Ethical safety of deep brain stimulation: A study on moral decision-making in Parkinson's disease
Ethical safety of deep brain stimulation: A study on moral decision-making in Parkinson's disease
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DOI：
10.1016/j.parkreldis.2015.04.011
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发表时间：
2015-07-01
影响因子：
4.1
通讯作者：
Priori, Alberto
中科院分区：
文献类型：
--
作者：
Fumagalli, Manuela;Marceglia, Sara;Priori, Alberto
简介：脑深部电刺激（DBS）治疗帕金森病（PD）可能会改变患者的决定和行为，即使是暂时的，也会引起重要的临床、伦理和法律的问题。异常的道德决策可能导致违反道德规则。先前的实验证明了在道德决策过程中丘脑底核（subthalamic）的激活。在这里，我们的目的是研究是否可以影响道德决策PD patients.Methods：11例患者PD和双边DBS植入物进行了计算机化的道德任务在ON和OFF刺激条件下。未植入DBS的PD患者的对照组执行相同的实验方案。结果：在同一患者的ON状态和OFF状态下，视觉刺激不能改变反应时和道德任务的反应（反应时间，p = 0.416），当我们比较DBS患者与仅接受最佳药物治疗的患者时，结论：道德判断是一个复杂过程的结果，需要认知执行功能、问题解决、对行为后果的预期、冲突处理、对情境和可能结果的情绪评估，涉及不同的脑区和神经回路。我们的数据表明，DBS的左不受影响的道德决定，从而暗示相关的临床和伦理影响DBS的后果对患者的行为，决策和判断能力。总之，该技术可以被认为是安全的道德行为。(C)2015爱思唯尔有限公司版权所有。
Introduction: The possibility that deep brain stimulation (DBS) in Parkinson's disease (PD) alters patients' decisions and actions, even temporarily, raises important clinical, ethical and legal questions. Abnormal moral decision-making can lead to ethical rules violations. Previous experiments demonstrated the subthalamic (STN) activation during moral decision-making. Here we aim to study whether STN DBS can affect moral decision-making in PD patients.Methods: Eleven patients with PD and bilateral STN DBS implant performed a computerized moral task in ON and OFF stimulation conditions. A control group of PD patients without DBS implant performed the same experimental protocol. All patients underwent motor, cognitive and psychological assessments.Results: STN stimulation was not able to modify neither reaction times nor responses to moral task both when we compared the ON and the OFF state in the same patient (reaction times, p = .416) and when we compared DBS patients with those treated only with the best medical treatment (reaction times: p = .408, responses: p = .776).Conclusions: Moral judgment is the result of a complex process, requiring cognitive executive functions, problem-solving, anticipations of consequences of an action, conflict processing, emotional evaluation of context and of possible outcomes, and involving different brain areas and neural circuits. Our data show that STN DBS leaves unaffected moral decisions thus implying relevant clinical and ethical implications for DBS consequences on patients' behavior, on decision-making and on judgment ability. In conclusion, the technique can be considered safe on moral behavior. (C) 2015 Elsevier Ltd. All rights reserved.