The Development Of Deep Brain Stimulation For Neurological And Psychiatric Disorders Clinical Societal And Ethical Issues
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The development of deep brain stimulation for neurological and psychiatric disorders: clinical, societal and ethical issues by Thomas E. Schlaepfer,Chiara Saviane Pdf
To date more than eighty thousand patients worldwide have received deep brain stimulation (DBS), mainly in order to alleviate symptoms of treatment-resistant disorders such as tremor associated with Parkinson’s disease, essential tremor, chronic pain, epilepsy, obsessive compulsive disorder, major depression and Tourette syndrome. The number of indications for neurological and psychiatric conditions using this technology is rapidly increasing, raising important societal and ethical issues that cannot be dealt with by scientists and clinicians on their own, but need discussions among all possible stakeholders on questions such as: what are the comprehensive risks and benefits of this technology? what is the real impact on patients’ life, in terms of health, quality of life and personal identity? This Research Topic provides an overview of potentials and limitations of deep brain stimulation as used to treat neurological and psychiatric conditions, bringing together Mini Reviews, Perspectives and Opinion papers from key stakeholders interested in the development and social impact of this technology. It is also a continuation of the debate that started among scientists, clinicians, patients, sociologists, journalists, philosophers and other experts during the “brains in dialogue on deep brain stimulation” workshop that was organized in September 2010 in Warsaw, Poland, by the FP7 project bid – brains in dialogue (www.neuromedia.eu) coordinated by the Interdisciplinary Laboratory of SISSA (Trieste, Italy).
Deep Brain Stimulation in Neurological and Psychiatric Disorders by Daniel Tarsy,Jerrold Lee Vitek,Philip Starr,Michael Okun Pdf
This important book discusses today’s most current and cutting-edge applications of Deep Brain Stimulation (DBS). The book begins with reviews of the functional anatomy and physiology of motor and nonmotor aspects of the basal ganglia and their connections which underlie the application of DBS to neurological and psychiatric disorders. This is followed by proposed mechanisms of action of DBS based on functional neuroimaging and neurophysiologic studies in animals and man.
The Clinical and Ethical Practice of Neuromodulation – Deep Brain Stimulation and Beyond by Markus Christen,Sabine Müller Pdf
Neuromodulation is among the fastest-growing areas of medicine, involving many diverse specialties and affecting hundreds of thousands of patients with numerous disorders worldwide. It can briefly be described as the science of how electrical, chemical, and mechanical interventions can modulate the nervous system function. A prominent example of neuromodulation is deep brain stimulation (DBS), an intervention that reflects a fundamental shift in the understanding of neurological and psychiatric diseases: namely as resulting from a dysfunctional activity pattern in a defined neuronal network that can be normalized by targeted stimulation. The application of DBS has grown remarkably and more than 130,000 patients worldwide have obtained a DBS intervention in the past 30 years—most of them for treating movement disorders. This Frontiers Research Topics provides an overview on the current discussion beyond basic research in DBS and other brain stimulation technologies. Researchers from various disciplines, who are working on broader clinical, ethical and social issues related to DBS and related neuromodulation technologies, have contributed to this research topic.
Deep Brain Stimulation by Damiaan Denys,Matthijs Feenstra,Rick Schuurman Pdf
Deep Brain Stimulation: A New Frontier in Psychiatry provides an overview of current developments and the future possibilities of deep brain stimulation for patients with therapy-refractory psychiatric disorders. The side-by-side presentation of clinical applications and animal research provides a truly translational approach. Also included is a special chapter on the ethical issues involved in deep brain stimulation in psychiatry. Deep brain stimulation of selected brain areas has been shown to result in a substantial improvement of symptoms and quality of life in patients suffering from obsessive-compulsive disorder, major depressive disorder and drug addiction. Although it is still an experimental therapy and the number of psychiatric patients that are treated is low, its effectiveness and safety makes deep brain stimulation the most promising therapy for treating other serious and life-threatening psychiatric conditions.
