Systems thinking has emerged as a means of conceptualizing and addressing complex public health problems, thereby challenging more commonplace understanding of problems and corresponding solutions as straightforward explanations of cause and effect. Systems thinking tries to address the complexity of problems through qualitative and quantitative modeling based on a variety of systems theories, each with their own assumptions and, more importantly, implicit and unexamined values. To date, however, there has been little engagement between systems scientists and those working in bioethics (...) and public health ethics. The goal of this paper is to begin to consider what it might mean to combine systems thinking with public health ethics to solve public health challenges. We argue that there is a role for ethics in systems thinking in public health as a means of elucidating implicit assumptions and facilitating ethics debate and dialogue with key stakeholders. (shrink)

The contribution of this book to the field of reconciliation is both theoretical and practical, recognizing that good theory guides effective practice and practice is the ground for compelling theory. Using a Girardian hermeneutic as a starting point, a new conceptual Gestalt emerges in these essays, one not fully integrated in a formal way but showing a clear understanding of some of the challenges and possibilities for dealing with the deep divisions, enmity, hatred, and other effects of violence. By situating (...) discourse about reconciliation within the context of Girardian thought, it becomes clear that like Peter who vowed he would never deny Jesus but ended up doing it three times any of us is susceptible to the siren call of angry resentment and retaliation. It is with a profound awareness of the power of violence that the emergence of mimetic discourse around reconciliation takes on particular urgency.". (shrink)

The contribution of this book to the field of reconciliation is both theoretical and practical, recognizing that good theory guides effective practice and practice is the ground for compelling theory. Using a Girardian hermeneutic as a starting point, a new conceptual Gestalt emerges in these essays, one not fully integrated in a formal way but showing a clear understanding of some of the challenges and possibilities for dealing with the deep divisions, enmity, hatred, and other effects of violence.

Schopenhauer argues, strikingly, that it would have been better if life had not come into existence. In this essay I consider this pessimistic judgment from a philosophical perspective. I take on the following three tasks. First, I consider whether such judgments, apparently products of temperament rather than reason, can be the subject of productive philosophical analysis. I argue that they can be, since, importantly, we can separate arguments for such judgments that establish them as plausible from those that do not. (...) Second, I evaluate Schopenhauer’s arguments for pessimism. I argue that although we must reject Schopenhauer’s main argument for pessimism, he has another, more plausible argument for pessimism that hitherto has been neglected by scholars. Finally, I argue that although pessimism can be established as the correct judgment about life in some possible worlds, in our world the question of pessimism or optimism cannot be definitively answered. (shrink)

The argument that cumulative technological culture originates in technical-reasoning skills is not the only alternative to social accounts; another possibility is that accumulation ofbothtechnical-reasoning skillsandenhanced social skills stemmed from the onset of a more basic cognitive ability such as recursive representational redescription. The paper confuses individual learning of pre-existing information with creative generation of new information.

This study investigates the child‐directed speech (CDS) of four Russian‐, six German, and six English‐speaking mothers to their 2‐year‐old children. Typologically Russian has considerably less restricted word order than either German or English, with German showing more word‐order variants than English. This could lead to the prediction that the lexical restrictiveness previously found in the initial strings of English CDS by Cameron‐Faulkner, Lieven, and Tomasello (2003) would not be found in Russian or German CDS. However, despite differences between the (...) three corpora that clearly derive from typological differences between the languages, the most significant finding of this study is a high degree of lexical restrictiveness at the beginnings of CDS utterances in all three languages. (shrink)

The connection between whole and part is intimate: not only can we share the same space, but I’m incapable of leaving my parts behind; settle the nonmereological facts and you thereby settle what is a part of what; wholes don’t seem to be an additional ontological commitment over their parts. Composition as identity promises to explain this intimacy. But it threatens to make the connection too intimate, for surely the parts could have made a different whole and the whole have (...) had different parts. In this paper I attempt to offer an account of parthood that is intimate enough but not too intimate: the parts generate the whole, but they are not themselves the whole. (shrink)

