scholarly journals Dimensions of the Threat to the Self Posed by Deep Brain Stimulation: Personal Identity, Authenticity, and Autonomy

Diametros ◽  
2021 ◽  
pp. 1-28
Author(s):  
Przemysław Zawadzki
Keyword(s):  
Deep Brain Stimulation ◽  
Personal Identity ◽  
Brain Stimulation ◽  
The Self ◽  
Adverse Side Effects ◽  
Therapeutic Benefits ◽  
The Impact ◽  
The Brain ◽  
Deep Brain ◽  
Stimulation Of

Deep Brain Stimulation (DBS) is an invasive therapeutic method involving the implantation of electrodes and the electrical stimulation of specific areas of the brain to modulate their activity. DBS brings therapeutic benefits, but can also have adverse side effects. Recently, neuroethicists have recognized that DBS poses a threat to the very fabric of human existence, namely, to the selves of patients. This article provides a review of the neuroethical literature examining this issue, and identifies the crucial dimensions related to the self which DBS may endanger—personal identity, authenticity, and autonomy. The most influential theories accounting for these dimensions are analyzed herein, and it is argued that most of these theories require further refinement. This paper also demonstrates the interrelation between personal identity, authenticity, and autonomy, and concludes that one can only fully understand the impact of DBS on the self when all of these factors are taken into account.

scholarly journals Deep stimulation in neurosurgery

2019 ◽  
Vol 10 (1) ◽  
pp. 63-71
Author(s):  
Aleksandr A. Kalinkin ◽  
Alexey G. Vinokurov ◽  
Olga N. Kalinkina ◽  
Alexander S. Ilinykh ◽  
Andrey A. Bocharov ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Deep Brain Stimulation ◽  
High Risk ◽  
Brain Stimulation ◽  
Conservative Therapy ◽  
The Central Nervous System ◽  
The Brain ◽  
Deep Brain ◽  
Stimulation Of

The technique of deep brain stimulation is used to treat patients with various diseases of the central nervous system who are not amenable to conservative therapy, while open interventions in them are associated with a high risk of complications. In the review, we evaluate the efficiency of the deep stimulation of different regions of the brain in some pharmacoresistant forms of diseases.

L-DOPA-INDUCED DYSKINESIA AND STEREOTACTIC SURGERY FOR PARKINSON'S DISEASE

Neurosurgery ◽  
2008 ◽  
Vol 62 (2) ◽  
pp. 311-325 ◽  
Author(s):  
Jorge Guridi ◽  
Jose A. Obeso ◽  
Maria C. Rodriguez-Oroz ◽  
Andres M. Lozano ◽  
Miguel Manrique
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Globus Pallidus Internus ◽  
The Impact ◽  
Deep Brain ◽  
Stimulation Of

Abstract OBJECTIVE To assess the impact of different surgical targets and techniques, such as ablation and deep brain stimulation, to treat patients with L-dopa-induced dyskinesia (LID), a major therapeutic complication of Parkinson's disease. METHODS This review analyzes the effects of early surgical procedures to treat hyperkinesia and the current methods and targets used to combat LID in Parkinson's disease, which are mainly thalamotomy, pallidotomy, and deep brain stimulation of the globus pallidus internus and the subthalamic nucleus. RESULTS Available information indicates that surgery of the globus pallidus internus and thalamus (the pallidal receiving area) and of the subthalamic nucleus has a pronounced antidyskinetic effect. This effect is associated with a concomitant improvement in the parkinsonian (“off”-medication) state. Although it is more profound with pallidal and subthalamic surgery, such an effect can also be observed to some extent with thalamic surgery. The latter is attributable to the fact that surgery of the ventralis intermedius is primarily effective for treating tremor. An integral pallidothalamic pathway is needed for dyskinesia to be expressed. Thus, LID is less frequent after subthalamotomy or deep brain stimulation of the subthalamic nucleus through a functional effect mediated by the physiological normalization of the motor system and by an indirect effect associated with a reduction in the daily dose of L-dopa. CONCLUSION Surgery is the only treatment available for Parkinson's disease that can predictably improve both the parkinsonian motor syndrome and LID. The exact mechanisms involved in these effects are not well understood. Pallidal and thalamic surgery affecting pallidal relays reduce LID frequency by disrupting the pallidothalamic circuit, probably eliminating the neuronal activity associated with dyskinesia. Alternatively, the antidyskinetic effect of subthalamic nucleus surgery may in part be attributable to a reduction in the L-dopa dose as well as to the stabilization of the basal ganglia circuits after the surgical procedure.