The consideration of ethical and social issues related to current uses of deep brain stimulation (DBS) as well as investigational uses should now be an integral part of contemporary DBS practice. Scholarship, interdisciplinary work groups, and peer processes have helped articulate standards that need to be respected and implemented in current DBS practice. Integrating new knowledge and interdisciplinary ethical perspectives could be considered a sign of the maturity and rigor of a DBS program. Still, investigational uses of DBS carry tremendous hope but also touch on sensitive and thorny ethical questions. These questions can benefit from the ethical wisdom generated for standard uses of DBS but also challenge current practices and professional conduct. Realizing this, interdisciplinary expert groups have been convened to identify and flesh out ethical guideposts for cutting-edge research in DBS. By implementing these ethical frameworks, DBS is an opportunity to develop promising treatments for a set of vulnerable and sometimes underserved patients while keeping their best interests in sight.
Fundamentals and Clinics of Deep Brain Stimulation by Yasin Temel,Albert F.G. Leentjens,Rob M.A. de Bie,Stephan Chabardes,Alfonso Fasano Pdf
This book provides a state-of-the-art overview of our current understanding of deep brain stimulation (DBS) for the treatment of neurological and psychiatric disorders. With a broad multidisciplinary scope, it presents contributions from leading experts in the field from Europe and America, who share not only their knowledge, but their experience as well. The book focuses both on basic and theoretical aspects of DBS, as well as clinical and practical aspects. It follows an evidence-based approach, and where possible offers clinical recommendations based on published guidelines. It starts with a general section, which discusses basic principles and general considerations. This is followed a sections dedicated to neurological disorders, and psychiatric disorders, in which only accepted indications are discussed. All experimental indications are discussed in the final chapter. The text is supplemented with numerous illustrations. Intended for medical specialists and residents involved in the treatment of patients with DBS, it also appeals to other professionals working with DBS patients, such as psychologists, nurses, physiotherapists, as well as basic and clinical neuroscientists.
The electrifying, forgotten history of Robert Heath's brain pacemaker, investigating the origins and ethics of one of today's most promising medical breakthroughs: deep brain stimulation The technology invented by psychiatrist Robert G. Heath in the 1950s and '60s has been described as among the most controversial experiments in US history. His work was alleged at the time to be part of MKUltra, the CIA's notorious "mind control" project. His research subjects included incarcerated convicts and gay men who wished to be "cured" of their sexual preference. Yet his cutting-edge research and legacy were quickly buried deep in Tulane University's archives. Investigative science journalist Lone Frank now tells the complete sage of this passionate, determined doctor and his groundbreaking neuroscience. More than fifty years after Heath's experiments, this very same treatment is becoming mainstream practice in modern psychiatry for everything from schizophrenia, anorexia, and compulsive behavior to depression, Parkinson's, and even substance addiction. Lone Frank uncovered lost documents and accounts of Heath's trailblazing work. She tracked down surviving colleagues and patients, and she delved into the current support for deep brain stimulation by scientists and patients alike. What has changed? Why do we today unquestioningly embrace this technology as a cure? How do we decide what is a disease of the brain to be cured and what should be allowed to remain unrobed and unprodded? And how do we weigh the decades of criticism against the promise of treatment that could be offered to millions of patients? Elegantly written and deeply fascinating, The Pleasure Shock weaves together biography, scientific history, and medical ethics. It is an adventure into our ever-shifting views of the mind and the fateful power we wield when we tinker with the self.
The Clinical and Ethical Practice of Neuromodulation - Deep Brain Stimulation and Beyond by Anonim Pdf
Euromodulation is among the fastest-growing areas of medicine, involving many diverse specialties and affecting hundreds of thousands of patients with numerous disorders worldwide. It can briefly be described as the science of how electrical, chemical, and mechanical interventions can modulate the nervous system function. A prominent example of neuromodulation is deep brain stimulation (DBS), an intervention that reflects a fundamental shift in the understanding of neurological and psychiatric diseases: namely as resulting from a dysfunctional activity pattern in a defined neuronal network that can be normalized by targeted stimulation. The application of DBS has grown remarkably and more than 130,000 patients worldwide have obtained a DBS intervention in the past 30 years--most of them for treating movement disorders. This Frontiers Research Topics provides an overview on the current discussion beyond basic research in DBS and other brain stimulation technologies. Researchers from various disciplines, who are working on broader clinical, ethical and social issues related to DBS and related neuromodulation technologies, have contributed to this research topic.
