Deep brain stimulation is a well-established therapy for the motor symptoms of Parkinson’s disease, but there remains an opportunity to improve symptom relief. The temporal pattern of stimulation is a new parameter to consider in DBS therapy, and we compared the effectiveness of Temporally Optimized Patterned Stimulation to standard DBS at reducing the motor symptoms of PD. Twenty-six subjects with DBS for PD received three different patterns of stimulation while on medication and using stimulation parameters optimized for standard DBS. Side (...) effects and motor symptoms were assessed after 30 min of stimulation with each pattern. Subjects experienced similar types of side effects with TOPS and standard DBS, and TOPS were well-tolerated by a majority of the subjects. On average, the most effective TOPS was as effective as standard DBS at reducing the motor symptoms of PD. In some subjects a TOPS pattern was the most effective pattern. Finally, the TOPS pattern with low average frequency was found to be as effective or more effective in about half the subjects while substantially reducing estimated stimulation energy use. TOPS DBS may provide a new programing option to improve DBS therapy for PD by improving symptom reduction and/or increasing energy efficiency. Optimizing stimulation parameters specifically for TOPS DBS may demonstrate further clinical benefit of TOPS DBS in treating the motor symptoms of Parkinson’s disease. (shrink)

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. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

Substantial discussion in the neuroethical literature has addressed the possibility that deep brain stimulation (DBS) and adaptive DBS (aDBS) could result in changes in personality, agency, and ide...

Background: Treating medication-refractory freezing of gait in Parkinson’s disease remains challenging despite several trials reporting improvements in motor symptoms using subthalamic nucleus or globus pallidus internus deep brain stimulation. Pedunculopontine nucleus region DBS has been used for medication-refractory FoG, with mixed findings. FoG, as a paroxysmal phenomenon, provides an ideal framework for the possibility of closed-loop DBS.Methods: In this clinical trial, five subjects with medication-refractory FoG underwent bilateral GPi DBS implantation to address levodopa-responsive PD symptoms with open-loop stimulation. Additionally, PPN (...) DBS leads were implanted for CL-DBS to treat FoG. The primary outcome of the study was a 40% improvement in medication-refractory FoG in 60% of subjects at 6 months when “on” PPN CL-DBS. Secondary outcomes included device feasibility to gauge the recruitment potential of this four-lead DBS approach for a potentially larger clinical trial. Safety was judged based on adverse events and explantation rate.Findings: The feasibility of this approach was demonstrated as we recruited five subjects with both “on” and “off” medication freezing. The safety for this population of patients receiving four DBS leads was suboptimal and associated with a high explantation rate of 40%. The primary clinical outcome in three of the five subjects was achieved at 6 months. However, the group analysis of the primary clinical outcome did not reveal any benefit.Interpretation: This study of a human PPN CL-DBS trial in medication-refractory FoG showed feasibility in recruitment, suboptimal safety, and a heterogeneous clinical effect in FoG outcomes. (shrink)

IntroductionDeep brain stimulation has become a standard treatment option for select patients with Parkinson’s disease. The selection process and surgical procedures employed have, to date, not been standardized.MethodsA comprehensive 58-question web-based survey was developed with a focus on DBS referral practices and peri-operative management. The survey was distributed to the Parkinson’s Foundation Centers of Excellence, members of the International Parkinson’s Disease and Movement Disorders Society, and the Parkinson Study Group between December 2015 and May 2016.ResultsThere were 207 individual respondents drawn (...) from 59 countries and 6 continents, of whom 64% received formal training in DBS. Thirteen percent of centers reported that DBS could proceed despite a confidence level of < 50% for PD diagnosis. A case-based approach to DBS candidacy was applied in 51.3% of centers without a cut-off for levodopa-responsiveness. Surprisingly, 33% of centers regularly used imaging for diagnostic confirmation of idiopathic PD. Thirty-one percent of centers reported that neuropsychological evaluation did not affect DBS target selection. Approximately half of the respondents reported determination of DBS candidacy based on a multidisciplinary committee evaluation and 1/3rd reported that a committee was used for target selection. Eight percent of respondents felt that psychosocial factors should not impact DBS candidacy nor site selection. Involvement of allied health professionals in the preoperative process was sparse. There was high variability in preoperative education about DBS outcome expectations. Approximately half of the respondents did not utilize a “default brain target,” though STN was used more commonly than GPi. Specific DBS procedure techniques applied, as well as follow-up timelines, were highly variable.ConclusionResults revealed high variability on the best approaches for DBS candidate selection, brain target selection, procedure type, and postoperative practices. Cognitive and mood assessments were underutilized. There was low reliance on multidisciplinary teams or psychosocial factors to impact the decision-making process. There were small but significant differences in practice across global regions, especially regarding multidisciplinary teams. The wide variability of responses across multiple facets of DBS care highlights the need for prospective studies to inform evidence-based guidelines. (shrink)

