There is a paucity of treatment options for cognitively normal individuals with drug resistant genetic generalized epilepsy. Centromedian nucleus of the thalamus deep brain stimulation may be a viable treatment for GGE. Here, we present the case of a 27-year-old cognitively normal woman with drug resistant GGE, with childhood onset. Seizure semiology are absence seizures and generalized onset tonic clonic seizures. At baseline she had 4–8 GTC seizures per month and weekly absence seizures despite three antiseizure medications and vagus (...) nerve stimulation. A multidisciplinary committee recommended off-label use of CM DBS in this patient. Over 12-months of CM DBS she had two GTC seizure days, which were in the setting of medication withdrawal and illness, and no GTC seizures in the last 6 months. There was no significant change in the burden of absence seizures. Presently, just two studies clearly document CM DBS in cognitively normal individuals with GGE or idiopathic generalized epilepsy [in contrast to studies of cognitively impaired individuals with developmental and epileptic encephalopathies ]. Our results suggest that CM DBS can be an effective treatment for cognitively normal individuals with GGE and underscore the need for prospective studies of CM DBS. (shrink)

Although being generally safe, the use of Deep Brain Stimulation has been associated with a significant number of patients experiencing postoperative psychological and neurological harm within experimental trials. A proportion of these postoperative severe adverse effects have lead to the decision to medically prescribe device deactivation or removal. However, there is little debate in the literature as to what is in the patient’s best interest when device removal has been prescribed; in particular, what should be the conceptual approach to (...) ethically guide the decision to remove or maintain implants. The purpose of this article is to examine the ethical issues raised when patients refuse brain device explantation despite medical prescription. In order to illustrate these issues, we report and discuss a clinical case involving a patient suffering from treatment resistant depression who experienced forms of postoperative self-estrangement, as well as suicidal attempts, but who resists giving consent to device explantation. (shrink)

Parkinson´s disease (PD) is a neurodegenerative disorder characterized by motor symptoms following dopaminergic depletion in the substantia nigra. Besides motor impairments however, several non-motor detriments can have the potential to considerably impact subjectively perceived quality of life in patients. Particularly emotion recognition of facial expressions has been shown to be affected in PD, and especially the perception of negative emotions like fear, anger or disgust is impaired. While emotion processing generally refers to automatic implicit as well as conscious explicit processing, (...) the focus of most previous studies in PD was on explicit recognition of emotions only, while largely ignoring implicit processing deficits. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is widely accepted as therapeutic measure in the treatment of PD and has been shown to advantageously influence motor problems. Among various concomitant non-motor effects of STN-DBS, modulation of facial emotion recognition under subthalamic stimulation has been investigated in previous studies with rather heterogeneous results. While there seems to be consensus regarding the processing of disgust which significantly deteriorates under STN stimulation, findings concerning emotions like fear or happiness report heterogeneous data and seem to depend on various experimental settings and measurements. In the present review, we summarized previous investigations focusing on STN-DBS influence on recognition of facial emotional expressions in patients suffering from PD. In a first step, we provide a synopsis of disturbances and problems in facial emotion processing observed in patients with PD. Secondly, we present findings of STN-DBS influence on facial emotion recognition and especially highlight different impacts of stimulation on implicit and explicit emotional processing. (shrink)

We can understand viewed scenes and extract task-relevant information within a few hundred milliseconds. This process is generally supported by three cortical regions that show selectivity for scene images: parahippocampal place area (PPA), medial place area (MPA) and occipital place area (OPA). Prior studies have focused on the visual information each region is responsive to, usually within the context of recognition or navigation. Here, we move beyond these tasks to investigate gaze allocation during scene viewing. Eye movements rely on a (...) scene’s visual representation to direct saccades, and thus foveal vision. In particular, we focus on the contribution of OPA, which is i) located in occipito-parietal cortex, likely feeding information into parts of the dorsal pathway critical for eye movements, and ii) contains strong retinotopic representations of the contralateral visual field. Participants viewed scene images for 1034 ms while their eye movements were recorded. On half of the trials, a 500 ms train of five transcranial magnetic stimulation (TMS) pulses was applied to the participant’s cortex, starting at scene onset. TMS was applied to the right hemisphere over either OPA or the occipital face area (OFA), which also exhibits a contralateral visual field bias but shows selectivity for face stimuli. Participants generally made an overall left-to-right, top-to-bottom pattern of eye movements across all conditions. When TMS was applied to OPA, there was an increased saccade latency for eye movements toward the contralateral relative to the ipsilateral visual field after the final TMS pulse (400ms). Additionally, TMS to the OPA biased fixation positions away from the contralateral side of the scene compared to the control condition, while the OFA group showed no such effect. There was no effect on horizontal saccade amplitudes. These combined results suggest that OPA might serve to represent local scene information that can then be utilized by visuomotor control networks to guide gaze allocation in natural scenes. (shrink)

