Ariane Lewis, Jan Claassen, Judy Illes, Ralf J Jox, Matthew Kirschen, Benjamin Rohaut, Stephen Trevick, Michael J Young, Joseph J Fins
BACKGROUND: The Curing Coma Campaign (CCC) is a multidisciplinary global initiative focused on evaluation, diagnosis, treatment, research, and prognostication for patients who are comatose due to any etiology. To support this mission, the CCC Ethics Working Group conducted a survey of CCC collaborators to identify the ethics priorities of the CCC and the variability in priorities based on country of practice. METHODS: An electronic survey on the ethics priorities for the CCC was developed using rank-choice questions and distributed between May and July 2021 to a listserv of the 164 collaborators of the CCC...
August 2022: Neurocritical Care
Camilla N Clark, Mark J Edwards, Bee Eng Ong, Luke Goodliffe, Hena Ahmad, Michael D Dilley, Shai Betteridge, Colette Griffin, Peter O Jenkins
Persistent symptoms following a minor head injury can cause significant morbidity, yet the underlying mechanisms for this are poorly understood. The shortcomings of the current terminology that refer to non-specific symptom clusters is discussed. This update considers the need for a multi-dimensional approach for the heterogenous mechanisms driving persistent symptoms after mild traumatic brain injury. Relevant pathophysiology is discussed to make the case for mild traumatic brain injury to be conceptualized as an interface disorder spanning neurology, psychiatry and psychology...
June 30, 2022: Brain
Michael J Young, William R Sanders, Rose Marujo, Yelena G Bodien, Brian L Edlow
Neuroprognostication following diffuse axonal injury (DAI) has historically relied on neuroimaging techniques with lower spatial resolution and contrast than techniques currently available in clinical practice. Since the initial studies of DAI classification and prognosis in the 1980s and 1990s, advances in neuroimaging have improved detection of brainstem microbleeds, a hallmark feature of Grade 3 DAI that has traditionally been associated with poor neurologic outcome. Here, we report clinical and radiologic data from two patients with severe traumatic brain injury and grade 3 DAI who recovered functional independence and returned to work within 4 months of injury...
April 2022: Neurohospitalist
Anita S Jwa, Russell A Poldrack
Sharing data is a scientific imperative that accelerates scientific discoveries, reinforces open science inquiry, and allows for efficient use of public investment and research resources. Considering these benefits, data sharing has been widely promoted in diverse fields and neuroscience has been no exception to this movement. For all its promise, however, the sharing of human neuroimaging data raises critical ethical and legal issues, such as data privacy. Recently, the heightened risks to data privacy posed by the rapid advances in artificial intelligence and machine learning techniques have made data sharing more challenging; the regulatory landscape around data sharing has also been evolving rapidly...
June 1, 2022: Human Brain Mapping
Christos Lazaridis, Fernando D Goldenberg, Ali Mansour, Christopher Kramer, Alexandra Tate
BACKGROUND: Insufficient attention has been devoted to shared decision-making (SDM) in the setting of acute brain injury (ABI). Communication occupies a central role that has been highlighted in recent research on SDM with brain injured patients, with respect to "the impact of specific clinician words and expressions". In this investigation, we seek to understand lay public understandings of the term "coma." METHODS: Qualitative analysis of lay interpretations of the term "cComa" using modified open coding of a free-text response question at the end of a survey exploring public attitudes in the context of hypothetical ABI...
February 2022: World Neurosurgery
Andrew Peterson, Michael J Young, Joseph J Fins
The 2018 practice guideline on disorders of consciousness marks an important turning point in the care of patients with severe brain injury. As clinicians and health systems implement the guideline in practice, several ethical challenges will arise in assessing the benefits, harms, feasibility, and cost of recommended interventions. We provide guidance for clinicians when interpreting these recommendations and call on professional societies to develop an ethical framework to complement the guideline as it is implemented in clinical practice...
April 26, 2022: Neurology
Michael J Young, James L Bernat
Essential to responsible practice and progress in neurology and neuroscience research is robust engagement with associated ethical dimensions and challenges. By virtue of the privileged relationship between personhood and the brain, and the importance of properties of the nervous system to what for most makes life worth living, conditions that affect neurologic function introduce a growing host of novel ethical and philosophical issues. Rather than serving a reactionary role, it is important for neurologists to anticipate such issues and develop familiarity with ethical analysis to inform quality medical practice and to safeguard neuroscience research...