Decades of research conducted in Western, Educated, Industrialized, Rich, & Democratic (WEIRD) societies have led many scholars to conclude that the use of mental states in moral judgment is a human cognitive universal, perhaps an adaptive strategy for selecting optimal social partners from a large pool of candidates. However, recent work from a more diverse array of societies suggests there may be important variation in how much people rely on mental states, with people in some societies judging accidental harms just (...) as harshly as intentional ones. To explain this variation, we develop and test a novel cultural evolutionary theory proposing that the intensity of kin-based institutions will favor less attention to mental states when judging moral violations. First, to better illuminate the historical distribution of the use of intentions in moral judgment, we code and analyze anthropological observations from the Human Area Relations Files. This analysis shows that notions of strict liability—wherein the role for mental states is reduced—were common across diverse societies around the globe. Then, by expanding an existing vignette-based experimental dataset containing observations from 321 people in a diverse sample of 10 societies, we show that the intensity of a society's kin-based institutions can explain a substantial portion of the population-level variation in people's reliance on intentions in three different kinds of moral judgments. Together, these lines of evidence suggest that people's use of mental states has coevolved culturally to fit their local kin-based institutions. We suggest that although reliance on mental states has likely been a feature of moral judgment in human communities over historical and evolutionary time, the relational fluidity and weak kin ties of today's WEIRD societies position these populations' psychology at the extreme end of the global and historical spectrum. (shrink)

Is there a distinctively epistemic kind of blame? It has become commonplace for epistemologists to talk about epistemic blame, and to rely on this notion for theoretical purposes. But not everyone is convinced. Some of the most compelling reasons for skepticism about epistemic blame focus on disanologies, or asymmetries, between the moral and epistemic domains. In this paper, I defend the idea that there is a distinctively epistemic kind of blame. I do so primarily by developing an account of the (...) nature of epistemic blame. My account draws on a prominent line of theorizing in moral philosophy that ties blame to our relationships with one another. I argue that with my account of epistemic blame on hand, the most compelling worries about epistemic blame can be deflated. There is a distinctively epistemic kind of blame. (shrink)

The Descartes Dictionary is an accessible guide to the world of the seventeenth-century philosopher René Descartes. Meticulously researched and extensively cross-referenced, this unique book covers all his major works, ideas and influences, and provides a firm grounding in the central themes of Descartes' thought. The introduction provides a biographical sketch, a brief account of Descartes' philosophical works, and a summary of the current state of Cartesian studies, discussing trends in research over the past four decades. The A-Z entries include clear (...) definitions of the key terms used in Descartes' writings and detailed synopses of his works. Also included are entries noting philosophical influences, of both figures that influenced Descartes and those that he in turn influenced. For anyone reading or studying Descartes, rationalism, or modern philosophy more generally, this original resource provides a wealth of useful information, analysis, and criticism. Including clear explanations of often complex terminology, The Descartes Dictionary covers everything that is essential to a sound understanding of Descartes' philosophy. (shrink)

Does Aristotle offer a definition of the soul? In fact, he rejects the possibility of defining the soul univocally. Because “life” is a homonymous concept, so too is “soul”. Given the specific causal role that Aristotle envisages for form and essence, the soul requires multiple different definitions to capture how it functions as a cause in each form of life. Aristotle suggests demonstrations can be given which express these causal definitions; I reconstruct these demonstrations in the paper.