Directional deep brain stimulation contacts provide greater spatial flexibility for therapy than traditional ring-shaped electrodes, but little is known about longitudinal changes of impedance and orientation. We measured monopolar and bipolar impedance of DBS contacts in 31 patients who underwent unilateral subthalamic nucleus deep brain stimulation as part of a randomized study. At different follow-up visits, patients were assigned new stimulation configurations and impedance was measured. Additionally, we measured the orientation of the directional lead during surgery, immediately (...) after surgery, and 1 year later. Here we contrast impedances in directional versus ring contacts with respect to local anatomy, active stimulation contact, and over time. Directional contacts display larger impedances than ring contacts. Impedances generally increase slightly over the first year of therapy, save for a transient decrease immediately post-surgery under general anesthesia during pulse generator placement. Local impedances decrease at active stimulation sites, and contacts in closest proximity to internal capsule display higher impedances than other anatomic sites. DBS leads rotate slightly in the immediate postoperative period but otherwise remain stable over the following year. These data provide useful information for setting clinical stimulation parameters over time. (shrink)

Felicitas Kraemer draws on the experiences of patients undergoing deep-brain stimulation to propose two distinct and potentially conflicting principles of respect: for an individual's autonomy , and for their authenticity. I argue instead that, according to commonly-invoked justifications of respect for autonomy, authenticity is itself in part constitutive of an analysis of autonomy worthy of respect; Kraemer's argument thus highlights the shortcomings of practical applications of respect for autonomy that emphasise competence while neglecting other important dimensions of autonomy such (...) as authenticity, since it shows that competence alone cannot be interpreted as a reliable indicator of an individual's capacity for exercising autonomy. I draw from relational accounts to suggest how respect for a more expansive conception of autonomy might be interpreted for individuals undergoing DBS and in general. (shrink)

Despite the general agreement that the interdisciplinary model of physical education (PE), based on the incorporation of core academic subjects into the PE curriculum, stimulates the holistic development of students, there is still a lack of methods for its implementation. Therefore, Eduball was created, i.e., a method that uses educational balls with printed letters, numbers, and other signs. Numerous studies have shown that children participating in activities with Eduballs can develop their physical fitness while simultaneously improving their academic performance, (...) particularly in math and language, including some writing skills. However, little is known about the effects of Eduball on children’s graphomotor skills, which are key for the academic performance of students throughout the entire schooling process. Here, we investigate whether 6-month participation in PE with Eduball stimulates graphomotor skills in primary school students, such as drawing prehandwriting letter patterns on unlined or lined paper and rewriting text on unlined or lined paper. Our results show that the Eduball class (N= 28) significantly improved these skills compared to the control class (N= 26) participating in traditional PE. For example, students from the experimental group wrote with a lower pen pressure and better stability of the line, in contrast to those from the control group. Therefore, this study demonstrates that the Eduball method successfully supports teachers in developing graphomotor skills in children. More broadly, our findings make clear once again that there is the need to integrate physical and cognitive development in education, which can be achieved by using an interdisciplinary model of PE. (shrink)

Tremor of the upper extremity is a significant cause of disability in some patients with multiple sclerosis. The MS tremor is complex because it contains an ataxic intentional tremor component due to the involvement of the cerebellum and cerebellar outflow pathways by MS plaques, which makes the MS tremor, in general, less responsive to medications or deep brain stimulation than those associated with essential tremor or Parkinson's disease. The cerebellar component has been thought to be the main reason (...) for making DBS less effective, although it is not clear whether it is due to the lack of suppression of the ataxic tremor by DBS or else. The goal of this study was to clarify the effect of DBS on cerebellar tremor compared to non-cerebellar tremor in a patient with MS. By wearing an accelerometer on the index finger of each hand, we were able to quantitatively characterize kinetic tremor by frequency and amplitude, with cerebellar ataxia component on one hand and that without cerebellar component on the other hand, at the beginning and end of the hand movement approaching a target at DBS Off and On status. We found that cerebellar tremor surprisingly had as good a response to DBS as the tremor without a cerebellar component, but the function control on cerebellar tremor was not as good due to its distal oscillation, which made the amplitude of tremor increasingly greater as it approached the target. This explains why cerebellar tremor or MS tremor with cerebellar component has a poor functional transformation even with a good percentage of tremor control. This case study provides a better understanding of the effect of DBS on cerebellar tremor and MS tremor by using a wearable device, which could help future studies improve patient selection and outcome prediction for DBS treatment of this disabling tremor. (shrink)

Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study (...) clinical expertise. The aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities. (shrink)