IntroductionDeep brain stimulation (DBS) is increasingly used to treat the symptoms of various neurologic and psychiatric conditions. People can undergo the procedure during reproductive years but the safety of DBS in pregnancy remains relatively unknown given the paucity of published cases. We thus conducted a review of the literature to determine the state of current knowledge about DBS in pregnancy and to determine how eligibility criteria are approached in clinical trials with respect to pregnancy and the potential for pregnancy.MethodsA literature (...) review was conducted in EMBASE to identify articles involving DBS and pregnancy. Two reviewers independently analyzed the articles to confirm inclusion. Data extracted for analysis included conditions treated, complications at all stages of pregnancy, neonatal/pediatric outcomes, and DBS target. A second search was then conducted using www.clinicaltrials.gov. The same two reviewers then assessed whether each trial excluded pregnant individuals, lactating individuals, or persons of childbearing age planning to conceive. Also assessed was whether contraception had to be deemed adequate prior to enrollment.ResultsThe literature search returned 681 articles. Following independent analysis and agreement of two reviewers, 8 pregnancy related DBS articles were included for analysis. These articles described 27 subjects, 29 pregnancies (2 with subsequent pregnancies), and 31 infants (2 twin pregnancies). There was 1 preterm birth at 35 weeks, and 3 patients who experienced discomfort from the DBS battery (i.e., impulse generator) placement site. All 27 patients had a DBS device implanted before they became pregnant, which remained in use throughout their pregnancy. There was exclusion of pregnant individuals from 68% of 135 interventional trials involving DBS. Approximately 44% of these trials excluded persons of childbearing age not on “adequate contraception” or wishing to conceive in the coming years. Finally, 22% excluded breastfeeding persons.ConclusionThe data from 29 pregnancies receiving DBS treatment during pregnancy was not associated with unexpected pregnancy or post-partum complication patterns. Many clinical trials have excluded pregnant individuals. Documentation of outcomes in larger numbers of pregnancies will help clarify the safety profile and will help guide study designs that will safely include pregnant patients. (shrink)

Objective: Deep brain stimulation targeted to the ventral intermediate nucleus of the thalamus is effective for motor symptoms in essential tremor, but there is limited data on cognitive outcomes. We examined cognitive outcomes in a large cohort of ET DBS patients.Methods: In a retrospective analysis, we used repeated-measures ANOVA testing to examine whether the age of tremor onset, age at DBS surgery, hemisphere side implanted with lead, unilateral vs. bilateral implantations, and presence of surgical complications influenced the cognitive outcomes. Neuropsychological (...) outcomes of interest were verbal memory, executive functioning, working memory, language functioning, visuospatial functioning, and general cognitive function.Results: We identified 50 ET DBS patients; 29 males; the mean age of tremor onset was 35.84 years with a median age of 38 years. The mean age at DBS was 68.18 years. There were 37 unilateral 30 left, seven right, and 13 bilateral brain implantations. In the subgroup analysis, there was a significant interaction between assessment and age of tremor onset ; F = 4.47; p = 0.043 for working memory. The post hoc testing found improvements for younger onset ET. Similarly, there was a significant interaction between assessment and complications vs. no complications subgroups; F = 4.34; p = 0.043 for verbal memory with worsening scores seen for ET patients with complications. The remaining tests were not significant.Conclusion: In this large cohort of ET patients with, DBS was not accompanied by a significant decline in many cognitive domains. These outcomes were possibly related to the selection of patients with normal cognitive functioning before surgery, unilateral DBS implantations for the majority, and selection of patients with optimal response to DBS. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