Author : Erwin B. Montgomery, Jr. Publisher : Oxford University Press, USA Page : 297 pages File Size : 49,9 Mb Release : 2015 Category : Medical ISBN : 9780199338825
20 Things to Know about Deep Brain Stimulation by Erwin B. Montgomery, Jr. Pdf
An iconoclast in-depth analysis of the current understanding of DBS: efficacy, safety, indications, selection criteria and post-operative management. This book is an epistemic analysis of the presumptions, assumptions and fallacies. It provides the revolutionary potential and the complexity of DBS in changing healthcare delivery; the ethics are discussed in detail.
William S. Anderson,The Society for Innovative Neuroscience
Author : William S. Anderson,The Society for Innovative Neuroscience Publisher : Thieme Page : 525 pages File Size : 52,8 Mb Release : 2019-05-10 Category : Medical ISBN : 9781638535287
Deep Brain Stimulation by William S. Anderson,The Society for Innovative Neuroscience Pdf
The one-stop resource on deep brain stimulation for functional neurosurgeons! Deep brain stimulation (DBS) is used to modulate dysfunctional circuits in the brain with stimulation pulses applied to specific target areas of the brain. Globally, DBS procedures have been most commonly performed for Parkinson's disease and essential tremor, but there are now new and growing research efforts studying DBS for psychiatric disorders and epilepsy. Deep Brain Stimulation: Techniques and Practices written by the Society for Innovative Neuroscience in Neurosurgery along with Dr. William S. Anderson and distinguished experts presents the latest DBS approaches. The book begins with a history of DBS, general frame-based techniques, patient selection primarily for movement disorders, multidisciplinary collaboration, and ethical considerations. Subsequent chapters detail diverse technologies and disease-specific treatment for Parkinson's disease, essential tremor, dystonia, OCD, epilepsy, major depression, Tourette syndrome, emerging psychiatric indications, and pediatric applications. Key highlights Lead placement techniques utilizing currently available customized platforms and robotics Microelectrode recording and image-based direct targeting with MRI and CT to enhance lead placement Lesioning methods including radiofrequency, and MR-guided focused ultrasound Discussion of recent innovations in tractography to delineate white matter tracts in the brain and closed loop stimulation DBS has helped thousands of patients with intractable conditions, allowing for a programmable therapy with durable treatment effect. This remarkable guide provides the essentials for functional neurosurgeons to pursue intraoperative research opportunities in this growing subspecialty and incorporate DBS into clinical practice.
20 Things to Know about Deep Brain Stimulation by Erwin B. Montgomery, Jr. Pdf
Twenty Things to Know About Deep Brain Stimulation is an extensive and in-depth critical analysis of the field of Deep Brain Stimulation (DBS) from what many may consider a revolutionary perspective. This book demonstrates the unique nature and incredible promise of DBS and shows how it is unparalleled as a therapeutic intervention. Dr. Montgomery provides an epistemic analysis of the presuppositions, assumptions and fallacies underlying current clinical understanding of DBS as well as the physiology and pathophysiology affected by DBS. Reviews of the safety and efficacy for a number of conditions, patient selections and issues in the post-operative management are also included. Given the revolutionary potential and the complexity of DBS in an ever changing healthcare delivery context, the ethics of DBS are discussed in detail.