How (Not) to Be Secular is what Jamie Smith calls "your hitchhiker's guide to the present" -- it is both a reading guide to Charles Taylor's monumental work A Secular Age and philosophical guidance on how we might learn to live in our times. Taylor's landmark book A Secular Age (2007) provides a monumental, incisive analysis of what it means to live in the post-Christian present -- a pluralist world of competing beliefs and growing unbelief. Jamie Smith's book (...) is a compact field guide to Taylor's insightful study of the secular, making that very significant but daunting work accessible to a wide array of readers. Even more, though, Smith's How (Not) to Be Secular is a practical philosophical guidebook, a kind of how-to manual on how to live in our secular age. It ultimately offers us an adventure in self-understanding and maps out a way to get our bearings in today's secular culture, no matter who "we" are -- whether believers or skeptics, devout or doubting, self-assured or puzzled and confused. This is a book for any thinking person to chew on. (shrink)

Prologue, invitation to thinking about God In the Hebrew Bible? -- Part I, questions about God? -- Why does God in the Bible have a body? -- What do God's body parts in the Bible mean? -- Why is God angry in the Bible? -- Does God in the Bible have gender or sexuality? -- Part II, questions about God in the world? -- What can creation tell us about God? -- Who-or what-is the Satan? -- Why do people suffer (...) according to the Hebrew Bible? -- Epilogue, God in the Bible and beyond. (shrink)

In this short paper, I critically examine Veli Mitova’s proposal that social-identity groups can have collective epistemic reasons. My primary focus is the role of privileged access in her account of how collective reasons become epistemic reasons for social-identity groups. I argue that there is a potentially worrying structural asymmetry in her account of two different types of cases. More specifically, the mechanisms at play in cases of “doxastic reasons” seem fundamentally different from those at play in cases of “epistemic-conduct (...) reasons”. The upshot is a need for further explanation of what unifies these dimensions of the account. (shrink)

One challenge in developing an account of the nature of epistemic blame is to explain what differentiates epistemic blame from mere negative epistemic evaluation. The challenge is to explain the difference, without invoking practices or behaviors that seem out of place in the epistemic domain. In this paper, I examine whether the most sophisticated recent account of the nature of epistemic blame—due to Jessica Brown—is up for the challenge. I argue that the account ultimately falls short, but does so in (...) an instructive way. Drawing on the lessons learned, I put forward an alternative approach to the nature of epistemic blame. My account understands epistemic blame in terms of modifications to the intentions and expectations that comprise our “epistemic relationships” with one another. This approach has a number of attractions shared by Brown’s account, but it can also explain the significance of epistemic blame. (shrink)

Plato’s references to Empedocles in the myth of the Statesman perform a crucial role in the overarching political argument of the dialogue. Empedocles conceives of the cosmos as structured like a democracy, where the constituent powers ‘rule in turn’, sharing the offices of rulership equally via a cyclical exchange of power. In a complex act of philosophical appropriation, Plato takes up Empedocles’ cosmic cycles of rule in order to ‘correct’ them: instead of a democracy in which rule is shared cyclically (...) amongst equal constituents, Plato’s cosmos undergoes cycles of the presence and absence of a single cosmic monarch who possesses ‘kingly epistēmē’. By means of a revision of Empedocles’ democratic cosmology, Plato’s richly woven myth is designed precisely to reject the appropriateness of democracy as a form of human political association and legitimate monarchy in its stead. (shrink)

ABSTRACT:Deliberative democratic theory, commonly used to explore questions of “political” corporate social responsibility, has become prominent in the literature. This theory has been challenged previously for being overly sanguine about firm profit imperatives, but left unexamined is whether corporate contexts are appropriate contexts for deliberative theory in the first place. We explore this question using the case of Starbucks’ “Race Together” campaign to show that significant challenges exist to corporate deliberation, even in cases featuring genuinely committed firms. We return to (...) the underlying social theory to show that this is not an isolated case: for-profit firms are predictably hostile contexts for deliberation, and significant normative and strategic problems can be expected should deliberative theory be imported uncritically to corporate contexts. We close with recent advances in deliberative democratic theory that might help update the PCSR project, and accommodate the application of deliberation to the corporate context, albeit with significant alterations. (shrink)

The chapter develops a taxonomy of views about the epistemic responsibilities of citizens in a democracy. Prominent approaches to epistemic democracy, epistocracy, epistemic libertarianism, and pure proceduralism are examined through the lens of this taxonomy. The primary aim is to explore options for developing an account of the epistemic responsibilities of citizens in a democracy. The chapter also argues that a number of recent attacks on democracy may not adequately register the availability of a minimal approach to the epistemic responsibilities (...) of citizens in a democracy. (shrink)

This title presents a comprehensive guide to interpretative phenomenological analysis (IPA) which is an increasingly popular approach to qualitative inquiry taught to undergraduate and postgraduate students today.