Background: Freezing of gait is a common symptom in Parkinson’s disease and can be difficult to treat with dopaminergic medications or with deep brain stimulation. Novel stimulation paradigms have been proposed to address suboptimal responses to conventional DBS programming methods. Burst-cycling deep brain stimulation delivers current in various frequencies of bursts, while maintaining an intra-burst frequency identical to conventional DBS.Objective: To evaluate the safety and tolerability of BCDBS in PD patients with FOG.Methods: Ten PD subjects with STN or GPi DBS (...) and complaints of FOG were recruited for this single center, single blinded within-subject crossover study. For each subject, we compared 4, 10, and 15 Hz BCDBS to conventional DBS during the PD medication-OFF state.Results: There were no serious adverse events with BCDBS. It was feasible and straightforward to program BCDBS in the clinic setting. The benefit was comparable to conventional DBS in measures of FOG, functional mobility and in PD motor symptoms. BCDBS had lower battery consumption when compared to conventional DBS.Conclusions: BCDBS was feasible, safe and well tolerated and it has potential to be a viable future DBS programming strategy. (shrink)

The elephant in the room -- Crabs and octopuses -- The central intelligence of a frog -- The cerebral cortex and consciousness -- Social consciousness -- Yoda and Darth: how can we find -- Consciousness in the brain? -- The hard problem and other perspectives on consciousness -- Conscious machines -- Uploading minds -- How to build visual consciousness.

Message from the planet -- When prophecy fails -- Energy and empire -- Climate economics -- Ethical emissions -- Dwelling in the light -- Mobility and pilgrimage -- Faithful feasting -- Remembering in time.

While addiction is not a legal defense in any legal system, the chapter assays whether it should be. The conclusion is largely negative, denying that there should be any general defense but allowing that in certain cases at least a partial defense would be appropriate. The chapter rejects the shibboleths commonly asserted in this area: that no addict can be excused because he or she was responsible for becoming an addict in the first place and that all addicts must be (...) excused because addiction is a brain disease. A more piecemeal, nuanced approach is taken to the issue. (shrink)

From the concrete experience of war, Michael S. Yandell constructs a phenomenology of “negative revelation” in which false or distorted claims of goodness and justice disintegrate and become meaningless, adding depth to the term moral injury.

In lieu of an abstract, here is a brief excerpt of the content:A Response to My ReadersMichael S. Hogue (bio)I. IntroductionI often begin writing for personal reasons: to slow my thinking, clarify and organize my thoughts, trace ideas, and sort concepts. Generally, a concern for something I consider wrong about the world motivates me to write. Provoked by such a concern, I write to understand why and how what is wrong came to be that way and why and how I (...) think it can or should be different. I write in reply to H. Richard Niebuhr's moral hermeneutic question, "What's going on?" And yet, while writing typically begins (for me) as a personal search for understanding, this search eventually leads me to (re) discover my formative communities of inquiry and interpretation. None of my questions or ideas, none of my orienting values, none of my interpretive impulses are mine alone. They do not, and cannot, exist independently of others' questions, ideas, values, and interpretations. To use Peirce's metaphor, they are slender fibers braided into a larger cable rather than independent links in a chain. The issues and questions that motivate my research; the topics I care about enough to develop into articles and books; the conceptual, critical, and normative vocabularies I bring to my research and writing; the intellectual traditions that shape the patterns of my thinking—none of these are strictly personal or individual. They have taken root and grown in me as I've learned with and from others. Writing reminds me that, as a person, I am a creature of relational processes because it shows me that my mind is not (exclusively) my own—what and how I think have been formed, animated, and limited by my experience with others in a larger world of experience that is broader and deeper than any individual mind.I open this brief essay with this comment to acknowledge my gratitude and indebtedness not only to the authors of the articles in this special issue (Walter Gulick, Robert Smid, John Teehan, and AJ Turner) but also to the larger community of scholars that comprise the readership of the American Journal of Theology and Philosophy (AJTP) and the Institute for American Religious and Philosophical Thought (IARPT). I attended my first IARPT (HIARPT, at the time) conference about seventeen years ago, soon after completing my Ph.D. I didn't know anyone personally then, but I knew several folks as authors of articles and books I had read in recent years. I discovered IARPT through the bibliography of Victor Anderson's book, Pragmatic Theology: Negotiating [End Page 80] the Intersections of an American Philosophy of Religion and Public Theology. I resonated with Anderson's articulation of a socially engaged public theology that drew from American pragmatist, historicist, and naturalist philosophies of religion. His mind had been where mine was going, into the dissenting tradition of American immanence, or the left wing of American radical theology, as I refer to it.While reading Anderson's book, I learned that many of the authors in his bibliography met every summer as a (relatively?) organized group of like-minded scholars. I joined them the next chance I had. And as things go with this group, I was immediately recruited to serve as the book review editor for the AJTP! Since that first meeting, I've attended as many IARPT meetings as my schedule allows, organized one of the summer conferences, served as AJTP book review editor for several years, and then served for several more years as the AJTP editor (following Michael Raposa's illustrious term!). Most recently, I was honored when Andrew Irvine and Austin Roberts made American Immanence a focus of the 2021 IARPT conference, "Political Thought and the Powers of Democracy: American Thought in the Anthropocene." Gulick's, Smid's, Teehan's, and Turner's articles began as papers for that conference.All this is to say what I have heard many others say through the years: the IARPT/AJTP community of interpretation has become a primary intellectual (and even spiritual) home for me. I am (and we are) fortunate to belong to a group of academic philosophers and theologians who collectively embody a rare (let us hope not... (shrink)

