scholarly journals Pattern theory of self and situating moral aspects: the need to include authenticity, autonomy and responsibility in understanding the effects of deep brain stimulation

2020 ◽  
Author(s):  
Przemysław Zawadzki
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Full Range ◽  
The Self ◽  
The Other ◽  
Pattern Theory ◽  
Complex Relation ◽  
Induced Changes ◽  
Deep Brain

AbstractThe aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation (DBS) on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (1), I argue that the pattern theory of self (PTS) can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves.

scholarly journals Sex Disparities in the Self-Evaluation of Subthalamic Deep Brain Stimulation Effects on Mood and Personality in Parkinson's Disease Patients

2020 ◽  
Vol 11 ◽  
Author(s):  
Amelie D. Dietrich ◽  
Johannes A. Koeppen ◽  
Carsten Buhmann ◽  
Monika Pötter-Nerger ◽  
Hans O. Pinnschmidt ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
The Self ◽  
Self Evaluation ◽  
Sex Disparities ◽  
Deep Brain

scholarly journals Deep Brain Stimulation, Authenticity and Value

2017 ◽  
Vol 26 (4) ◽  
pp. 658-670 ◽  
Author(s):  
SVEN NYHOLM ◽  
ELIZABETH O’NEILL
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
The Self ◽  
Bad Faith ◽  
True Self ◽  
Her Family ◽  
Jean Paul ◽  
The Family ◽  
Existentialist Philosophy ◽  
Deep Brain

Abstract:In this article, we engage in dialogue with Jonathan Pugh, Hannah Maslen, and Julian Savulescu about how to best interpret the potential impacts of deep brain stimulation on the self. We consider whether ordinary peoples’ convictions about the true self should be interpreted in essentialist or existentialist ways. Like Pugh, Maslen, and Savulescu, we argue that it is useful to understand the notion of the true self as having both essentialist and existentialist components. We also consider two ideas from existentialist philosophy—Jean-Paul Sartre and Simone de Beauvoir’s ideas about “bad faith” and “ambiguity”—to argue that there can be value to patients in regarding themselves as having a certain amount of freedom to choose what aspects of themselves should be considered representative of their true selves. Lastly, we consider the case of an anorexia nervosa patient who shifts between conflicting mind-sets. We argue that mind-sets in which it is easier for the patient and his or her family to share values can plausibly be considered to be more representative of the patient’s true self, if this promotes a well-functioning relationship between the patient and the family. However, we also argue that families are well advised to give patients room to determine what such shared values mean to them, as it can be alienating for patients if they feel that others try to impose values on them from the outside.

Lateralized effect of pallidal stimulation on self-mutilation in Lesch-Nyhan disease

2014 ◽  
Vol 14 (6) ◽  
pp. 594-597 ◽  
Author(s):  
Taylor J. Abel ◽  
Brian D. Dalm ◽  
Andrew J. Grossbach ◽  
Adam W. Jackson ◽  
Teri Thomsen ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
The Self ◽  
Lead Fracture ◽  
Self Mutilation ◽  
Pallidal Stimulation ◽  
Generalized Dystonia ◽  
Hypoxanthine Guanine Phosphoribosyltransferase ◽  
Deep Brain

Lesch-Nyhan disease (LND) is an X-linked hereditary disorder caused by a deficiency of hypoxanthine-guanine phosphoribosyltransferase. This syndrome is characterized by hyperuricemia, self-mutilation, cognitive impairment, and movement disorders such as spasticity and dystonia. The authors describe the case of a 15-year-old boy who underwent bilateral placement of globus pallidus internus (GPi) deep brain stimulation (DBS) electrodes for the treatment of generalized dystonia. His self-mutilating behavior gradually disappeared several weeks after the start of GPi stimulation. The dystonia and self-mutilating behavior returned on the left side only after a right lead fracture. This case is the first reported instance of LND treated with DBS in which the stimulation was interrupted and the self-mutilation returned in a lateralized fashion. The findings indicate that the neurobehavioral aspect of LND is lateralized and that contralateral GPi stimulation is responsible for lateralized improvement in self-injurious behavior.

Deep Brain Stimulation Generator Failure due to External Defibrillation in a Patient with Essential Tremor

2020 ◽  
pp. 1-2
Author(s):  
Gregory Davis ◽  
Zachary Levine
Keyword(s):  
Cardiac Arrest ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Case Reports ◽  
The Other ◽  
Deep Brain Stimulator ◽  
Rf Transmission ◽  
Deep Brain

There exist only two case reports to date of open cardiac defibrillation with deep brain stimulator system (DBS) implantation. We report a 64-year-old male with DBS system in place for essential tremor who underwent cardiac defibrillation after cardiac arrest. Afterwards, his device impedances were all high and his tremor symptoms returned. Both problems resolved with implantation of a new generator and required no changes to the intracranial leads or extension cables. This is significantly different from the two previous reports. One included a significantly different DBS system relying on transcutaneous RF transmission and reported a lesioning effect after cardioversion. The other utilized a modern DBS system but reported damage to the generator and intracranial leads. We report that only the generator sustained damage, and that there were no intracranial changes that occurred.

scholarly journals The phenomenology of deep brain stimulation-induced changes in OCD: an enactive affordance-based model

2013 ◽  
Vol 7 ◽  
Author(s):  
Sanneke de Haan ◽  
Erik Rietveld ◽  
Martin Stokhof ◽  
Damiaan Denys
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Induced Changes ◽  
Deep Brain

scholarly journals They Affect the Person, but for Better or Worse? Perceptions of Electroceutical Interventions for Depression Among Psychiatrists, Patients, and the Public