BackgroundThe preferable position of Deep Brain Stimulation electrodes is proposed to be located in the dorsolateral subthalamic nucleus to improve general motor performance. The optimal DBS electrode localization for the post-operative improvement of balance and gait is unknown.MethodsIn this single-center, retrospective analyses, 66 Parkinson’s disease patients were assessed pre- and post-operatively by using MDS-UPDRS, freezing of gait score, Giladi’s gait and falls questionnaire and Berg balance scale. The clinical outcome was related to the DBS electrode coordinates in x, (...) y, z plane as revealed by image-based reconstruction. Binomial generalized linear mixed models with fixed-effect variables electrode asymmetry, parkinsonian subtype, medication, age class and clinical DBS induced changes were analyzed.ResultsSubthalamic nucleus-deep brain stimulation improved all motor, balance and FoG scores in MED OFF condition, however there were heterogeneous results in MED ON condition. DBS electrode reconstructed coordinates impacted the responsiveness of axial symptoms. FoG and balance responders showed slightly more medially located STN electrode coordinates and less medio-lateral asymmetry of the electrode reconstructed coordinates across hemispheres compared to non-responders.ConclusionDeep brain stimulation electrode reconstructed coordinates, particularly electrode asymmetry on the medio-lateral axis affected the post-operative responsiveness of balance and FoG symptoms in PD patients. (shrink)

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of (...) results between studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. (shrink)

There is evidence to suggest that some patients who undergo Deep Brain Stimulation can experience changes to dispositional, emotional and behavioural states that play a central role in conceptions of personality, identity, autonomy, authenticity, agency and/or self. For example, some patients undergoing DBS for Parkinson’s Disease have developed hypersexuality, and some have reported increased apathy. Moreover, experimental psychiatric applications of DBS may intentionally seek to elicit changes to the patient’s dispositional, emotional and behavioural states, in so far as dysfunctions (...) in these states may undergird the targeted disorder. Such changes following DBS have been of considerable interest to ethicists, but there is a considerable degree of conflict amongst different parties to this debate about whether DBS really does change PIAAAS, and whether this matters. This paper explores these conflicting views and suggests that we may be able to mediate this conflict by attending more closely to what parties to the debate mean when they invoke the concepts lumped together under the acronym PIAAAS. Drawing on empirical work on patient attitudes, this paper outlines how these different understandings of the concepts incorporated into PIAAAS have been understood in this debate, and how they may relate to other fundamental concepts in medical ethics such as well-being and autonomy. The paper clarifies some key areas of disagreement in this context, and develops proposals for how ethicists might fruitfully contribute to future empirical assessments of apparent changes to PIAAAS following DBS treatment. (shrink)

The problem of developing research and innovation in accordance with society’s general needs and values has received increasing attention in research policy. In the last 7 years, the concept of “Responsible Research and Innovation” has gained prominence in this regard, along with the resulting question of how best to integrate awareness about science–society relations into daily practices in research and higher education. In this context, post-graduate training has been seen as a promising entrance point, but tool-kit approaches more frequently (...) have been used. In this paper, we present and analyze an experiment—in the format of a Ph.D. course for early-career researchers—deploying an alternative approach. Drawing on Argyris and Schön’s framing of reflective practice, and their distinctions between espoused theories and theories-in-use, the analyzed course endeavored to stimulate double-loop learning. Focusing on dislocatory moments, this paper analyses how the course tried to teach participants to reflect upon their own practices, values, and ontologies, and whether this provided them with the resources necessary to reflect on their theories-in-use in their daily practices. (shrink)

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of (...) results between studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. (shrink)

Contemplative practices, such as meditation and yoga, are increasingly popular among the general public and as topics of research. Beneficial effects associated with these practices have been found on physical health, mental health, and cognitive performance. However, studies and theories that clarify the underlying mechanisms are lacking or scarce. This theoretical review aims to address and compensate this scarcity. We will show that various contemplative activities have in common that breathing is regulated or attentively guided. This respiratory discipline in (...) turn could parsimoniously explain the physical and mental benefits of contemplative activities through changes in autonomic balance. We propose a neurophysiological model that explains how these specific respiration styles could operate, by phasically and tonically stimulating the vagal nerve: respiratory vagal nerve stimulation. The vagal nerve, as a proponent of the parasympathetic nervous system, is the prime candidate in explaining the effects of contemplative practices on health, mental health, and cognition. We will discuss implications and limitations of our model. (shrink)

Background: Ideas always have and always will change the world; with ideas-engagement enabling individuals to become more knowledgeable, better able to make good decisions and better positioned to re-align their values in response to new progressive norms and beliefs. Given these potential benefits, of primary interest is how citizens can be most effectively encouraged to engage with new ideas. Methods: With this study we test the efficacy of two approaches designed to enhance citizen’s perceptions regarding the value of ideas-engagement. Specifically, (...) we recontextualise a previously undertaken small-scale randomised control trial designed to stimulate states of either curiosity or pragmatic prospection amongst two randomly allocated groups of respondents. Our target variables involve the importance respondents attribute to staying up to date, as well as to four related attitudinal variables. Our target audience is the voting age population of England. Results: 515 participants took part in the experiment, with 269 receiving the curiosity stimulating intervention and 246, the prospection intervention. Our findings suggest that, by the end of four weeks, only the intervention designed to promote pragmatic prospection had significantly impacted on the importance respondents attribute to staying up to date. It also positively impacted the value- scores for one of the secondary attitudinal variables (relating to the importance of supporting physical and mental-health). Conclusions: While this study provides useful insight regarding ideas-engagement, further work is needed. In particular, future studies will require a larger sample, so as to ascertain the impact of these approaches on ‘ideas refusers’. Also required is the inclusion of a control group to provide a definitive counter factual. Furthermore, since positive changes in attitudes towards ideas- engagement also ideally leads to changes in behaviours, questions are also needed to examine the sources of ideas respondents subsequently engage with (or not) as a result of these interventions. (shrink)