There is a loud and persistent drum beat of support for schools, for citizenship, for diversity and inclusion, and increasingly for labor market readiness with very little critical attention to the assumptions underlying these agendas, let alone to their many internal contradictions. Accordingly, in this book I examine the philosophical, motivational, and practical challenges of education theory, policy, and practice in the twenty-first century. As I proceed, I do not neglect the historical, comparative international context so essential to better understanding (...) where we are, as well as what is attainable in terms of educational justice. I argue that we must constructively critique some of our most cherished beliefs about education if we are to save the hope of real justice from the rhetoric of imagined justice. (shrink)

A theory of embolism based on an optimization model of blood flow is proposed and used to explain the topographic distribution of emboli in arterial trees.

Recently we proposed a theory of consciousness, the attention schema theory, based on findings in cognitive psychology and systems neuroscience. In that theory, consciousness is an internal model o...

In this essay I defend the following prima facie argument: civic virtue is not dependent on integration and in fact may be best fostered under conditions of segregation. I demonstrate that civic virtue can and does take place under conditions of involuntary segregation, but that voluntary separation—as a response to segregation—is a more effective way to facilitate it. While segregation and disadvantage commonly coexist, spatial concentrations, particularly when there is a strong voluntary aspect present, often aid in fostering civic virtue. (...) Accordingly, so long as separation provides the conditions necessary for the promotion of civic virtue, integration is not an irreducible good. (shrink)

Originally published: Oxford: Clarendon, 1997.

The concept of causation is fundamental to ascribing moral and legal responsibility for events. Yet the precise relationship between causation and responsibility remains unclear. This book clarifies that relationship through an analysis of the best accounts of causation in metaphysics, and a critique of the confusion in legal doctrine.

The concept of causation is fundamental to ascribing moral and legal responsibility for events. Yet the precise relationship between causation and responsibility remains unclear. This book clarifies that relationship through an analysis of the best accounts of causation in metaphysics, and a critique of the confusion in legal doctrine. The result is a powerful argument in favour of reforming the moral and legal understanding of how and why we attribute responsibility to agents.

This article explores the relationships between legal proof and fundamental epistemic concepts such as knowledge and justification. A survey of the legal literature reveals a confusing array of seemingly inconsistent proposals and presuppositions regarding these relationships. This article makes two contributions. First, it reconciles a number of apparent inconsistencies and tensions in accounts of the epistemology of legal proof. Second, it argues that there is a deeper connection between knowledge and legal proof than is typically argued for or presupposed in (...) the legal literature. This connection is illustrated through a discussion of the Gettier problem in epistemology. It is argued that the gap or disconnect between truth and justification that undermines knowledge in Gettier cases also potentially undermines the success of legal verdicts. (shrink)

The third edition of a work that defines the field of cognitive neuroscience, with extensive new material including new chapters and new contributors.