The standard methodology of comparative psychology has long relied upon a distinction between cognition and ‘mere association’; cognitive explanations of nonhuman animals behaviors are only regarded as legitimate if associative explanations for these behaviors have been painstakingly ruled out. Over the last ten years, however, a crisis has broken out over the distinction, with researchers increasingly unsure how to apply it in practice. In particular, a recent generation of psychological models appear to satisfy existing criteria for both cognition and association. (...) Salvaging the standard methodology of comparative psychology will thus require significant conceptual redeployment. In this article, I trace the historical development of the distinction in comparative psychology, distinguishing two styles of approach. The first style tries to make out the distinction in terms of the properties of psychological models, for example by focusing on criteria like the presence of rules & propositions vs. links & nodes. The second style of approach attempts to operationalize the distinction by use of specific experimental tests for cognition performed on actual animals. I argue that neither style of criteria is self-sufficient, and both must cooperate in an iterative empirical investigation into the nature of animal minds if the distinction is to be reformed. (shrink)

The main objection to pragmatism about knowledge is that it entails that truth-irrelevant factors can make a difference to knowledge. Blake Roeber (2018) has recently argued that this objection fails. I agree with Roeber. But in this paper, I present another way of thinking about the dispute between purists and pragmatists about knowledge. I do so by formulating a new objection to pragmatism about knowledge. This is that pragmatism about knowledge entails that factors irrelevant to both truth and “cognitive agency” (...) can make a difference to knowledge. An interesting additional upshot of my argument is the connection revealed between the debate between pragmatists and purists about knowledge, and the debate between “alethists” and pragmatists about reasons for belief. (shrink)

There is a widely accepted distinction between being directly responsible for a wrongdoing versus being somehow indirectly or vicariously responsible for the wrongdoing of another person or collective. Often this is couched in analyses of complicity, and complicity’s role in the relationship between individual and collective wrongdoing. Complicity is important because, inter alia, it allows us to make sense of individuals who may be blameless or blameworthy to a relatively low degree for their immediate conduct, but are nevertheless blameworthy to (...) a higher degree for their implication in some larger (or another person’s) wrongdoing. In this paper, I argue that there is a distinctively epistemic kind of complicity. First, I motivate the distinction between direct and vicarious responsibility with three interlocking arguments, respectively appealing to: i) the structure of rational agency; ii) linguistic considerations; iii) the role of “principal vs. accomplice” in legal doctrine. I show how these arguments naturally extend to the epistemic domain, motivating an epistemic form of vicarious responsibility. I then examine complicity as a mechanism of vicarious epistemic responsibility. To fill this out, I engage with an epistemic analogue of the debate about the role of intention versus causal contribution in complicity. I propose a Casual Account of Epistemic Complicity, arguing that it accommodates a wide range of cases, and enables fine-grained explanations of degrees of culpability for epistemic complicity. With an adequate account of epistemic complicity on hand, we can explain what is objectionable about an important class of epistemic agent who, on an individual level, may be epistemically blameless or blameworthy to a relatively low degree, but whose relation to other individuals or collectives nevertheless makes them epistemically blameworthy to a higher degree. I explore some broader implications of this result. (shrink)