scholarly journals Deep brain stimulation modulates directional limbic connectivity in obsessive-compulsive disorder

Brain ◽  
2020 ◽  
Vol 143 (5) ◽  
pp. 1603-1612 ◽  
Author(s):  
Egill Axfjord Fridgeirsson ◽  
Martijn Figee ◽  
Judy Luigjes ◽  
Pepijn van den Munckhof ◽  
P Richard Schuurman ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Obsessive Compulsive Disorder ◽  
Brain Stimulation ◽  
Internal Capsule ◽  
Connectivity Analysis ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
The Impact ◽  
Deep Brain ◽  
Stimulation Of

Abstract Deep brain stimulation is effective for patients with treatment-refractory obsessive-compulsive disorder. Deep brain stimulation of the ventral anterior limb of the internal capsule rapidly improves mood and anxiety with optimal stimulation parameters. To understand these rapid effects, we studied functional interactions within the affective amygdala circuit. We compared resting state functional MRI data during chronic stimulation versus 1 week of stimulation discontinuation in patients, and obtained two resting state scans from matched healthy volunteers to account for test-retest effects. Imaging data were analysed using functional connectivity analysis and dynamic causal modelling. Improvement in mood and anxiety following deep brain stimulation was associated with reduced amygdala-insula functional connectivity. Directional connectivity analysis revealed that deep brain stimulation increased the impact of the ventromedial prefrontal cortex on the amygdala, and decreased the impact of the amygdala on the insula. These results highlight the importance of the amygdala circuit in the pathophysiology of obsessive-compulsive disorder, and suggest a neural systems model through which negative mood and anxiety are modulated by stimulation of the ventral anterior limb of the internal capsule for obsessive-compulsive disorder and possibly other psychiatric disorders.

scholarly journals Deep Brain Stimulation of the Subthalamic Nucleus Modulates Reward-Related Behavior: A Systematic Review

2020 ◽  
Vol 14 ◽  
Author(s):  
Yvan M. Vachez ◽  
Meaghan C. Creed
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Systematic Analysis ◽  
Reward Seeking ◽  
Therapeutic Benefits ◽  
Motivated Behavior ◽  
Stn Dbs ◽  
Deep Brain ◽  
Stimulation Of

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for the motor symptoms of movement disorders including Parkinson's Disease (PD). Despite its therapeutic benefits, STN-DBS has been associated with adverse effects on mood and cognition. Specifically, apathy, which is defined as a loss of motivation, has been reported to emerge or to worsen following STN-DBS. However, it is often challenging to disentangle the effects of STN-DBS per se from concurrent reduction of dopamine replacement therapy, from underlying PD pathology or from disease progression. To this end, pre-clinical models allow for the dissociation of each of these factors, and to establish neural substrates underlying the emergence of motivational symptoms following STN-DBS. Here, we performed a systematic analysis of rodent studies assessing the effects of STN-DBS on reward seeking, reward motivation and reward consumption across a variety of behavioral paradigms. We find that STN-DBS decreases reward seeking in the majority of experiments, and we outline how design of the behavioral task and DBS parameters can influence experimental outcomes. While an early hypothesis posited that DBS acts as a “functional lesion,” an analysis of lesions and inhibition of the STN revealed no consistent pattern on reward-related behavior. Thus, we discuss alternative mechanisms that could contribute to the amotivational effects of STN-DBS. We also argue that optogenetic-assisted circuit dissection could yield important insight into the effects of the STN on motivated behavior in health and disease. Understanding the mechanisms underlying the effects of STN-DBS on motivated behavior-will be critical for optimizing the clinical application of STN-DBS.

