [PMID: 37141095 DOI: 10.1016/j.celrep.2023.112467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/06/2023] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
There are vast gaps in our understanding of the organization and operation of the human nervous system at the level of individual neurons and their networks. Here, we report reliable and robust acute multichannel recordings using planar microelectrode arrays (MEAs) implanted intracortically in awake brain surgery with open craniotomies that grant access to large parts of the cortical hemisphere. We obtained high-quality extracellular neuronal activity at the microcircuit, local field potential level and at the cellular, single-unit level. Recording from the parietal association cortex, a region rarely explored in human single-unit studies, we demonstrate applications on these complementary spatial scales and describe traveling waves of oscillatory activity as well as single-neuron and neuronal population responses during numerical cognition, including operations with uniquely human number symbols. Intraoperative MEA recordings are practicable and can be scaled up to explore cellular and microcircuit mechanisms of a wide range of human brain functions.
Collapse
Affiliation(s)
- Viktor M Eisenkolb
- Translational Neurotechnology Laboratory, Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lisa M Held
- Translational Neurotechnology Laboratory, Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Alexander Utzschmid
- Translational Neurotechnology Laboratory, Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Xiao-Xiong Lin
- Translational Neurotechnology Laboratory, Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig Maximilians University Munich, Großhaderner Straße 2, 82152 Planegg-Martinsried, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Simon N Jacob
- Translational Neurotechnology Laboratory, Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| |
Collapse
|
26
|
Böhler C, Vomero M, Soula M, Vöröslakos M, Porto Cruz M, Liljemalm R, Buzsaki G, Stieglitz T, Asplund M. Multilayer Arrays for Neurotechnology Applications (MANTA): Chronically Stable Thin-Film Intracortical Implants. Adv Sci (Weinh) 2023; 10:e2207576. [PMID: 36935361 DOI: 10.1002/advs.202207576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/07/2023] [Indexed: 05/18/2023]
Abstract
Flexible implantable neurointerfaces show great promise in addressing one of the major challenges of implantable neurotechnology, namely the loss of signal connected to unfavorable probe tissue interaction. The authors here show how multilayer polyimide probes allow high-density intracortical recordings to be combined with a reliable long-term stable tissue interface, thereby progressing toward chronic stability of implantable neurotechnology. The probes could record 10-60 single units over 5 months with a consistent peak-to-peak voltage at dimensions that ensure robust handling and insulation longevity. Probes that remain in intimate contact with the signaling tissue over months to years are a game changer for neuroscience and, importantly, open up for broader clinical translation of systems relying on neurotechnology to interface the human brain.
Collapse
Affiliation(s)
- Christian Böhler
- Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, 79110, Freiburg, Germany
| | - Maria Vomero
- Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, 79110, Freiburg, Germany
| | - Marisol Soula
- Neuroscience Institute, Langone Medical Center, New York University, New York, 10016, USA
| | - Mihály Vöröslakos
- Neuroscience Institute, Langone Medical Center, New York University, New York, 10016, USA
| | - Maria Porto Cruz
- Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, 79110, Freiburg, Germany
| | - Rickard Liljemalm
- Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110, Freiburg, Germany
| | - György Buzsaki
- Neuroscience Institute, Langone Medical Center, New York University, New York, 10016, USA
- Department of Physiology and Neuroscience, Langone Medical Center, New York University, New York, 10016, USA
- Department of Neurology, Langone Medical Center, New York University, New York, 10016, USA
| | - Thomas Stieglitz
- Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, 79110, Freiburg, Germany
- Bernstein Center Freiburg, University of Freiburg, 79110, Freiburg, Germany
| | - Maria Asplund
- Department of Microsystems Engineering (IMTEK), University of Freiburg, 79110, Freiburg, Germany
- BrainLinks-BrainTools Center, University of Freiburg, 79110, Freiburg, Germany
- Department of Microtechnology and Nanoscience, Chalmers University of Technology, Gothenburg, SE-41296, Sweden
- Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, 97187, Sweden
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, 79110, Freiburg, Germany
| |
Collapse
|
27
|
Xu Z, Truong ND, Nikpour A, Kavehei O. A miniaturized and low-energy subcutaneous optical telemetry module for neurotechnology. J Neural Eng 2023; 20. [PMID: 37116505 DOI: 10.1088/1741-2552/acd147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/28/2023] [Indexed: 04/30/2023]
Abstract
This study presents a proof-of-concept optical telemetry module that leverages a single light-emitting diode (LED) to transmit data at a high bit rate while consuming low power and occupying a minimal area. Our experiments showed that we could achieve 108 Mbit/s and 54 Mbit/s back telemetry data rates for tissue thicknesses of 3 mm and 8 mm, respectively. The proposed module is designed to be powered by near-field coupling and achieve bidirectional communication by low-speed downlink from near-field communication (NFC). It aims to minimize the size of the implant while providing reliable transmission that meets the requirements of high-speed wireless communication from a multi-electrode array neurotechnology implant outside the body. The power consumption of the module is 1.57 mW, including the power consumption of related circuits, resulting in an efficiency of 14.5 pJ/bit, at a tissue thickness of 3 mm and a data rate of 108 Mbit. The use of an optical lens, combined with tissue scattering effect and optimized emission angle, makes the module robust to misalignments of up to ±5 mm and ±15˚ between the implantable and external units. The LED in the implantable unit is only 0.98 x 0.98 x 0.6 mm3, and the testing module is composed of discrete components and laboratory instruments. This work aims to show how it is possible to strike a balance between a small, reliable, and high-bit-rate data uplink between a neural implant and its proximal, wirelessly connected external unit. This optical telemetry module has the potential to be integrated into a significantly miniaturized system through an application-specific integrated circuit (ASIC) and can support up to 1,000 channels of neural recordings, each sampled at 9 kSps with a 12-bit readout resolution.