A plausible condition on having the standing to blame someone is that the target of blame's wrongdoing must in some sense be your “business”—the wrong must in some sense harm or affect you, or others close to you. This is known as the business condition on standing to blame. Many cases of epistemic blame discussed in the literature do not obviously involve examples of someone harming or affecting another. As such, not enough has been said about how an individual's epistemic (...) failing can really count as another person's business. In this paper, I deploy a relationship-based account of epistemic blame to clarify the conditions under which the business condition can be met in the epistemic domain. The basic idea is that one person's epistemic failing can be another's business in virtue of the way it impairs their epistemic relationship. (shrink)

The paper critically examines recent work on justifications and excuses in epistemology. I start with a discussion of Gerken’s claim that the “excuse maneuver” is ad hoc. Recent work from Timothy Williamson and Clayton Littlejohn provides resources to advance the debate. Focusing in particular on a key insight in Williamson’s view, I then consider an additional worry for the so-called excuse maneuver. I call it the “excuses are not enough” objection. Dealing with this objection generates pressure in two directions: one (...) is to show that excuses are a positive enough normative standing to help certain externalists with important cases; the other is to do so in a way that does not lead back to Gerken’s objection. I show how a Williamson-inspired framework is flexible enough to deal with both sources of pressure. Perhaps surprisingly, I draw on recent virtue epistemology. (shrink)

This article suggests evidence for and reasons why prior acquisition may either facilitate or inhibit acquisition of a new construction. It investigates acquisition of the German passive and future constructions which contain a lexical verb with either the auxiliary sein “to be” or werden “to become”, and are related through these to potential supporting constructions. We predicted that a supported construction should be acquired earlier, faster, and unusually rapidly. An inhibited construction should show an extended depressed usage. We analyzed a (...) dense corpus of a German boy between 2;0 and 5;0. He acquired the sein- before the werden-passive. The former was supported by his prior acquisition of the sein copula, whereas the werden-passive itself supported one werden copula construction. He acquired the werden-future extremely slowly due to the hindrance of a semantically identical construction. These results fit with an emergentist approach in which apparently “sudden” acquisition is still due to gradual learning mechanisms. (shrink)

Distinguishing between excuses and exemptions advances our understanding of a standard range of problem cases in debates about epistemic norms. But it leaves open a problem of accounting for blameless norm violation in ‘prospective agents’. By shifting focus in our theory of excuses from rational excellence to norms governing the dispositions of agents, we can account for a fuller range of normative phenomena at play in debates about epistemic norms.

One typical aim of responsibilist virtue epistemology is to employ the notion of intellectual virtue in pursuit of an ameliorative epistemology. This paper focuses on “political inquiry” as a case study for examining the ameliorative value of intellectual virtue. The main claim is that the case of political inquiry threatens to expose responsibilist virtue epistemology in a general way as focusing too narrowly on the role of individual intellectual character traits in attempting to improve our epistemic practices.

Gender dysphoria is a clinically significant incongruence between expressed gender and assigned gender, with rapidly growing prevalence among children. The UK High Court recently conducted a judicial review regarding the service provision at a youth-focussed gender identity clinic in Tavistock. The high court adjudged it ‘highly unlikely’ that under-13s, and ‘doubtful’ that 14–15 years old, can be competent to consent to puberty blocker therapy for GD. They based their reasoning on the limited evidence regarding efficacy, the likelihood of progressing to (...) cross-sex hormone therapy and the ‘life-changing consequences’ of puberty blockers. In this article, I offer two concurrent arguments to dispute their reasoning. First, I argue that minors can be competent to consent to puberty blockers for GD, because the decision to undergo puberty blocker therapy is no more complex or far-reaching than other medical decisions that we accept a child should be able to make. Second, I argue that—irrespective of competence—such legal restriction for all children fundamentally contradicts the central ethical tenet of child healthcare: best interests. For these two reasons, the high court should not restrict access to puberty blockers for competent GD children. (shrink)