Deep Brain Stimulation, Continuity over Time, and the True Self

2016 ◽  
Vol 25 (4) ◽  
pp. 647-658 ◽  
Author(s):  
SVEN NYHOLM ◽  
ELIZABETH O’NEILL
Keyword(s):  
Anorexia Nervosa ◽  
Deep Brain Stimulation ◽  
Personal Identity ◽  
Brain Stimulation ◽  
The Self ◽  
True Self ◽  
Treatment Refractory ◽  
Over Time ◽  
Deep Brain

Abstract:One of the topics that often comes up in ethical discussions of deep brain stimulation (DBS) is the question of what impact DBS has, or might have, on the patient’s self. This is often understood as a question of whether DBS poses a threat to personal identity, which is typically understood as having to do with psychological and/or narrative continuity over time. In this article, we argue that the discussion of whether DBS is a threat to continuity over time is too narrow. There are other questions concerning DBS and the self that are overlooked in discussions exclusively focusing on psychological and/or narrative continuity. For example, it is also important to investigate whether DBS might sometimes have a positive (e.g., a rehabilitating) effect on the patient’s self. To widen the discussion of DBS, so as to make it encompass a broader range of considerations that bear on DBS’s impact on the self, we identify six features of the commonly used concept of a person’s “true self.” We apply these six features to the relation between DBS and the self. And we end with a brief discussion of the role DBS might play in treating otherwise treatment-refractory anorexia nervosa. This further highlights the importance of discussing both continuity over time and the notion of the true self.

scholarly journals Impact of deep brain stimulation of the subthalamic nucleus on natural language in patients with Parkinson’s disease

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244148
Author(s):  
Felicitas Ehlen ◽  
Bassam Al-Fatly ◽  
Andrea A. Kühn ◽  
Fabian Klostermann
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Natural Language ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Motor Improvement ◽  
The Impact ◽  
Deep Brain ◽  
Stimulation Of

Background In addition to the typical motor symptoms, a majority of patients suffering from Parkinson’s disease experience language impairments. Deep Brain Stimulation of the subthalamic nucleus robustly reduces motor dysfunction, but its impact on language skills remains ambiguous. Method To elucidate the impact of subthalamic deep brain stimulation on natural language production, we systematically analyzed language samples from fourteen individuals (three female / eleven male, average age 66.43 ± 7.53 years) with Parkinson’s disease in the active (ON) versus inactive (OFF) stimulation condition. Significant ON-OFF differences were considered as stimulation effects. To localize their neuroanatomical origin within the subthalamic nucleus, they were correlated with the volume of tissue activated by therapeutic stimulation. Results Word and clause production speed increased significantly under active stimulation. These enhancements correlated with the volume of tissue activated within the associative part of the subthalamic nucleus, but not with that within the dorsolateral motor part, which again correlated with motor improvement. Language error rates were lower in the ON vs. OFF condition, but did not correlate with electrode localization. No significant changes in further semantic or syntactic language features were detected in the current study. Conclusion The findings point towards a facilitation of executive language functions occurring rather independently from motor improvement. Given the presumed origin of this stimulation effect within the associative part of the subthalamic nucleus, this could be due to co-stimulation of the prefrontal-subthalamic circuit.

scholarly journals A Numerical Study to Compare Stimulations by Intraoperative Microelectrodes and Chronic Macroelectrodes in the DBS Technique

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
A. Paffi ◽  
F. Apollonio ◽  
M. G. Puxeddu ◽  
M. Parazzini ◽  
G. d’Inzeo ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Basal Ganglia ◽  
Brain Stimulation ◽  
Electric Stimulation ◽  
Numerical Study ◽  
Optimal Parameters ◽  
The Brain ◽  
Correct Target ◽  
Deep Brain ◽  
Stimulation Of

Deep brain stimulation is a clinical technique for the treatment of parkinson’s disease based on the electric stimulation, through an implanted electrode, of specific basal ganglia in the brain. To identify the correct target of stimulation and to choose the optimal parameters for the stimulating signal, intraoperative microelectrodes are generally used. However, when they are replaced with the chronic macroelectrode, the effect of the stimulation is often very different. Here, we used numerical simulations to predict the stimulation of neuronal fibers induced by microelectrodes and macroelectrodes placed in different positions with respect to each other. Results indicate that comparable stimulations can be obtained if the chronic macroelectrode is correctly positioned with the same electric center of the intraoperative microelectrode. Otherwise, some groups of fibers may experience a completely different electric stimulation.

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