Collapse
Affiliation(s)
- Zhangyu Xu
- School of Biomedical Engineering, University of Sydney - Camperdown and Darlington Campus, Building J03, The University of Sydney, NSW 2006, Sydney, New South Wales, 2006, AUSTRALIA
| | - Nhan Duy Truong
- School of Biomedical Engineering, University of Sydney - Camperdown and Darlington Campus, The University of Sydney, Camperdown, Sydney, New South Wales, 2006, AUSTRALIA
| | - Armin Nikpour
- Department of Neurology , Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, New South Wales, 2050, AUSTRALIA
| | - Omid Kavehei
- School of Electrical and Information Engineering, University of Sydney - Camperdown and Darlington Campus, Office 951, Electrical Engineering Building J03, Sydney, New South Wales, 2006, AUSTRALIA
| |
Collapse
|
28
|
Bonizzato M, Guay Hottin R, Côté SL, Massai E, Choinière L, Macar U, Laferrière S, Sirpal P, Quessy S, Lajoie G, Martinez M, Dancause N. Autonomous optimization of neuroprosthetic stimulation parameters that drive the motor cortex and spinal cord outputs in rats and monkeys. Cell Rep Med 2023; 4:101008. [PMID: 37044093 PMCID: PMC10140617 DOI: 10.1016/j.xcrm.2023.101008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/16/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
Neural stimulation can alleviate paralysis and sensory deficits. Novel high-density neural interfaces can enable refined and multipronged neurostimulation interventions. To achieve this, it is essential to develop algorithmic frameworks capable of handling optimization in large parameter spaces. Here, we leveraged an algorithmic class, Gaussian-process (GP)-based Bayesian optimization (BO), to solve this problem. We show that GP-BO efficiently explores the neurostimulation space, outperforming other search strategies after testing only a fraction of the possible combinations. Through a series of real-time multi-dimensional neurostimulation experiments, we demonstrate optimization across diverse biological targets (brain, spinal cord), animal models (rats, non-human primates), in healthy subjects, and in neuroprosthetic intervention after injury, for both immediate and continual learning over multiple sessions. GP-BO can embed and improve "prior" expert/clinical knowledge to dramatically enhance its performance. These results advocate for broader establishment of learning agents as structural elements of neuroprosthetic design, enabling personalization and maximization of therapeutic effectiveness.
Collapse
Affiliation(s)
- Marco Bonizzato
- Department of Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montreal, QC H3T 1J4, Canada; Department of Electrical Engineering and Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC H3T 1J4, Canada; CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC H4J 1C5, Canada; Mila - Québec AI Institute, Montreal, QC H2S 3H1, Canada.
| | - Rose Guay Hottin
- Department of Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montreal, QC H3T 1J4, Canada; Department of Electrical Engineering and Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC H3T 1J4, Canada; Mila - Québec AI Institute, Montreal, QC H2S 3H1, Canada
| | - Sandrine L Côté
- Department of Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Elena Massai
- Department of Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Léo Choinière
- Department of Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montreal, QC H3T 1J4, Canada; Mila - Québec AI Institute, Montreal, QC H2S 3H1, Canada
| | - Uzay Macar
- Department of Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montreal, QC H3T 1J4, Canada; Mila - Québec AI Institute, Montreal, QC H2S 3H1, Canada
| | - Samuel Laferrière
- Mila - Québec AI Institute, Montreal, QC H2S 3H1, Canada; Computer Science Department, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Parikshat Sirpal
- Department of Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montreal, QC H3T 1J4, Canada; Mila - Québec AI Institute, Montreal, QC H2S 3H1, Canada
| | - Stephan Quessy
- Department of Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Guillaume Lajoie
- Mila - Québec AI Institute, Montreal, QC H2S 3H1, Canada; Mathematics and Statistics Department, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Marina Martinez
- Department of Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montreal, QC H3T 1J4, Canada; CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC H4J 1C5, Canada
| | - Numa Dancause
- Department of Neurosciences and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montreal, QC H3T 1J4, Canada.
| |
Collapse
|
29
|
Kosal M, Putney J. Neurotechnology and international security: Predicting commercial and military adoption of brain-computer interfaces (BCIs) in the United States and China. Politics Life Sci 2023; 42:81-103. [PMID: 37140225 DOI: 10.1017/pls.2022.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In the past decade, international actors have launched "brain projects" or "brain initiatives." One of the emerging technologies enabled by these publicly funded programs is brain-computer interfaces (BCIs), which are devices that allow communication between the brain and external devices like a prosthetic arm or a keyboard. BCIs are poised to have significant impacts on public health, society, and national security. This research presents the first analytical framework that attempts to predict the dissemination of neurotechnologies to both the commercial and military sectors in the United States and China. While China started its project later with less funding, we find that it has other advantages that make earlier adoption more likely. We also articulate national security risks implicit in later adoption, including the inability to set international ethical and legal norms for BCI use, especially in wartime operating environments, and data privacy risks for citizens who use technology developed by foreign actors.
Collapse
|
30
|
Elston TW, Wallis JD. Decoding cognition in real-time. Trends Cogn Sci 2022; 26:1073-1075. [PMID: 36150969 DOI: 10.1016/j.tics.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/11/2022] [Indexed: 01/12/2023]
Abstract
How can we study unobservable cognitive processes that cannot be measured directly? This has been an enduring challenge for cognitive scientists. In this essay we discuss advances in neurotechnology that could allow cognitive processes to be decoded in real-time and the implications that this may have for cognitive science and the treatment of neuropsychiatric disease.