Fussend auf der Quantentheorie und Wellenmechanik, sowie unter Berücksichtigung der „Topik” desAristoteles und der SystemeDrieschs undWhiteheads studiert der Autor die Resultate welche die biologische Forschung bis jetzt bezüglich der Erscheinungen der biologischen Induktion, der Stimulation und der Vererbung geliefert hat und umreisst schliesslich eine allgemeine Theorie dieser Erscheinungen, welche sie durch interne, normative Beziehungen zwischen verschiedenen Ganzheiten erklärt. Diese Ganzheiten haben als solche keine Existenz im Raum, sondern nur in der Zeit in derselben Weise wie bei einem grammatikalischen, esthetischen (...) oder ethischen Gesetz. Diese Gesetze äussern sich mittels Symbolen, welche ihren Sinn repräsentieren und die Substanzen, welche Induktion, Stimulation oder Vererbung bewirken, werden als solche Symbole aufgefasst, welche ihre Wirkung nicht produzieren, sondern sie nur in einer andern Ganzheit induzieren, einer Ganzheit, welche auf das betreffende Symbol anspricht und welche dem Gesetz, das durch das Symbol repräsentiert wird, gehorcht.Se basant sur la théorie des quanta et sur la mécanique des ondes, ainsi que sur la „Topique” d'ARistote et les systèmes philosophiques deDriesch et deWhitehead, l'auteur examine les résultats biologiques relatives aux phénomènes de l'induction, de la stimulation et de l'activité des gènes acquis jusqu'à présent et propose en conclusion l'esquisse d'une théorie générale de ces phénomènes qui les explique par des relations internes et normatives ayant lieu entre différentes entités. Ces entités ont une existence non spatiale, mais temporelle, semblablement à des lois grammaticales, esthétiques ou éthiques. Ces lois s'expressent par le moyen de symboles qui représentent leur sens et les substances inducteurs, stimulateurs ou géniques sont interprêtées comme étant des symboles semblables qui ne produisent pas leurs effets mais les induisent seulement dans une autre entité qui répond au symbole et obéit à la loi normative que ce dernier représente. (shrink)

Single-pulse and repetitive transcranial magnetic stimulation are used in clinical practice for diagnostic and therapeutic purposes. However, rTMS-based therapies that lead to a significant and sustained reduction in neuropsychiatric symptoms remain scarce. While it is generally accepted that the stimulation frequency plays a crucial role in producing the therapeutic effects of rTMS, less attention has been dedicated to determining the role of the electric field strength. Conventional threshold-based intensity selection approaches, such as the resting motor threshold, produce variable (...) stimulation intensities and electric fields across participants and cortical regions. Insufficient standardization of electric field strength may contribute to the variability of rTMS effects and thus therapeutic success. Computational approaches that can prospectively optimize the electric field and standardize it across patients and cortical targets may overcome some of these limitations. Here, we discuss these approaches and propose that electric field standardization will be instrumental for translational science frameworks aimed at deciphering the subcellular, cellular, and network mechanisms of rTMS. Advances in understanding these mechanisms will be important for optimizing rTMS-based therapies in psychiatry. (shrink)

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected (...) impacts to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD. (shrink)

Deep brain stimulation of the subthalamic nucleus is a clinically effective tool for treating medically refractory Parkinson’s disease, but its neural mechanisms remain debated. Previous work has demonstrated that STN DBS results in evoked potentials in the primary motor cortex, suggesting that modulation of cortical physiology may be involved in its therapeutic effects. Due to technical challenges presented by high-amplitude DBS artifacts, these EPs are often measured in response to low-frequency stimulation, which is generally ineffective at PD symptom (...) management. This study aims to characterize STN-to-cortex EPs seen during clinically relevant high-frequency STN DBS for PD. Intraoperatively, we applied STN DBS to 6 PD patients while recording electrocorticography from an electrode strip over the ipsilateral central sulcus. Using recently published techniques, we removed large stimulation artifacts to enable quantification of STN-to-cortex EPs. Two cortical EPs were observed – one synchronized with DBS onset and persisting during ongoing stimulation, and one immediately following DBS offset, here termed the “start” and the “end” EPs respectively. The start EP is, to our knowledge, the first long-latency cortical EP reported during ongoing high-frequency DBS. The start and end EPs differ in magnitude and latency, and the end, but not the start, EP magnitude has a significant relationship to ongoing high gamma power during the EP. These contrasts may suggest mechanistic or circuit differences in EP production during the two time periods. This represents a potential framework for relating DBS clinical efficacy to the effects of a variety of stimulation parameters on EPs. (shrink)