Augmentation of Brain Function: Facts, Fiction and Controversy by Manuel F. Casanova,Mikhail Lebedev,Ioan Opris Pdf
The final volume in this tripartite series on Brain Augmentation is entitled “From Clinical Applications to Ethical Issues and Futuristic Ideas”. Many of the articles within this volume deal with translational efforts taking the results of experiments on laboratory animals and applying them to humans. In many cases, these interventions are intended to help people with disabilities in such a way so as to either restore or extend brain function. Traditionally, therapies in brain augmentation have included electrical and pharmacological techniques. In contrast, some of the techniques discussed in this volume add specificity by targeting select neural populations. This approach opens the door to where and how to promote the best interventions. Along the way, results have empowered the medical profession by expanding their understanding of brain function. Articles in this volume relate novel clinical solutions for a host of neurological and psychiatric conditions such as stroke, Parkinson’s disease, Huntington’s disease, epilepsy, dementia, Alzheimer’s disease, autism spectrum disorders (ASD), traumatic brain injury, and disorders of consciousness. In disease, symptoms and signs denote a departure from normal function. Brain augmentation has now been used to target both the core symptoms that provide specificity in the diagnosis of a disease, as well as other constitutional symptoms that may greatly handicap the individual. The volume provides a report on the use of repetitive transcranial magnetic stimulation (rTMS) in ASD with reported improvements of core deficits (i.e., executive functions). TMS in this regard departs from the present-day trend towards symptomatic treatment that leaves unaltered the root cause of the condition. In diseases, such as schizophrenia, brain augmentation approaches hold promise to avoid lengthy pharmacological interventions that are usually riddled with side effects or those with limiting returns as in the case of Parkinson’s disease. Brain stimulation can also be used to treat auditory verbal hallucination, visuospatial (hemispatial) neglect, and pain in patients suffering from multiple sclerosis. The brain acts as a telecommunication transceiver wherein different bandwidth of frequencies (brainwave oscillations) transmit information. Their baseline levels correlate with certain behavioral states. The proper integration of brain oscillations provides for the phenomenon of binding and central coherence. Brain augmentation may foster the normalization of brain oscillations in nervous system disorders. These techniques hold the promise of being applied remotely (under the supervision of medical personnel), thus overcoming the obstacle of travel in order to obtain healthcare. At present, traditional thinking would argue the possibility of synergism among different modalities of brain augmentation as a way of increasing their overall effectiveness and improving therapeutic selectivity. Thinking outside of the box would also provide for the implementation of brain-to-brain interfaces where techniques, proper to artificial intelligence, could allow us to surpass the limits of natural selection or enable communications between several individual brains sharing memories, or even a global brain capable of self-organization. Not all brains are created equal. Brain stimulation studies suggest large individual variability in response that may affect overall recovery/treatment, or modify desired effects of a given intervention. The subject’s age, gender, hormonal levels may affect an individual’s cortical excitability. In addition, this volume discusses the role of social interactions in the operations of augmenting technologies. Finally, augmenting methods could be applied to modulate consciousness, even though its neural mechanisms are poorly understood. Finally, this volume should be taken as a debate on social, moral and ethical issues on neurotechnologies. Brain enhancement may transform the individual into someone or something else. These techniques bypass the usual routes of accommodation to environmental exigencies that exalted our personal fortitude: learning, exercising, and diet. This will allow humans to preselect desired characteristics and realize consequent rewards without having to overcome adversity through more laborious means. The concern is that humans may be playing God, and the possibility of an expanding gap in social equity where brain enhancements may be selectively available to the wealthier individuals. These issues are discussed by a number of articles in this volume. Also discussed are the relationship between the diminishment and enhancement following the application of brain-augmenting technologies, the problem of “mind control” with BMI technologies, free will the duty to use cognitive enhancers in high-responsibility professions, determining the population of people in need of brain enhancement, informed public policy, cognitive biases, and the hype caused by the development of brain- augmenting approaches.
Deep Brain Stimulation by Shilpa Chitnis MD, PhD,Pravin Khemani MD,Michael S. Okun MD Pdf
Deep Brain Stimulation addresses the practical tips required to program and manage deep brain stimulation devices in the clinic. The number of deep brain stimulation devices worldwide will soon eclipse 200,000 and is an approved surgical treatment for medically refractory neurological movement disorders such as Parkinson disease, tremors, and dystonia. It is, therefore, inevitable that clinicians and nurses will require the necessary tools, and exemplary real-life cases, to manage these complex patients. This book offers a case-based approach to common and uncommon neurologic problems related to deep brain stimulator problems. Each case is a clinical pearl, accompanied by a discussion as well as practical tips to improve patient management.
Author : William J. Marks, Jr Publisher : Cambridge University Press Page : 251 pages File Size : 48,6 Mb Release : 2015-09-03 Category : Medical ISBN : 9781107084254