Collapse
Affiliation(s)
- Thomas W Elston
- Helen Wills Neuroscience Institute, University of California at Berkeley, Berkeley, CA 94720, USA
| | - Joni D Wallis
- Department of Psychology and Helen Wills Neuroscience Institute, University of California at Berkeley, Berkeley, CA 94720, USA.
| |
Collapse
|
31
|
Cardenas A, Petrevska M, Biddiss E, Fehlings D. Clinician perspectives on the implementation of inpatient cycling-based exergames for children with cerebral palsy: A qualitative study. Dev Neurorehabil 2022; 25:531-541. [PMID: 35815548 DOI: 10.1080/17518423.2022.2099474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To understand the perspectives of key stakeholder clinicians in implementing inpatient cycling-based exergames for children with cerebral palsy (CP) into pediatric rehabilitation. METHODS Sixteen clinicians (nurses, physiotherapists, recreational therapists) that participated in a study exploring the feasibility of implementing cycling-based exergames for inpatient children with CP were interviewed. Clinicians' responses were coded using the Theoretical Domains Framework (TDF). Beliefs were generated from each response and relevant domains were identified. RESULTS Ten domains from the TDF were identified as relevant. Key enablers to clinician participation in future implementation included revision of clinician roles and responsibilities, the belief that children with CP will benefit from exergames, and the belief in potential applicability to other pediatric populations. Barriers included clinician limited time and exergame responsibilities not aligning with perceived clinician roles. CONCLUSIONS This study identifies key barriers and enablers that future inpatient pediatric rehabilitation settings should consider when incorporating exergames into rehabilitation practice.
Collapse
Affiliation(s)
- Analyssa Cardenas
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marina Petrevska
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elaine Biddiss
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Institute of Biomaterials & Biomedical Engineering, Faculty of Engineering, University of Toronto, Toronto, ON, Canada
| | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
32
|
Apantaku GO, McDonald PJ, Aguiar M, Cabrera LY, Chiong W, Connolly MB, Hrincu V, Ibrahim GM, Kaal KJ, Lawson A, Naftel R, Racine E, Safari A, Harrison M, Illes J. Clinician preferences for neurotechnologies in pediatric drug-resistant epilepsy: A discrete choice experiment. Epilepsia 2022; 63:2338-2349. [PMID: 35699675 PMCID: PMC9796345 DOI: 10.1111/epi.17328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Novel and minimally invasive neurotechnologies offer the potential to reduce the burden of epilepsy while avoiding the risks of conventional resective surgery. Few neurotechnologies have been tested in randomized controlled trials with pediatric populations, leaving clinicians to face decisions about whether to recommend these treatments with insufficient evidence about the relevant risks and benefits. This study specifically explores the preferences of clinicians for treating pediatric drug-resistant epilepsy (DRE) with novel neurotechnologies. METHODS A discrete-choice experiment (DCE) was designed to elicit the preferences of clinicians with experience in treating children with DRE using novel neurotechnological interventions. The preferences for six key attributes used when making treatment decisions (chances of clinically significant improvement in seizures, major and minor risks from intervention, availability of evidence, financial burden for the family, and access to the intervention) were estimated using a conditional logit model. The estimates from this model were then used to predict the adoption of existing novel neurotechnological interventions. RESULTS Sixty-eight clinicians completed the survey: 33 neurosurgeons, 28 neurologists, and 7 other clinicians. Most clinicians were working in the United States (74%), and the remainder (26%) in Canada. All attributes, apart from the nearest location with access to the intervention, influenced preferences significantly. The chance of clinically significant improvement in seizures was the most positive influence on clinician preferences, but low-quality evidence and a higher risk of major complications could offset these preferences. Of the existing neurotechnological interventions, vagus nerve stimulation was predicted to have the highest likelihood of adoption; deep brain stimulation had the lowest likelihood of adoption. SIGNIFICANCE The preferences of clinicians are drive primarily by the likelihood of achieving seizure freedom for their patients, but preferences for an intervention are largely eradicated if only low quality of evidence supporting the intervention is available. Until better evidence supporting the use of potentially effective, novel neurotechnologies becomes available, clinicians are likely to prefer more established treatments.
Collapse
Affiliation(s)
- Glory O. Apantaku
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Patrick J. McDonald
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Division of Neurosurgery, Department of Surgery, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Section of Neurosurgery, Department of SurgeryUniversity of ManitobaWinnipegManitobaCanada
| | - Magda Aguiar
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Laura Y. Cabrera
- Department of Science and Mechanics, Center for Neural EngineeringPennsylvania State UniversityUniversity ParkPennsylvaniaUSA,Rock Ethics InstitutePennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Winston Chiong
- Department of Neurology, Memory and Aging Center, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Mary B. Connolly
- Division of Neurology, Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Viorica Hrincu
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - George M. Ibrahim
- Division of Neurosurgery, Department of Surgery, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - K. Julia Kaal
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Ashley Lawson
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Robert Naftel
- Department of NeurosurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Eric Racine
- Pragmatic Health Ethics Research UnitInstitut de recherches cliniques de MontréalMontréalQuébecCanada,Department of Preventive and Social Medicine, Faculty of MedicineUniversité de MontréalMontréalQuébecCanada,Department of Neurology and Neurosurgery, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - Abdollah Safari
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Mark Harrison
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Centre for Health Evaluation and Outcome SciencesSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| |
Collapse
|
33
|
Das R, Curia G, Heidari H. Preface to 'Advanced neurotechnologies: translating innovation for health and well-being'. Philos Trans A Math Phys Eng Sci 2022; 380:20210004. [PMID: 35658683 PMCID: PMC9168438 DOI: 10.1098/rsta.2021.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Rupam Das
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| | - Giulia Curia
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Hadi Heidari
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| |
Collapse
|
34
|
Kim HJ, Ho JS. Wireless interfaces for brain neurotechnologies. Philos Trans A Math Phys Eng Sci 2022; 380:20210020. [PMID: 35658679 DOI: 10.1098/rsta.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/13/2021] [Indexed: 06/15/2023]
Abstract
Wireless interfaces enable brain-implanted devices to remotely interact with the external world. They are critical components in modern research and clinical neurotechnologies and play a central role in determining their overall size, lifetime and functionality. Wireless interfaces use a wide range of modalities-including radio-frequency fields, acoustic waves and light-to transfer energy and data to and from an implanted device. These forms of energy interact with living tissue through distinct mechanisms and therefore lead to systems with vastly different form factors, operating characteristics, and safety considerations. This paper reviews recent advances in the development of wireless interfaces for brain neurotechnologies. We summarize the requirements that state-of-the-art brain-implanted devices impose on the wireless interface, and discuss the working principles and applications of wireless interfaces based on each modality. We also investigate challenges associated with wireless brain neurotechnologies and discuss emerging solutions permitted by recent developments in electrical engineering and materials science. This article is part of the theme issue 'Advanced neurotechnologies: translating innovation for health and well-being'.