2021 ◽  
pp. 104973232110376
Author(s):  
Robyn Bluhm ◽  
Emily Castillo ◽  
Eric D. Achtyes ◽  
Aaron M. McCright ◽  
Laura Y. Cabrera
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Magnetic Stimulation ◽  
Treatment Effectiveness ◽  
Qualitative Content Analysis ◽  
Personality Change ◽  
The Self ◽  
The Public ◽  
Ethical Implications ◽  
Deep Brain

Responding to reports of cases of personality change following deep brain stimulation, neuroethicists have debated the nature and ethical implications of these changes. Recently, this literature has been challenged as being overblown and therefore potentially an impediment to patients accessing needed treatment. We interviewed 16 psychiatrists, 16 patients with depression, and 16 members of the public without depression, all from the Midwestern United States, about their views on how three electroceutical interventions (deep brain stimulation, electroconvulsive therapy, and transcranial magnetic stimulation) used to treat depression might affect the self. Participants were also asked to compare the electroceuticals’ effects on the self with the effects of commonly used depression treatments (psychotherapy and pharmaceuticals). Using qualitative content analysis, we found that participants’ views on electroceuticals’ potential effects on the self mainly focused on treatment effectiveness and side effects. Our results have implications for both theoretical discussions in neuroethics and clinical practice in psychiatry.

Multitarget, dual-electrode deep brain stimulation of the thalamus and subthalamic area for treatment of Holmes' tremor

2014 ◽  
Vol 120 (5) ◽  
pp. 1025-1032 ◽  
Author(s):  
Kazutaka Kobayashi ◽  
Yoichi Katayama ◽  
Hideki Oshima ◽  
Mitsuru Watanabe ◽  
Koichiro Sumi ◽  
...  
Keyword(s):  
Neural Network ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Rating Scale ◽  
The Other ◽  
Parkinsonian Tremor ◽  
Holmes Tremor ◽  
Dual Lead ◽  
Deep Brain

Object Holmes' tremor (HT) is generally considered to be a symptomatic tremor associated with lesions of the cerebellum, midbrain, or thalamus. Deep brain stimulation (DBS) therapy for essential tremor and parkinsonian tremor has proved quite successful. In contrast, surgical treatment outcomes for HT have often been disappointing. The use of 2 ipsilateral DBS electrodes implanted in parallel within the thalamus for severe essential tremor has been reported. Since dual-lead stimulation within a single target can cover a wider area than single-lead stimulation, it produces greater effects. On the other hand, DBS of the subthalamic area (SA) was recently reported to be effective for refractory tremor. Methods The authors implanted 2 DBS electrodes (one at the nucleus ventralis oralis/nucleus ventralis intermedius and the other at the SA) in 4 patients with HT. For more than 2 years after implantation, each patient's tremor was evaluated using a tremor rating scale under the following 4 conditions of stimulation: “on” for both thalamus and SA DBS; “off” for both thalamus and SA DBS; “on” for thalamus and “off” for SA DBS; and “on” for SA and “off” for thalamus DBS. Results The tremor in all patients was improved for more than 2 years (mean 25.8 ± 3.5 months). Stimulation with 2 electrodes exerted greater effect on the tremor than did 1-electrode stimulation. Interestingly, in all patients progressive effects were observed, and in one patient treated with DBS for 1 year, tremor did not appear even while stimulation was temporarily switched off, suggesting irreversible improvement effects. The presence of both resting and intentional/action tremor implies combined destruction of the pallidothalamic and cerebellothalamic pathways in HT. A larger stimulation area may thus be required for HT patients. Multitarget, dual-lead stimulation permits coverage of the wide area needed to suppress the tremor without adverse effects of stimulation. Some reorganization of the neural network may be involved in the development of HT because the tremor appears several months after the primary insult. The mechanism underlying the absence of tremor while stimulation was temporarily off remains unclear, but the DBS may have normalized the abnormal neural network. Conclusions The authors successfully treated patients with severe HT by using dual-electrode DBS over a long period. Such DBS may offer an effective and safe treatment modality for intractable HT.

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 Anticonvulsant vs. Proconvulsant Effect of in situ Deep Brain Stimulation at the Epileptogenic Focus

2021 ◽  
Vol 15 ◽  
Author(s):  
Ping Chou ◽  
Chung-Chin Kuo
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Rational Design ◽  
The Other ◽  
Anticonvulsant Effect ◽  
Epileptogenic Focus ◽  
Kindling Effect ◽  
Wide Range ◽  
Deep Brain

Since deep brain stimulation (DBS) at the epileptogenic focus (in situ) denotes long-term repetitive stimulation of the potentially epileptogenic structures, such as the amygdala, the hippocampus, and the cerebral cortex, a kindling effect and aggravation of seizures may happen and complicate the clinical condition. It is, thus, highly desirable to work out a protocol with an evident quenching (anticonvulsant) effect but free of concomitant proconvulsant side effects. We found that in the basolateral amygdala (BLA), an extremely wide range of pulsatile stimulation protocols eventually leads to the kindling effect. Only protocols with a pulse frequency of ≤1 Hz or a direct current (DC), with all of the other parameters unchanged, could never kindle the animal. On the other hand, the aforementioned DC stimulation (DCS), even a pulse as short as 10 s given 5 min before the kindling stimuli or a pulse given even to the contralateral BLA, is very effective against epileptogenicity and ictogenicity. Behavioral, electrophysiological, and histological findings consistently demonstrate success in seizure quenching or suppression as well as in the safety of the specific DBS protocol (e.g., no apparent brain damage by repeated sessions of stimulation applied to the BLA for 1 month). We conclude that in situ DCS, with a novel and rational design of the stimulation protocol composed of a very low (∼3% or 10 s/5 min) duty cycle and assuredly devoid of the potential of kindling, may make a successful antiepileptic therapy with adequate safety in terms of little epileptogenic adverse events and tissue damage.

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