We ordinarily suppose that there is a difference between having and failing to exercise a rational capacity on the one hand, and lacking a rational capacity altogether on the other. This is crucial for our allocations of responsibility. Someone who has but fails to exercise a capacity is responsible for their failure to exercise their capacity, whereas someone who lacks a capacity altogether is not. However, as Gary Watson pointed out in his seminal essay ’Skepticism about Weakness of Will’, the (...) idea of an unexercised capacity is much more difficult to make sense of than it initially appears. The aim of ’Rational Capacities’ is to provide the needed explication of this idea. (shrink)

This article investigates the potential of fMRI to test assumptions about different components in models of complex cognitive tasks. If the components of a model can be associated with specific brain regions, one can make predictions for the temporal course of the BOLD response in these regions. An event‐locked procedure is described for dealing with temporal variability and bringing model runs and individual data trials into alignment. Statistical methods for testing the model are described that deal with the scan‐to‐scan correlations (...) in the errors of measurement of the BOLD signal. This approach is illustrated using a “sacrificial” ACT‐R model that involves mapping 6 modules onto 6 brain regions in an experiment from Ravizza, Anderson, and Carter (in press) concerned with equation solving. The model's visual encoding predicted the BOLD response in the fusiform gyrus, its controlled retrieval predicted the BOLD response in the lateral inferior prefrontal cortex, and its subgoal setting predicted the BOLD response in the anterior cingulate cortex. On the other hand, its motor programming failed to predict anticipatory activation in the motor cortex, its representational changes failed to predicted the pattern of activity in the posterior parietal cortex, and its procedural component failed to predict an initial spike in caudate. The results illustrate the power of such data to direct the development of a theory of complex problem solving, both at the level of a specific task model as well as at the level of the cognitive architecture. (shrink)

WE must first state the subject of our inquiry and the faculty to which it belongs: its subject is demonstration and the faculty that carries it out demonstrative science.

This paper provides a critical overview of recent work on epistemic blame. The paper identifies key features of the concept of epistemic blame and discusses two ways of motivating the importance of this concept. Four different approaches to the nature of epistemic blame are examined. Central issues surrounding the ethics and value of epistemic blame are identified and briefly explored. In addition to providing an overview of the state of the art of this growing but controversial field, the paper highlights (...) areas where future work is needed. (shrink)

It is clear throughout Cognitive Gadgets Heyes believes the development of cognitive capacities results from the interaction of genes and experience. However, she opposes cognitive instincts theorists to her own view that uniquely human capacities are cognitive gadgets. Instinct theorists believe that cognitive capacities are substantially produced by selection, with the environment playing a triggering role. Heyes’s position is that humans have similar general learning capacities to those present across taxa, and that sophisticated human cognition is substantially created by our (...) socioculturally transmitted environment. It is a core strategy of Heyes to provide evidence of learning altering a cognitive capacity to conclude that a capacity is a cognitive gadget and not an instinct. We draw on recent work on the evolution of learning preparedness to examine the adequacy of this strategy. In particular, we analyse experimental evolution work showing how selection affects cognition within the laboratory. First, this work reveals that change due to learning can still be retained under genetic assimilation. This suggests that domain-specific adaptation can coexist with learning, moderate nativism, an option missed by the instinct versus gadget distinction. Second, we describe the conditions that select for increased preparedness in learning: certainty, reliability, and particular costs. We consider how these conditions can be used when conducting evolutionary reasoning about cognition, applying them to the important capacity for imitation. We find that the conditions lend theoretical support to moderate nativism about the capacity to imitate, which is supported by psychological evidence. (shrink)

Is there an epistemic analogue of moral motivational internalism? The answer to this question has implications for our understanding of the nature of epistemic normativity. For example, some philosophers have argued from claims that epistemic judgement is not necessarily motivating to the view that epistemic judgement is not normative. This paper examines the options for spelling out an epistemic analogue of moral motivational internalism. It is argued that the most promising approach connects epistemic judgements to doxastic dispositions, which are related (...) to motivation in a fairly tenuous sense. It is also argued that this approach currently lacks a plausible and informative account of the nature and workings of these doxastic dispositions, and, hence, an explanation of the range of phenomena internalist theses typically set out to explain. The most promising route for developing such an account, based on recent expressivist work, is investigated and found inadequate for the task. (shrink)

Paul Sheehy has argued that the modal realist cannot satisfactorily allow for the necessity of God’s existence. In this short paper I show that she can, and that Sheehy only sees a problem because he has failed to appreciate all the resources available to the modal realist. God may be an abstract existent outside spacetime or He may not be: but either way, there is no problem for the modal realist to admit that He exists at every concrete possible world.