Collapse
Affiliation(s)
- Han-Joon Kim
- Department of Electrical and Computer Engineering National University of Singapore, Queenstown, Singapore
| | - John S Ho
- Department of Electrical and Computer Engineering National University of Singapore, Queenstown, Singapore
- The N.1 Institute for Health National University of Singapore, Queenstown, Singapore
- Institute for Health Innovation and Technology, National University of Singapore, Queenstown, Singapore
| |
Collapse
|
35
|
van Velthoven EAM, van Stuijvenberg OC, Haselager DRE, Broekman M, Chen X, Roelfsema P, Bredenoord AL, Jongsma KR. Ethical implications of visual neuroprostheses-a systematic review. J Neural Eng 2022; 19. [PMID: 35475424 DOI: 10.1088/1741-2552/ac65b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/08/2022] [Indexed: 11/12/2022]
Abstract
Objective. The aim of this review was to systematically identify the ethical implications of visual neuroprostheses.Approach. A systematic search was performed in both PubMed and Embase using a search string that combined synonyms for visual neuroprostheses, brain-computer interfaces (BCIs), cochlear implants (CIs), and ethics. We chose to include literature on BCIs and CIs, because of their ethically relavant similarities and functional parallels with visual neuroprostheses.Main results. We included 84 articles in total. Six focused specifically on visual prostheses. The other articles focused more broadly on neurotechnologies, on BCIs or CIs. We identified 169 ethical implications that have been categorized under seven main themes: (a) benefits for health and well-being; (b) harm and risk; (c) autonomy; (d) societal effects; (e) clinical research; (f) regulation and governance; and (g) involvement of experts, patients and the public.Significance. The development and clinical use of visual neuroprostheses is accompanied by ethical issues that should be considered early in the technological development process. Though there is ample literature on the ethical implications of other types of neuroprostheses, such as motor neuroprostheses and CIs, there is a significant gap in the literature regarding the ethical implications of visual neuroprostheses. Our findings can serve as a starting point for further research and normative analysis.
Collapse
Affiliation(s)
- E A M van Velthoven
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands
| | - O C van Stuijvenberg
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands
| | - D R E Haselager
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands
| | - M Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurosurgery, Leiden Medical Center, Leiden, The Netherlands
| | - X Chen
- Department of Vision & Cognition, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - P Roelfsema
- Department of Vision & Cognition, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, VU University, Amsterdam, The Netherlands.,Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - A L Bredenoord
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - K R Jongsma
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands
| |
Collapse
|
36
|
García-López E, Muñoz JM, Andorno R. Editorial: Neurorights and Mental Freedom: Emerging Challenges to Debates on Human Dignity and Neurotechnologies. Front Hum Neurosci 2022; 15:823570. [PMID: 35002662 PMCID: PMC8727361 DOI: 10.3389/fnhum.2021.823570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - José M Muñoz
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain.,International Center for Neuroscience and Ethics, Tatiana Foundation, Madrid, Spain.,Asociación Mexicana de Neuroética, Mexico City, Mexico
| | - Roberto Andorno
- Faculty of Law and Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland
| |
Collapse
|
37
|
Schalk G, Worrell S, Mivalt F, Belsten A, Kim I, Morris JM, Hermes D, Klassen BT, Staff NP, Messina S, Kaufmann T, Rickert J, Brunner P, Worrell GA, Miller KJ. Toward a fully implantable ecosystem for adaptive neuromodulation in humans: Preliminary experience with the CorTec BrainInterchange device in a canine model. Front Neurosci 2022; 16:932782. [PMID: 36601593 PMCID: PMC9806357 DOI: 10.3389/fnins.2022.932782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
This article describes initial work toward an ecosystem for adaptive neuromodulation in humans by documenting the experience of implanting CorTec's BrainInterchange (BIC) device in a beagle canine and using the BCI2000 environment to interact with the BIC device. It begins with laying out the substantial opportunity presented by a useful, easy-to-use, and widely available hardware/software ecosystem in the current landscape of the field of adaptive neuromodulation, and then describes experience with implantation, software integration, and post-surgical validation of recording of brain signals and implant parameters. Initial experience suggests that the hardware capabilities of the BIC device are fully supported by BCI2000, and that the BIC/BCI2000 device can record and process brain signals during free behavior. With further development and validation, the BIC/BCI2000 ecosystem could become an important tool for research into new adaptive neuromodulation protocols in humans.