Transcranial magnetic stimulation can be used to mask visual stimuli, disrupting visual task performance or preventing visual awareness. While TMS masking studies generally fix stimulation intensity, we hypothesized that varying the intensity of TMS pulses in a masking paradigm might inform several ongoing debates concerning TMS disruption of vision as measured subjectively versus objectively, and pre-stimulus versus post-stimulus TMS masking. We here show that both pre-stimulus TMS pulses and post-stimulus TMS pulses could strongly mask visual stimuli. We found (...) no dissociations between TMS effects on the subjective and objective measures of vision for any masking window or intensity, ruling out the option that TMS intensity levels determine whether dissociations between subjective and objective vision are obtained. For the post-stimulus time window particularly, we suggest that these data provide new constraints for models of vision and visual awareness. Finally, our data are in line with the idea that pre-stimulus masking operates differently from conventional post-stimulus masking. (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)

Transcranial magnetic stimulation, as a relatively new type of treatment, is a safe and non-invasive method for pain therapy. Here, we used CiteSpace software to visually analyze 440 studies concerning transcranial magnetic stimulation in pain research from 2010 to 2021, indexed by Web of Science, to clarify the research hotspots in different periods and characterize the process of discovery in this field. The United States ranked first in this field. Lefaucheur JP, Fregni F, and Andrade ACD made great (...) contributions to this field of study. The most prolific institution was University of São Paulo. The four main hot keywords were neuropathic pain, motor cortex, connectivity, and non-invasive brain stimulation. There were three main points that were generally accepted: definite analgesic effect of high-frequency rTMS of M1 contralateral to pain side in neuropathic pain; there are inconclusive recommendations regarding rTMS of the dorsolateral prefrontal cortex in fibromyalgia and neuropathic pain; there is low-quality evidence that single doses of high-frequency rTMS of the motor cortex may have short-term effects on chronic pain. This bibliometric analysis indicated that prospective, multi-center, large-sample, randomized controlled trials are still needed to further verify the effectiveness of various transcranial magnetic stimulation parameters in pain research. (shrink)

Ein Leitmotiv der medizinethischen Auseinandersetzung mit der tiefen Hirnstimulation (THS) ist die Beschäftigung mit Fragen personaler Identität. Da es sich bei personaler Identität auch um ein Problem der theoretischen Philosophie handelt, wird in diesem Aufsatz nicht nur die praktische Frage nach der ethischen Legitimation der THS durch informierte Einwilligung gestellt und ein modifiziertes Legitimationskriterium für wesensändernde THS erarbeitet. Vielmehr wird zunächst versucht, das Problem, um das es in der Debatte um THS und personaler Identität geht, besser zu verstehen.

Deception scholars have argued that increasing the liar’s cognitive system artificially can produce deception cues. However, if too much load is imposed the truth tellers’ performance can also be impaired. To address this issue, we designed a veracity task that incorporated a secondary task to increase cognitive load gradually. Also, because deception has been associated with activity in the inferior frontal cortex (IFC), we examined the influence of transcranial direct current stimulation of the IFC on performance. During stimulation, (...) participants truthfully or deceptively indicated whether each of a number of statements shown on screen was true or not. Higher load decreased recall but not general compliance or response times (RTs). Truthful trials yielded higher compliance rates and faster RTs than deceptive trials except for the highest load level. Anodal right stimulation decreased compliance in truthful trials when participants were not overloaded. Truth telling was more vulnerable to cognitive load and tDCS than lying. (shrink)

Does DBS change a patient’s personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson’s disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with (...) patients suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality. (shrink)

Ein Leitmotiv der medizinethischen Auseinandersetzung mit der tiefen Hirnstimulation (THS) ist die Beschäftigung mit Fragen personaler Identität. Da es sich bei personaler Identität auch um ein Problem der theoretischen Philosophie handelt, wird in diesem Aufsatz nicht nur die praktische Frage nach der ethischen Legitimation der THS durch informierte Einwilligung gestellt und ein modifiziertes Legitimationskriterium für wesensändernde THS erarbeitet. Vielmehr wird zunächst versucht, das Problem, um das es in der Debatte um THS und personaler Identität geht, besser zu verstehen.