March 22, 2022: Neurology
Michael J Young
The accelerating integration of telehealth technologies in neurology practice has transformed traditional interactions between neurologists and patients, allied clinicians and society. Despite the immense promise of these technologies to improve systems of neurological care, the infusion of telehealth technologies into neurology practice introduces a host of unique ethical challenges. Proactive consideration of the ethical dimensions of teleneurology and of the impact of these innovations on the field of neurology more generally can help to ensure responsible development and deployment across stages of implementation...
January 11, 2022: Seminars in Neurology
Natalie Gilmore, Douglas I Katz, Swathi Kiran
PURPOSE: To summarize existing literature from a range of fields (i.e., neurology, neuropsychology, neuroscience, neuroimaging, rehabilitation, speech-language pathology) that is relevant to the development and/or revision of cognitive rehabilitation programs for individuals with acquired brain injury (ABI) and in particular, for young adults. METHOD: This paper reviews a range of ABI-associated topics including: 1) mechanisms of injury; 2) biological, individual-specific, and behavioral drivers of recovery; and 3) current methods of cognitive rehabilitation...
August 2021: Perspectives of the ASHA Special Interest Groups
Charles E Binkley, Michael S Politz, Brian P Green
Implantable brain-computer interface (BCI) and other devices with potential for both therapeutic purposes and human enhancement are being rapidly developed. The distinction between therapeutic and enhancement uses of these devices is not well defined. While the US Food and Drug Administration (FDA) rightly determines what is safe and effective, this article argues that the FDA should not make subjective, value-laden assessments about risks and benefits when it comes to approval of BCIs for therapy and enhancement...
September 1, 2021: AMA Journal of Ethics
Eileen Fitzpatrick-DeSalme, Angela Long, Ferzeen Patel, John Whyte
Brain injury resulting in coma may evolve into a prolonged disorder of consciousness, including the vegetative and minimally conscious states. Early detection of emerging consciousness has positive prognostic significance, and improvement in consciousness at any point may indicate the potential for meaningful communication and environmental control. Despite the importance of accurate assessment of consciousness, research indicates that as many as 40% of patients with a disorder of consciousness may be assessed incorrectly...
January 1, 2022: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Ren Xu, Rossella Spataro, Brendan Z Allison, Christoph Guger
Disorders of consciousness include coma, unresponsive wakefulness syndrome (also known as vegetative state), and minimally conscious state. Neurobehavioral scales such as coma recovery scale-revised are the gold standard for disorder of consciousness assessment. Brain-computer interfaces have been emerging as an alternative tool for these patients. The application of brain-computer interfaces in disorders of consciousness can be divided into four fields: assessment, communication, prediction, and rehabilitation...
January 1, 2022: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Gavin D Perkins, Clifton W Callaway, Kirstie Haywood, Robert W Neumar, Gisela Lilja, Matthew J Rowland, Kelly N Sawyer, Markus B Skrifvars, Jerry P Nolan
As more people are surviving cardiac arrest, focus needs to shift towards improving neurological outcomes and quality of life in survivors. Brain injury after resuscitation, a common sequela following cardiac arrest, ranges in severity from mild impairment to devastating brain injury and brainstem death. Effective strategies to minimise brain injury after resuscitation include early intervention with cardiopulmonary resuscitation and defibrillation, restoration of normal physiology, and targeted temperature management...
October 2, 2021: Lancet
Adam Rodman, Anthony C Breu
Cardiopulmonary determination of death is a mainstay of the practice of internal medicine and pulmonary physicians. Despite this, there is considerable variability in death examinations. This article tracks the evolution of the tripartite death examination, initially developed in the middle of the 19th century to protect against premature burial. Although the societal context for controversies about death determination has shifted to discussions about end-of-life care in ICUs and organ transplantation, the cardiopulmonary death examination has largely remained unchanged from its original formulation...
February 2022: Chest
Michael J Young, Yelena G Bodien, Joseph T Giacino, Joseph J Fins, Robert D Truog, Leigh R Hochberg, Brian L Edlow
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...