Collapse
Affiliation(s)
- Gerwin Schalk
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
- Chen Frontier Lab for Applied Neurotechnology, Tianqiao and Chrissy Chen Institute, Shanghai, China
- *Correspondence: Gerwin Schalk
| | - Samuel Worrell
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Filip Mivalt
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Biomedical Engineering, Brno University of Technology, Brno, Czechia
| | - Alexander Belsten
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, United States
- National Center for Adaptive Neurotechnologies, Albany, NY, United States
| | - Inyong Kim
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - Dora Hermes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Bryan T. Klassen
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Nathan P. Staff
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Steven Messina
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, United States
| | - Timothy Kaufmann
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, United States
| | | | - Peter Brunner
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, United States
- National Center for Adaptive Neurotechnologies, Albany, NY, United States
| | - Gregory A. Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Kai J. Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
38
|
Angerhöfer C, Colucci A, Vermehren M, Hömberg V, Soekadar SR. Post-stroke Rehabilitation of Severe Upper Limb Paresis in Germany - Toward Long-Term Treatment With Brain-Computer Interfaces. Front Neurol 2021; 12:772199. [PMID: 34867760 PMCID: PMC8637332 DOI: 10.3389/fneur.2021.772199] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
Severe upper limb paresis can represent an immense burden for stroke survivors. Given the rising prevalence of stroke, restoration of severe upper limb motor impairment remains a major challenge for rehabilitation medicine because effective treatment strategies are lacking. Commonly applied interventions in Germany, such as mirror therapy and impairment-oriented training, are limited in efficacy, demanding for new strategies to be found. By translating brain signals into control commands of external devices, brain-computer interfaces (BCIs) and brain-machine interfaces (BMIs) represent promising, neurotechnology-based alternatives for stroke patients with highly restricted arm and hand function. In this mini-review, we outline perspectives on how BCI-based therapy can be integrated into the different stages of neurorehabilitation in Germany to meet a long-term treatment approach: We found that it is most appropriate to start therapy with BCI-based neurofeedback immediately after early rehabilitation. BCI-driven functional electrical stimulation (FES) and BMI robotic therapy are well suited for subsequent post hospital curative treatment in the subacute stage. BCI-based hand exoskeleton training can be continued within outpatient occupational therapy to further improve hand function and address motivational issues in chronic stroke patients. Once the rehabilitation potential is exhausted, BCI technology can be used to drive assistive devices to compensate for impaired function. However, there are several challenges yet to overcome before such long-term treatment strategies can be implemented within broad clinical application: 1. developing reliable BCI systems with better usability; 2. conducting more research to improve BCI training paradigms and 3. establishing reliable methods to identify suitable patients.
Collapse
Affiliation(s)
- Cornelius Angerhöfer
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annalisa Colucci
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mareike Vermehren
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Hömberg
- Department of Neurology, SRH Gesundheitszentrum Bad Wimpfen GmbH, Bad Wimpfen, Germany
| | - Surjo R Soekadar
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
39
|
Valeriani D, Ayaz H, Kosmyna N, Poli R, Maes P. Editorial: Neurotechnologies for Human Augmentation. Front Neurosci 2021; 15:789868. [PMID: 34858136 PMCID: PMC8631818 DOI: 10.3389/fnins.2021.789868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Hasan Ayaz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Nataliya Kosmyna
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Riccardo Poli
- School of Computer Science and Electronic Engineering, University of Essex, Colchester, United Kingdom
| | - Pattie Maes
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| |
Collapse
|
40
|
Chua LK, Chung YC, Bellard D, Swan L, Gobreial N, Romano A, Glatt R, Bonaguidi MA, Lee DJ, Jin Y, Liu CY, Fisher BE. Gamified Dual-Task Training for Individuals with Parkinson Disease: An Exploratory Study on Feasibility, Safety, and Efficacy. Int J Environ Res Public Health 2021; 18:12384. [PMID: 34886114 DOI: 10.3390/ijerph182312384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022]
Abstract
Objectives: The feasibility and safety of the use of neurorehabilitation technology (SMARTfit® Trainer system) by physical therapists in implementing a gamified physical-cognitive dual-task training (DTT) paradigm for individuals with Parkinson disease (IWPD) was examined. Additionally, the efficacy of this gamified DTT was compared to physical single-task training (STT), both of which were optimized using physio-motivational factors, on changes in motor and cognitive outcomes, and self-assessed disability in activities of daily living. Methods: Using a cross-over study design, eight participants with mild-to-moderate idiopathic PD (including one with mild cognitive impairment) completed both training conditions (i.e., gamified DTT and STT). For each training condition, the participants attended 2–3 sessions per week over 8.8 weeks on average, with the total amount of training being equivalent to 24 1 h sessions. A washout period averaging 11.5 weeks was inserted between training conditions. STT consisted of task-oriented training involving the practice of functional tasks, whereas for gamified DTT, the same task-oriented training was implemented simultaneously with varied cognitive games using an interactive training system (SMARTfit®). Both training conditions were optimized through continual adaptation to ensure the use of challenging tasks and to provide autonomy support. Training hours, heart rate, and adverse events were measured to assess the feasibility and safety of the gamified DTT protocol. Motor and cognitive function as well as perceived disability were assessed before and after each training condition. Results: Gamified DTT was feasible and safe for this cohort. Across participants, significant improvements were achieved in more outcome measures after gamified DTT than they were after STT. Individually, participants with specific demographic and clinical characteristics responded differently to the two training conditions. Conclusion: Physical therapists’ utilization of technology with versatile hardware configurations and customizable software application selections was feasible and safe for implementing a tailor-made intervention and for adapting it in real-time to meet the individualized, evolving training needs of IWPD. Specifically in comparison to optimized STT, there was a preliminary signal of efficacy for gamified DTT in improving motor and cognitive function as well as perceived disability in IWPD.