Our understanding of human visual perception generally rests on the assumption that conscious visual states represent the interaction of spatial structures in the environment and our nervous system. This assumption is questioned by circumstances where conscious visual states can be triggered by external stimulation which is not primarily spatially defined. Here, subjective colors and forms are evoked by flickering light while the precise nature of those experiences varies over flicker frequency and phase. What’s more, the occurrence of one subjective (...) experience appears to be associated with the occurrence of others. While these data indicate that conscious visual experience may be evoked directly by particular variations in the flow of spatially unstructured light over time, it must be assumed that the systems responsible are essentially temporal in character and capable of representing a variety of visual forms and colors, coded in different frequencies or at different phases of the same processing rhythm. (shrink)

Habituation, a form of non‐associative learning, isno longer studied exclusively within the fields of psychology and neuroscience. Indeed, the same stimulus–response pattern is observed at the molecular, cellular, and organismal scales and is not dependent upon the presence of neurons. Hence, a more inclusive theory is required to accommodate aneural forms of habituation. Here an abstraction of the habituation process that does not rely upon particular biological pathways or substrates is presented. Instead, five generalizable elements that define the habituation process (...) are operationalized. The formulation can be applied to interrogate systems as they respond to several stimulation paradigms, providing new insights and supporting existing behavioral data. The model can be used to deduce the relative contribution of elements that contribute to the measurable output of the system. The results suggest that habituation serves as a general biological strategy that any system can implement to adaptively respond to harmless, repetitive stimuli. (shrink)

This chapter considers the present account to be a sufficient response to the generality problem as an objection that specifically targets reliabilism. It identifies the main challenge for reliabilism in relation to the typing of belief‐forming processes. The chapter focuses on insights in cognitive science in a way that should make this response attractive to practitioners of naturalized epistemology, including Goldman himself. The most stimulating part of Conee and Feldman's attack can charitably be viewed as targeting the notion that the (...) reliabilist concepts of knowledge and justification are sufficiently similar to their folk counterparts. The chapter focuses for simplicity on the reliabilist theory of justification (RJ) and on Conee and Feldman's criticism as targeting the faithfulness of RJ with regard to everyday concept of justification. For the purposes of neutralizing Conee and Feldman's central challenge it was sufficient to give a purely descriptive account of how people type belief‐forming processes. (shrink)

Mind wandering refers to a state when attention shifts from the task at hand or current situation toward thoughts, feelings, and imaginations. This state is often accompanied by a decline in mood, and patients suffering from major depression exhibit more perseverative MW. Hence, although the directionality of the relationship between mood and MW is still under investigation, it may be useful to explore possible avenues to reduce MW. In an earlier pilot study, we investigated MW during auditory beat stimulation (...) in healthy subjects using thought-probes during a sustained attention to response task. We found evidence for reduced MW during monaural 5 Hz beats compared to silence, sine tones, and binaural 5 Hz beats. Moreover, the data tentatively suggested that this reduction was particularly pronounced in subjects with high levels of MW during silence. In the current study, we therefore asked whether MW can be reduced by monaural theta beats in subjects with high trait-levels of MW, as indicated by an online MW questionnaire. Preselected subjects performed a SART task with thought-probes assessing the propensity to mind wander, meta-awareness, and the temporal orientation of MW. Stimulation conditions comprised monaural theta beats, as well as silence, and sine tones as control conditions. Our main hypothesis stating that the propensity to mind wander during monaural theta beats is reduced compared to both control conditions was only partly confirmed. Indeed, MW was significantly diminished during exposure to the theta beats compared to sine tones. However, reduced MW during theta beats versus silence was only observed in a subgroup using stricter inclusion criteria. Considering possible reasons for this outcome, our data suggest that the preselection procedure was suboptimal and that beat effects are modulated by the individual responses to auditory stimulation in general. (shrink)

Idiopathic generalized epilepsy is a common type of epilepsy and despite an increase in the number of available anti-seizure medications, approximately 20–30% of people with IGE continue to experience seizures despite adequate medication trials. Unlike focal epilepsy, resective surgery is not a viable treatment option for IGE; however, neuromodulation may be an effective surgical treatment for people with IGE. Thalamic stimulation through deep brain stimulation and responsive neurostimulation have been explored for the treatment of generalized and focal epilepsies. (...) Although the data regarding DBS and RNS in IGE is limited to case reports and case series, the results of the published studies have been promising. The current manuscript will review the published literature of DBS and RNS within the centromedian nucleus of the thalamus for the treatment of IGE, as well as highlight an illustrative case. (shrink)

Launched in 1920 by C K Ogden and others as the successor to the Cambridge Magazine , Psyche occupied a unique place for over 30 years as a journal of general and linguistic psychology. Committed from the outset to keeping readers abreast of developments in the burgeoning fields of experimental, theoretical, and applied psychology, Psyche provided not only systematic reporting in these domains but set itself the task of stimulating research of high quality by the critical thrust of its (...) editorial stance. In addition to full-length articles, Psyche featured lively correspondence and discussion, a regular chronicle of research in the US and on the continent, a comprehensive survey of current literature, and regular reports from the meetings and congresses of associations and societies. I A Richards, E J Dingwall and Whately Smith were among those who added their regular contributions to editorials and features by C K Ogden. (shrink)