What kind of animals are human beings? And how do our visions of the human shape our theories of social action and institutions? In Moral, Believing Animals>, Christian Smith advances a creative theory of human persons and culture that offers innovative, challenging answers to these and other fundamental questions in sociological, cultural, and religious theory. Smith suggests that human beings have a peculiar set of capacities and proclivities that distinguishes them significantly from other animals on this planet. Despite (...) the vast differences in humanity between cultures and across history, no matter how differently people narrate their lives and histories, there remains an underlying structure of human personhood that helps to order human culture, history, and narration. Drawing on important recent insights in moral philosophy, epistemology, and narrative studies, Smith argues that humans are animals who have an inescapable moral and spiritual dimension. They cannot avoid a fundamental moral orientation in life and this, says Smith, has profound consequences for how sociology must study human beings. (shrink)

Epistemological Disjunctivism is a view about paradigm cases of perceptual knowledge. Duncan Pritchard claims that it is particularly well suited to accounting for internalist and externalist intuitions. A number of authors have disputed this claim, arguing that there are problems for Pritchard’s way with internalist intuitions. I share the worry. However, I don’t think it has been expressed as effectively as it can be. My aim in this paper is to present a new way of formulating the worry, in terms (...) of an “explanatory challenge”. The explanatory challenge is a simple, yet powerful and illuminating challenge for Epistemological Disjunctivism. It is illuminating in the sense that it shows us why Epistemological Disjunctivism must take on certain internalistically problematic commitments. A secondary aim of this paper is to examine whether the recently much-discussed distinction between justifications and excuses in epistemology can support an adequate response. I will argue that it cannot. (shrink)

BackgroundResponsive neurostimulation has been utilized as a treatment for intractable epilepsy. The RNS System delivers stimulation in response to detected abnormal activity, via leads covering the seizure foci, in response to detections of predefined epileptiform activity with the goal of decreasing seizure frequency and severity. While thalamic leads are often implanted in combination with cortical strip leads, implantation and stimulation with bilateral thalamic leads alone is less common, and the ability to detect electrographic seizures using RNS System thalamic leads is (...) uncertain.ObjectiveThe present study retrospectively evaluated fourteen patients with RNS System depth leads implanted in the thalamus, with or without concomitant implantation of cortical strip leads, to determine the ability to detect electrographic seizures in the thalamus. Detailed patient presentations and lead trajectories were reviewed alongside electroencephalographic analyses.ResultsAnterior nucleus thalamic leads, whether bilateral or unilateral and combined with a cortical strip lead, successfully detected and terminated epileptiform activity, as demonstrated by Cases 2 and 3. Similarly, bilateral centromedian thalamic leads or a combination of one centromedian thalamic alongside a cortical strip lead also demonstrated the ability to detect electrographic seizures as seen in Cases 6 and 9. Bilateral pulvinar leads likewise produced reliable seizure detection in Patient 14. Detections of electrographic seizures in thalamic nuclei did not appear to be affected by whether the patient was pediatric or adult at the time of RNS System implantation. Sole thalamic leads paralleled the combination of thalamic and cortical strip leads in terms of preventing the propagation of electrographic seizures.ConclusionThalamic nuclei present a promising target for detection and stimulation via the RNS System for seizures with multifocal or generalized onsets. These areas provide a modifiable, reversible therapeutic option for patients who are not candidates for surgical resection or ablation. (shrink)

A clearly written, authoritative introduction to Taylor's work.