Collapse
|
41
|
Moss AU, Li ZR, Rommelfanger KS. Assessing the Perceived Value of Neuroethics Questions and Policy to Neuro-Entrepreneurs. Front Neurosci 2021; 15:702019. [PMID: 34720850 PMCID: PMC8548819 DOI: 10.3389/fnins.2021.702019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/13/2021] [Indexed: 12/01/2022] Open
Abstract
Neuroscience and its findings have deep personal and cultural meaning, so the implications of brain science raise new flavors of ethical issues not covered by traditional bioethics. The field of neuroethics bridges this gap, addressing and responding to the ethical, legal, and social issues intimately related to the evolving landscape of neuroscience. Neuroethical concerns have registered at the highest levels of government. In 2018, an interdisciplinary global neuroethics group working with leading scientists from the International Brain Initiative, a consortium of seven large-scale national-level brain research projects around the globe, published “Neuroethics Questions to Guide Ethical Research in the International Brain Initiatives.” The document provides guiding questions to consider throughout the lifecycle of neuroscience research. These questions tackle issues such as identity, morality, cross-cultural differences, privacy, and potential stakeholder involvement in ethical decision-making. In our work with the International Brain Initiative, we noted the important role that the private sector will play in translating and scaling neuroscience for society. We also noticed a gap in communication and collaboration between government, academia and the private sector. These guiding questions were largely co-created with policy makers and academics, so it was unclear how these issues might be received by neuro-entrepreneurs and neuro-industry. We hoped to identify not only common concerns, but also a common language for discussing neuroethical issues with stakeholders outside of government and academia. We used empirical ethics methods to assess the perceived value and attitudes of neuro-entrepreneurs toward neuroethical issues and whether or not these issues align with the process of neuro-innovation. We conducted one-on-one structured interviews with 21 neuro-entrepreneurs in the private sector and used two independent reviewers to analyze for themes. From this preliminary research, we identified key neuroethical themes and processual pain points of neurotech entrepreneurs throughout the innovation process. We also provide a preliminary neuroethics needs assessment for neuro-industry and suggest avenues through which neuroethicists can work with neurotech leadership to build an ethically aligned future. Overall, we hope to raise awareness and provide actionable steps toward advancing and accelerating societally impactful neuroscience.
Collapse
Affiliation(s)
- Ankita U Moss
- Neuroethics and Neurotech Innovation Collaboratory, Neuroethics Program, Emory University Center for Ethics, Atlanta, GA, United States
| | - Zone R Li
- Neuroethics and Neurotech Innovation Collaboratory, Neuroethics Program, Emory University Center for Ethics, Atlanta, GA, United States
| | - Karen S Rommelfanger
- Neuroethics and Neurotech Innovation Collaboratory, Neuroethics Program, Emory University Center for Ethics, Atlanta, GA, United States.,Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, United States
| |
Collapse
|
42
|
Abstract
INTRODUCTION Implanted neurostimulation devices are gaining traction as therapeutic options for people with certain forms of drug-resistant focal epilepsy. Some of these devices enable chronic electroencephalography (cEEG), which offers views of the dynamics of brain activity in epilepsy over unprecedented time horizons. AREAS COVERED This review focuses on clinical insights and basic neuroscience discoveries enabled by analyses of cEEG from an exemplar device, the NeuroPace RNS® System. Applications of RNS cEEG covered here include counting and lateralizing seizures, quantifying medication response, characterizing spells, forecasting seizures, and exploring mechanisms of cognition. Limitations of the RNS System are discussed in the context of next-generation devices in development. EXPERT OPINION The wide temporal lens of cEEG helps capture the dynamism of epilepsy, revealing phenomena that cannot be appreciated with short duration recordings. The RNS System is a vanguard device whose diagnostic utility rivals its therapeutic benefits, but emerging minimally invasive devices, including those with subscalp recording electrodes, promise to be more applicable within a broad population of people with epilepsy. Epileptology is on the precipice of a paradigm shift in which cEEG is a standard part of diagnostic evaluations and clinical management is predicated on quantitative observations integrated over long timescales.
Collapse
Affiliation(s)
- Vikram R Rao
- Associate Professor of Clinical Neurology, Chief, Epilepsy Division, Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| |
Collapse
|
43
|
Hrincu V, McDonald PJ, Connolly MB, Harrison MJ, Ibrahim GM, Naftel RP, Chiong W, Alam A, Ribary U, Illes J. Choice and Trade-offs: Parent Decision Making for Neurotechnologies for Pediatric Drug-Resistant Epilepsy. J Child Neurol 2021; 36:943-949. [PMID: 34078159 PMCID: PMC8458226 DOI: 10.1177/08830738211015010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This qualitative study investigated factors that guide caregiver decision making and ethical trade-offs for advanced neurotechnologies used to treat children with drug-resistant epilepsy. Caregivers with affected children were recruited to semi-structured focus groups or interviews at one of 4 major epilepsy centers in Eastern and Western Canada and the USA (n = 22). Discussions were transcribed and qualitative analytic methods applied to examine values and priorities (eg, risks, benefits, adherence, invasiveness, reversibility) of caregivers pertaining to novel technologies to treat drug-resistant epilepsy. Discussions revealed 3 major thematic branches for decision making: (1) features of the intervention-risks and benefits, with an emphasis on an aversion to perceived invasiveness; (2) decision drivers-trust in the clinical team, treatment costs; and (3) quality of available information about neurotechnological options. Overall, caregivers' definition of treatment success is more expansive than seizure freedom. The full involvement of their values and priorities must be considered in the decision-making process.