This study examines the link between social media networks and democratization process by focusing on the 2015 General Electionsin Nigeria. Relying on Manuel Castells’ network theory and empirical fieldsurvey, the paper investigates the prevalent conditions that have nurtured SMNsparticipation in Nigeria’s democratic space and the challenges and prospects ofsocial media as catalysts for deepening democracy in the country. The paperasserts that although social media remains veritable tools for democraticconsolidation worldwide, the salience and impact are still at the nascentstage in (...) Nigeria. Besides, institutional and legal impediments, economic andinfrastructural challenges have contrived to limit the envisaged positive impactof SMNs in the democratization process in Nigeria. The paper recommendsefforts to stimulate Internet penetration and social media affordance while theNigerian cyberspace should be more democratised. (shrink)

Richard Morehouse has identified two crucial areas, central to the pedagogical core of Philosophy for Children. These, he claims enable techniques associated with P4C to be generalized to other contexts. After Lipman, he reminds us that the power of the P4C curriculum is found, first in the novels which are written to be "captivating and beguilding, designed to liberate the literary and illustrative powers of the children and to stimulate their thinking." This philosophical 'liberation' is both enabled by and enables (...) the child's insight into the individual as 'concrete wholes existing in relationships.' The reading of the novels is the basis for the other major program component, the discussion that prompts the 'reflection on that experience,' 'the pulling of leading ideas from the narrative and the application of conceptual tools to the understanding of those ideas.' The ideas that constitute the content of the P4C program are drawn from the philosophical texts and are applied to the text in the discussion. These ideas include the 'basic tools of philosophy.'. (shrink)

Activities of product design and manufacturing are carried out on a worldwide scale. Operations like outsourcing and fabless manufacturing occur frequently in both design and manufacturing processes to stimulate outbreaks of the abovementioned phenomena. In this situation, manufacturing knowledge data, that have been collected and used only by the same enterprise in the same place and within the same ethnic group up to now, are not sufficient or precise enough for making a plan of ongoing manufacturing. This paper tries to (...) suggest an example of manufacturing knowledge data containing an element of production culture and to estimate a risk of manufacturing trouble that could happen between each production culture. (shrink)

Based upon the proceedings of the First International Conference on the History of General Relativity, held at Boston University's Osgood Hill Conference Center, North Andover, Massachusetts, 8-11 May 1986, this volume brings together essays by twelve prominent historians and philosophers of science and physicists. The topics range from the development of general relativity (John Norton, John Stachel) and its early reception (Carlo Cattani, Michelangelo De Maria, Anne Kox), through attempts to understand the physical implications of the theory (Jean (...) Eisenstaedt, Peter Havas) and to quantize it (Peter G. Bergmann), to elaborations of the theory into a unified theory of electromagnetism and gravitation (Vladimir P. Vizgin, Michel Biezunski), and considerations of its cosmological extensions (Pierre Kerszberg, George F.R. Ellis). This is the first volume to survey many of the most important questions in the history of general relativity, with many of the contributions drawing upon such original resources as the Einstein Archive. It is hoped that it will stimulate much-needed further research in this hitherto neglected area. (shrink)

This paper presents a personal view of the interaction between the analysis of choice under uncertainty and the analysis of production under uncertainty. Interest in the foundations of the theory of choice under uncertainty was stimulated by applications of expected utility theory such as the Sandmo model of production under uncertainty. This interest led to the development of generalized models including rank-dependent expected utility theory. In turn, the development of generalized expected utility models raised the question of whether such models (...) could be used in the analysis of applied problems such as those involving production under uncertainty. Finally, the revival of the state-contingent approach led to the recognition of a fundamental duality between choice problems and production problems. (shrink)

This book is an in-depth exploration of the nature of sensations and how they are affected by different types of stimuli. The author, Harold Griffing, presents a detailed analysis of the ways in which pressure and impact can influence sensations, and offers insights into how these findings can be applied in a variety of contexts. This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work (...) is in the "public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

This book poses the question of: what is an ideal tax system, in a utopian society?What is taxation? It is "government-required sacrifice for the general welfare" imposed on the members of society.1 This clear and simple definition allows the author to explore hypothetical tax systems of utopian communities based on their corresponding moral principles, viewing more broadly than just pecuniary taxes. This is an enlightening exercise, and in this sense the book successfully stimulates the reader's mind. As the functional (...) context of taxation as defined above can take the form of nonmonetary rules and legal requirement of society, the author studies such "constructive" taxes in utopian societies, as... (shrink)

Interest in the foundations of the theory of choice under uncertainty was stimulated by applications of expected utility theory such as the Sandmo model of production under uncertainty. The development of generalized expected utility models raised the question of whether such models could be used in the analysis of applied problems such as those involving production under uncertainty. Finally, the revival of the state-contingent approach led to the recognition of a fundamental duality between choice problems and production problems.