ABSTRACTThis article defends the importance of epistemic safety for legal evidence. Drawing on discussions of sensitivity and safety in epistemology, the article explores how similar considerations apply to legal proof. In the legal context, sensitivity concerns whether a factual finding would be made if it were false, and safety concerns how easily a factual finding could be false. The article critiques recent claims about the importance of sensitivity for the law of evidence. In particular, this critique argues that sensitivity does (...) not have much of an effect on the value of legal evidence and that it fails to explain legal doctrine. By contrast, safety affects the quality of legal evidence, and safety better explains central features of the law of evidence, including probative value, admissibility rules, and standards of proof. (shrink)

A recalcitrant emotion is one which conflicts with evaluative judgement. (A standard example is where someone is afraid of flying despite believing that it poses little or no danger.) The phenomenon of emotional recalcitrance raises an important problem for theories of emotion, namely to explain the sense in which recalcitrant emotions involve rational conflict. In this paper I argue that existing ‘neojudgementalist’ accounts of emotions fail to provide plausible explanations of the irrationality of recalcitrant emotions, and develop and defend my (...) own neojudgementalist account. On my view, recalcitrant emotions are irrational insofar as they incline the subject to accept an evaluative construal that the subject has already rejected. (shrink)

At the University of Sheffield between 2011 and 2012, a leading group of philosophers, psychologists, and others gathered to explore the nature and significance of implicit bias. The two volumes of Implicit Bias and Philosophy emerge from these workshops. Each volume philosophically examines core areas of psychological research on implicit bias as well as the ramifications of implicit bias for core areas of philosophy. Volume II: Moral Responsibility, Structural Injustice, and Ethics is comprised of three parts. “Moral Responsibility for Implicit (...) Bias” contains chapters examining the relationship of implicit biases to concepts that are central to moral responsibility, including control, awareness, reasons-responsiveness, and alienation. The chapters in the second part—“Structural Injustice”—explore the connections between the implicit biases held by individuals and the structural injustices of the societies in which they are situated. And finally, the third part—“The Ethics of Implicit Bias: Theory and Practice”—contains chapters examining strategies for implicit attitude change, the ramifications of research on implicit bias for philosophers working in ethics, and suggestions for combating implicit biases in the fields of philosophy and law. (shrink)

Starting from Marr's ideas about levels of explanation, a theory of the data structures and access processes in human memory is demonstrated on 10 tasks. Functional characteristics of human memory are captured implementation-independently. Our theory generates a multidimensional task classification subsuming existing classifications such as the distinction between tasks that are implicit versus explicit, data driven versus conceptually driven, and simple associative (two-way bindings) versus higher order (threeway bindings), providing a broad basis for new experiments. The formal language clarifies the (...) binding problem in episodic memory, the role of input pathways in both episodic and semantic (lexical) memory, the importance of the input set in episodic memory, and the ubiquitous calculation of an intersection in theories of episodic and lexical access. (shrink)

The traditional desire view of painfulness maintains that pain sensations are painful because the subject desires that they not be occurring. A significant criticism of this view is that it apparently succumbs to a version of the Euthyphro Dilemma: the desire view, it is argued, is committed to an implausible answer to the question of why pain sensations are painful. In this paper, I explain and defend a new desire view, and one which can avoid the Euthyphro Dilemma. This new (...) view maintains that painfulness is a property, not of pain sensations, but of a pain experience, understood as a relational state constituted by a pain sensation and a desire that the sensation not be occurring. (shrink)

The article explores the agreements and disagreements between the author and the authors of Responsible Brains on how neuroscience relates to moral responsibility. The agreements are fundamental: neuroscience is not the harbinger of revolutionary revision of our views of when persons are morally responsible for the harms that they cause. The disagreements are in the details of what is needed for neuroscience to be the helper of the moral sciences.