Collapse
Affiliation(s)
- Viorica Hrincu
- University of British Columbia, Division of Neurology, Department of Medicine, Vancouver, British Columbia, Canada
| | - Patrick J. McDonald
- University of British Columbia, Division of Neurology, Department of Medicine, Vancouver, British Columbia, Canada,Faculty of Medicine, Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary B. Connolly
- Department of Pediatrics, Division of Neurology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Mark J. Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - George M. Ibrahim
- Division of Neurosurgery, Hospital for Sick Children and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert P. Naftel
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Winston Chiong
- Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California
| | - Armaghan Alam
- University of British Columbia, Division of Neurology, Department of Medicine, Vancouver, British Columbia, Canada
| | - Urs Ribary
- Department of Pediatrics, Division of Neurology, BC Children’s Hospital, Vancouver, British Columbia, Canada,Behavioral & Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, BC, Canada
| | - Judy Illes
- University of British Columbia, Division of Neurology, Department of Medicine, Vancouver, British Columbia, Canada,Correspondence: Judy Illes, CM, PhD, Professor of Neurology, Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Koerner S124 Vancouver, BC, V6T 2B5 CANADA, Tel: 604.822.0746
| |
Collapse
|
44
|
Thomson CJ, Segrave RA, Fitzgerald PB, Richardson KE, Racine E, Carter A. "Nothing to Lose, Absolutely Everything to Gain": Patient and Caregiver Expectations and Subjective Outcomes of Deep Brain Stimulation for Treatment-Resistant Depression. Front Hum Neurosci 2021; 15:755276. [PMID: 34658822 PMCID: PMC8511461 DOI: 10.3389/fnhum.2021.755276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background: How "success" is defined in clinical trials of deep brain stimulation (DBS) for refractory psychiatric conditions has come into question. Standard quantitative psychopathology measures are unable to capture all changes experienced by patients and may not reflect subjective beliefs about the benefit derived. The decision to undergo DBS for treatment-resistant depression (TRD) is often made in the context of high desperation and hopelessness that can challenge the informed consent process. Partners and family can observe important changes in DBS patients and play a key role in the recovery process. Their perspectives, however, have not been investigated in research to-date. The aim of this study was to qualitatively examine patient and caregivers' understanding of DBS for TRD, their expectations of life with DBS, and how these compare with actual experiences and outcomes. Methods: A prospective qualitative design was adopted. Semi-structured interviews were conducted with participants (six patients, five caregivers) before DBS-implantation and 9-months after stimulation initiation. All patients were enrolled in a clinical trial of DBS of the bed nucleus of the stria terminalis. Interviews were thematically analyzed with data saturation achieved at both timepoints. Results: Two primary themes identified were: (1) anticipated vs. actual outcomes, and (2) trial decision-making and knowledge. The decision to undergo DBS was driven by the intolerability of life with severe depression coupled with the exhaustion of all available treatment options. Participants had greater awareness of surgical risks compared with stimulation-related risks. With DBS, patients described cognitive, emotional, behavioral and physical experiences associated with the stimulation, some of which were unexpected. Participants felt life with DBS was like "a roller coaster ride"-with positive, yet unsustained, mood states experienced. Many were surprised by the lengthy process of establishing optimum stimulation settings and felt the intervention was still a "work in progress." Conclusion: These findings support existing recommendations for iterative informed consent procedures in clinical trials involving long-term implantation of neurotechnology. These rich and descriptive findings hold value for researchers, clinicians, and individuals and families considering DBS. Narrative accounts capture patient and family needs and should routinely be collected to guide patient-centered approaches to DBS interventions.
Collapse
Affiliation(s)
- Cassandra J. Thomson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Rebecca A. Segrave
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Paul B. Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare, Camberwell, VIC, Australia
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Karyn E. Richardson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Montreal, QC, Canada
- Department of Medicine and Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
- Medicine and Biomedical Ethics Unit, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Adrian Carter
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| |
Collapse
|
45
|
Young MJ, Bodien YG, Giacino JT, Fins JJ, Truog RD, Hochberg LR, Edlow BL. The neuroethics of disorders of consciousness: a brief history of evolving ideas. Brain 2021; 144:3291-3310. [PMID: 34347037 DOI: 10.1093/brain/awab290] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 07/10/2021] [Indexed: 11/12/2022] Open
Abstract
Neuroethical questions raised by recent advances in the diagnosis and treatment of disorders of consciousness are rapidly expanding, increasingly relevant, and yet underexplored. The aim of this thematic review is to provide a clinically applicable framework for understanding the current taxonomy of disorders of consciousness and to propose an approach to identifying and critically evaluating actionable neuroethical issues that are frequently encountered in research and clinical care for this vulnerable population. Increased awareness of these issues and clarity about opportunities for optimizing ethically-responsible care in this domain are especially timely given recent surges in critically ill patients with unusually prolonged disorders of consciousness associated with coronavirus disease 2019 (COVID-19) around the world. We begin with an overview of the field of neuroethics: what it is, its history and evolution in the context of biomedical ethics at large. We then explore nomenclature used in disorders of consciousness, covering categories proposed by the American Academy of Neurology, the American Congress of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research, including definitions of terms such as coma, the vegetative state, unresponsive wakefulness syndrome, minimally conscious state, covert consciousness, and the confusional state. We discuss why these definitions matter, and why there has been such evolution in this nosology over the years, from Jennett and Plum in 1972 to the Multi-Society Task Force in 1994, the Aspen Working Group in 2002 and up until the 2018 American and 2020 European Disorders of Consciousness guidelines. We then move to a discussion of clinical aspects of disorders of consciousness, the natural history of recovery, and ethical issues that arise within the context of caring for persons with disorders of consciousness. We conclude with a discussion of key challenges associated with assessing residual consciousness in disorders of consciousness, potential solutions and future directions, including integration of crucial disability rights perspectives.
Collapse
Affiliation(s)
- Michael J Young
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,USA.,Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA 02138, USA
| | - Yelena G Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,USA.,Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | | | - Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY 10021, USA
| | - Robert D Truog
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
| | - Leigh R Hochberg
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,USA.,School of Engineering and Carney Institute for Brain Science, Brown University, Providence, RI 02906, USA.,VA RR&D Center for Neurorestoration and Neurotechnology, Department of Veterans Affairs Medical Center, Providence, RI 02908, USA
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA
| |
Collapse
|
46
|
Serruya MD, Rosenwasser RH. An artificial nervous system to treat chronic stroke. Artif Organs 2021; 45:804-812. [PMID: 34156104 DOI: 10.1111/aor.13998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/20/2021] [Accepted: 05/18/2021] [Indexed: 01/01/2023]
Abstract
Despite remarkable advances in the treatment of numerous medical conditions, neurological disease and injury remains an outstanding challenge and cause of disability worldwide. The decreased regenerative capacity and extreme complexity and heterogeneity of nervous tissue, in particular the brain, and the fact that the brain remains the least understood organ, have hampered our ability to provide definitive treatments for prevalent conditions such as stroke. Stroke is the second-leading cause of death worldwide, and the nervous system is intimately involved in other prevalent conditions including ischemic heart disease, diabetes mellitus, and hypertension. Advances in neuromodulation, electroceuticals, microsurgical techniques, optogenetics, brain-computer interfaces, and autologous constructs offer potential solutions to address the otherwise permanent neurological deficits of stroke and other conditions. Here we review these various approaches to build an "artificial nervous system" that could restore function and independence in people living with these conditions. We focus on stroke both because it is the leading cause of neurological disability worldwide and because we anticipate that advances in the reversal of stroke-related deficits will have ripple effects benefiting people with other neurological conditions including spinal cord injury, traumatic brain injury, ALS, and muscular dystrophy.