In lieu of an abstract, here is a brief excerpt of the content:Response to Anthony J. Palmer, “A Philosophical View of the General Education Core”Nico SchülerAnthony J. Palmer's paper is not only an interesting one but it also continues an absolutely necessary discussion on the general education core curriculum for American undergraduate students. Initially, Palmer summarized the global conditions with which we are presently confronted. This discussion led him to the re-examination of the general education core at (...) the undergraduate level. The goal of such education should be to "prepare students to develop a world where haphazard processes be minimized.... To accomplish that goal, the student must be enabled to integrate a wide variety of facts and ideas, theories, and applications that will become holistic in substance and unified in practice." More specifically, he then focused on the general education courses for music education students and finally, since the current concept is failing in presenting integrated knowledge, he proposed a new philosophy of the general education core. This new philosophy contains three steps: (1) cultivating personal qualities, (2) understanding multiculturalism, and (3) understanding the complexities of humanity itself and its relationship to the earth. [End Page 198]This philosophy is intriguing and does indeed deserve a broad discussion. To start that discussion, I would like to raise several fundamental issues. First, such a philosophy of general education cannot exist as a pure philosophy of the undergraduate general education core (nor can it specifically focus on music students). The ultimate goal of such a philosophy must be to turn toward the general education core of all levels of education, especially beginning with the youngest age groups. A student, educated according to existing philosophies up to age eighteen, will have the hardest time in suddenly connecting the various areas and fields of study in a globalized worldview. The reasons for this problem are cultural. At eighteen, students are culturally so formed that a new cultural opening is hardly possible. The philosophy should, instead, focus on the spiral that professors stimulate: our graduates are the teachers of the next generation, some of whom become teachers and will educate the following generation, and so on. Palmer's goal can, in my opinion, only be reached if we first focus on the general education of all ages, and then stimulate a slow but continuous change throughout the next generations. This change may exploit the cultural open-mindedness of students of all ages within the educational and cultural limitations that were set by their previous education. Indeed, such cultivation in early adulthood can benefit our university students, as Palmer states, but cultivation at such a late stage is limited.Second, the philosophy suggested by Palmer may be hard to realize practically. All mass media would work against such a realization. The organization of classes is, with our current commercialized course offering system, impractical in terms of Palmer's suggestions. Academic units within universities generate money through large general education classes. Who would pay for smaller classes? (I am not speaking about the small, private liberal arts colleges that Palmer mentions but about public colleges and universities, many of which are very large.) If general education were to be moved to a newly created academic unit, as Palmer suggests, who would reimburse the academic units that would lose the credit hours? How could we create the additional classes that would be needed to bring all the areas together that he suggests (music, art, religion, myth, history, language, philosophy, psychology, paleontology, archeology, anthropology, biology, and zoology)? In addition, some of his philosophy is based on Carl Roger's view of personal relationships, which parents as well as teachers have to establish. But how are the parents of our students to establish such relationships? And who is going to educate the parents? American culture itself would certainly be an obstacle for the realization of such an educational philosophy. Furthermore, how do we select the students who are unsuccessful in becoming self-initiated learners? How do we identify those who are not well-read? Should they not be removed? Much of the current educational system is based on the assumption that all, or most, [End Page 199] students are very talented. Realizing Palmer's philosophy would mean... (shrink)

Une pensée qui voyage. Voici ce que donne à voir Guillaume Tusseau, théoricien du droit devenu comparatiste sans avoir jamais quitté les rives de la théorie, dans ce petit ouvrage en français, dense et stimulant, publié au Canada. L’avant-propos retrace les expériences de recherche mais aussi les contrées par lesquelles cette réflexion est passée pour se livrer enfin sous la forme modestement désignée de « Notes sur quelques allers-retours aporétiques » entre le droit comparé et la théorie générale du droit. (...) Plaçant ainsi sa réflexion sous le signe de la légèreté, Guillaume Tusseau désamorce l’appréhension que peut susciter un tel programme associant droit comparé et théorie générale du droit ; rien de moins. Inspiré par un colloque de 2016, organisé à La Rochelle par Isabelle Boucobza aujourd’hui professeure à l’Université Paris Nanterre, intitulé « Le droit comparé : de la périphérie au centre? », l’auteur a depuis cheminé, chargé de cette recherche initiale, de Paris à Bogotá, pu... (shrink)

BackgroundNeuroethics describes several interdisciplinary topics exploring the application and implications of engaging neuroscience in societal contexts. To explore this topic, we present Part 3 of a four-part bibliography of neuroethics’ literature focusing on the “ethics of neuroscience.”MethodsTo complete a systematic survey of the neuroethics literature, 19 databases and 4 individual open-access journals were employed. Searches were conducted using the indexing language of the U.S. National Library of Medicine. A Python code was used to eliminate duplications in the final bibliography.ResultsThis bibliography (...) consists of 1137 papers, 56 books, and 134 book chapters published from 2002 through 2014, covering ethical issues in neuroimaging, neurogenetics, neurobiomarkers, neuro-psychopharmacology, brain stimulation, neural stem cells, neural tissue transplants, pediatric-specific issues, dual-use, and general neuroscience research issues. These works contain explanations of recent research regarding neurotechnology, while exploring ethical issues in future discoveries and use. (shrink)