December 16, 2021: Brain
Lars Christensen, Hanne Jensen, Steffen Kristensen, Mathias Goldinger, Jakob Gjedsted, Steffen Christensen, Charles Sprung, Alex Avidan, Spyros D Mentzelopoulos, Hans-Henrik Bulow
INTRODUCTION: Patients in intensive care units (ICUs) have treatment limited or withdrawn if further treatment is considered futile. This multicentre prospective observational study was part of a European study of patterns of limitations. METHODS: In the first six months of 2016, all patients admitted to three Danish ICUs were screened and those with treatment limitations or death in the ICU were included. End-of-life outcomes were classified into five mutually exclusive categories: withholding, withdrawing, shortening of dying process, failed cardio-pulmonary resuscitation and brain death...
July 13, 2021: Danish Medical Journal
Joncarmen V Mergenthaler, Winston Chiong, Daniel Dohan, Josh Feler, Cailin R Lechner, Philip A Starr, Jalayne J Arias
Intracranial electrophysiological research methods, including those applying electrodes on the cortical surface or in deep structures, have become increasingly important in human neuroscience. They also pose novel ethical concerns, as human studies require the participation of neurological patients undergoing surgery for conditions such as epilepsy and Parkinson's disease. Research participants in this setting may be vulnerable to conflicts of interest, therapeutic misconception, and other threats to valid recruitment and consent...
January 2021: AJOB Neuroscience
Katherine E MacDuffie, Scott Ransom, Eran Klein
Neurotechnologies are rapidly being developed with the aim of alleviating suffering caused by disease and assisting individuals with various disabilities. As the capabilities and applications of neural devices advance, potential ethical challenges related to agency, identity, privacy, equality, normality and justice have been noted. We sought to explore attitudes toward these ethical challenges in two important, but understudied groups of stakeholders-members of the neural device industry and members of the general public...
March 31, 2021: AJOB Neuroscience
Sara Goering, Eran Klein, Laura Specker Sullivan, Anna Wexler, Blaise Agüera Y Arcas, Guoqiang Bi, Jose M Carmena, Joseph J Fins, Phoebe Friesen, Jack Gallant, Jane E Huggins, Philipp Kellmeyer, Adam Marblestone, Christine Mitchell, Erik Parens, Michelle Pham, Alan Rubel, Norihiro Sadato, Mina Teicher, David Wasserman, Meredith Whittaker, Jonathan Wolpaw, Rafael Yuste
Advancements in novel neurotechnologies, such as brain computer interfaces (BCI) and neuromodulatory devices such as deep brain stimulators (DBS), will have profound implications for society and human rights. While these technologies are improving the diagnosis and treatment of mental and neurological diseases, they can also alter individual agency and estrange those using neurotechnologies from their sense of self, challenging basic notions of what it means to be human. As an international coalition of interdisciplinary scholars and practitioners, we examine these challenges and make recommendations to mitigate negative consequences that could arise from the unregulated development or application of novel neurotechnologies...
2021: Neuroethics
Vinata Vedam-Mai, Karl Deisseroth, James Giordano, Gabriel Lazaro-Munoz, Winston Chiong, Nanthia Suthana, Jean-Philippe Langevin, Jay Gill, Wayne Goodman, Nicole R Provenza, Casey H Halpern, Rajat S Shivacharan, Tricia N Cunningham, Sameer A Sheth, Nader Pouratian, Katherine W Scangos, Helen S Mayberg, Andreas Horn, Kara A Johnson, Christopher R Butson, Ro'ee Gilron, Coralie de Hemptinne, Robert Wilt, Maria Yaroshinsky, Simon Little, Philip Starr, Greg Worrell, Prasad Shirvalkar, Edward Chang, Jens Volkmann, Muthuraman Muthuraman, Sergiu Groppa, Andrea A Kühn, Luming Li, Matthew Johnson, Kevin J Otto, Robert Raike, Steve Goetz, Chengyuan Wu, Peter Silburn, Binith Cheeran, Yagna J Pathak, Mahsa Malekmohammadi, Aysegul Gunduz, Joshua K Wong, Stephanie Cernera, Wei Hu, Aparna Wagle Shukla, Adolfo Ramirez-Zamora, Wissam Deeb, Addie Patterson, Kelly D Foote, Michael S Okun
We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field...
2021: Frontiers in Human Neuroscience
2021-06-02 02:59:17
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