Collapse
Affiliation(s)
- Mijail D Serruya
- Department of Neurology, Farber Institute of Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert H Rosenwasser
- Department of Neurosurgery, Farber Institute of Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
47
|
Cardenas A, Warner D, Switzer L, Graham TCN, Cimolino G, Fehlings D. Inpatient Exergames for Children with Cerebral Palsy following Lower Extremity Orthopedic Surgery: A Feasibility Study. Dev Neurorehabil 2021; 24:230-236. [PMID: 33416415 DOI: 10.1080/17518423.2020.1858359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Evaluate the feasibility of implementing cycling-based exergames for children with cerebral palsy (CP) following lower extremity orthopedic surgery and explore its impact on pain and well-being.Methods: Ten children with CP were recruited; the first five received physiotherapy (comparison) and next five received fifteen exergame sessions over 3 weeks and physiotherapy (case) (NCT0376907). Feasibility indicators evaluated recruitment, questionnaire and exergame completion. Faces Pain Scale-Revised (FPS-R), PROMIS Pediatric Pain Interference Scale (PPIS), and KIDSCREEN-27 were administered. Wilcoxon signed-rank and effect size (r) tests evaluated within-group differences and between-group differences were assessed using Mann-Whitney U tests.Results: All feasibility indicators were met. Large effects for improved case group pain were identified (FPS-R r = 0.60, PPIS r = 0.58), as well as significant improvement in KIDSCREEN-27 total (U = 0.50, p = .05) and psychological well-being (U = 3.00, p = .01) scores, favoring the case group.Conclusions: Incorporating pediatric exergames is feasible and demonstrates potential for improving pain and well-being.
Collapse
Affiliation(s)
- Analyssa Cardenas
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Daniel Warner
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lauren Switzer
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | | | | | - Darcy Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,School of Computing, Queen's University, Kingston, ON, Canada
| |
Collapse
|
48
|
Abstract
The BRAIN 2.0 roadmap lauds the neuroscientific advances made in the first decade of the BRAIN Initiative, but also calls attention to the need to carefully consider how these advances will inform and perhaps alter our understanding of "those deepest behaviors that, as humans we hold dear" (Roadmap, Executive Summary). In this short statement, we briefly consider several features of the BRAIN Neuroethics subgroup's roadmap that lie within our area of expertise, including the recommendations to (1) enhance integration of neuroscience and neuroethics, and (2) provide additional tools and resources for neuroscientists to recognize neuroethics issues and opportunities for neuroethics research.
Collapse
Affiliation(s)
| | - Eran Klein
- University of Washington.,Oregon Health And Science University
| |
Collapse
|
49
|
Abdullah JM. Progress in Clinical Neurosciences, Cognitive Neurosciences, Clinical Psychology, Neurotechnology and Brain Mapping in Malaysia. Malays J Med Sci 2021; 28:1-14. [PMID: 33958956 PMCID: PMC8075602 DOI: 10.21315/mjms2021.28.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/28/2021] [Indexed: 10/24/2022] Open
Abstract
Last year, there was an increase in the amount of manpower in Malaysia, especially in terms of the numbers of neurosurgeons, cognitive neuroscientists and clinical psychologists. One way to increase the number of cognitive neurotechnologists in the country in 2021 is to allow neuroscientists to register as neurotechnologists with the Malaysian Board of Technologists (MBOT). The Malaysian Brain Mapping project has risen from its humble beginnings as an initiative of the Universiti Sains Malaysia Brain Mapping Group in 2017. There is currently a proposal for its entry into the national arena via the Precision Medicine Initiative with the Academy Science Malaysia, the Ministry of Science, Technology and Innovation, Ministry of Higher Education and Ministry of Health. The current Malaysian Government's Science, Technology, Innovation and Economy (STIE) plan was launched in 2020, leading to the establishment of neurotechnology as one of 10 STIE drivers.
Collapse
Affiliation(s)
- Jafri Malin Abdullah
- Malaysian Journal of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
50
|
Abstract
Recent advances in brain-computer interface technology to restore and rehabilitate neurologic function aim to enable persons with disabling neurologic conditions to communicate, interact with the environment, and achieve other key activities of daily living and personal goals. Here we evaluate the principles, benefits, challenges, and future directions of brain-computer interfaces in the context of neurorehabilitation. We then explore the clinical translation of these technologies and propose an approach to facilitate implementation of brain-computer interfaces for persons with neurologic disease.
Collapse
Affiliation(s)
- Michael J Young
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Lin
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- School of Engineering and Carney Institute for Brain Science, Brown University, Providence, Rhode Island
- Department of Veterans Affairs Medical Center, VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island
| | - Leigh R Hochberg
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- School of Engineering and Carney Institute for Brain Science, Brown University, Providence, Rhode Island
- Department of Veterans Affairs Medical Center, VA RR&D Center for Neurorestoration and Neurotechnology, Providence, Rhode Island
| |
Collapse
|