Farah Focquaert

Different resting state brain activity and functional connectivity in patients who respond and not respond to bifrontal tDCS for tinnitus suppression

Tinnitus is an ongoing phantom percept. It has been demonstrated that bifrontal transcranial direct current stimulation (tDCS) can reduce tinnitus. In this study, one group of patients reported a substantial improvement in their tinnitus perception, whereas another group described minor or no beneficial effect at all. The objective was to verify whether the activity and connectivity of the resting brain is different for people who will respond to bifrontal tDCS for tinnitus in comparison with non-responders. Higher gamma band activity was demonstrated in right primary and secondary auditory cortex and right parahippocampus for responders. It has been shown that gamma band activity in the auditory cortex is correlated with tinnitus loudness and that the anterior cingulate is involved in tinnitus distress. People who were going to respond to bifrontal tDCS also demonstrated an increased functional connectivity in the gamma band between the right dorsolateral prefrontal cortex (DLPFC) and the right parahippocampus as well as the right DLPFC and subgenual anterior cingulate cortex (sgACC). An analysis revealed that responders to bifrontal tDCS also experienced a larger suppression effect on TMS placed over the right temporal cortex (i.e. auditory cortex) than non-responders. Responders to bifrontal tDCS seem to differ in resting brain activity compared to non-responders in the right auditory cortex and parahippocampal area. They also have a different functional connectivity between DLPFC and, respectively, the sgACC and parahippocampal area. These connectivities might explain the suppression effect for both tinnitus loudness and tinnitus-related distress.

Coercion, Incarceration, and Chemical Castration: An Argument From Autonomy

In several jurisdictions, sex offenders may be offered chemical castration as an alternative to further incarceration. In some, agreement to chemical castration may be made a formal condition of parole or release. In others, refusal to undergo chemical castration can increase the likelihood of further incarceration though no formal link is made between the two. Offering chemical castration as an alternative to further incarceration is often said to be partially coercive, thus rendering the offender’s consent invalid. The dominant response to this objection has been to argue that any coercion present in such cases is compatible with valid consent. In this article, we take a different tack, arguing that, even if consent would not be valid, offering chemical castration will often be supported by the very considerations that underpin concerns about consent: considerations of autonomy. This is because offering chemical castration will often increase the offender’s autonomy, both at the time the offer is made and in the future.

Mandatory neurotechnological treatment: ethical issues

What if neurofeedback or other types of neurotechnological treatment, by itself or in combination with behavioral treatment, could achieve a successful “rewiring” of the psychopath’s brain? Imagine that such treatments exist and that they provide a better long-term risk-minimizing strategy compared to imprisonment. Would it be ethical to offer such treatments as a condition of probation, parole, or (early) prison release? In this paper, I argue that it can be ethical to offer effective, non-invasive neurotechnological treatments to offenders as a condition of probation, parole, or (early) prison release provided that: (1) the status quo is in no way cruel, inhuman, degrading, or in some other way wrong, (2) the treatment option is in no way cruel, inhuman, degrading, or in some other way wrong, (3) the treatment is in the best interests of the offender, and (4) the offender gives his/her informed consent.

The ethical desirability of moral bioenhancement: a review of reasons

BackgroundThe debate on the ethical aspects of moral bioenhancement focuses on the desirability of using biomedical as opposed to traditional means to achieve moral betterment. The aim of this paper is to systematically review the ethical reasons presented in the literature for and against moral bioenhancement.DiscussionA review was performed and resulted in the inclusion of 85 articles. We classified the arguments used in those articles in the following six clusters: (1) why we (don’t) need moral bioenhancement, (2) it will (not) be possible to reach consensus on what moral bioenhancement should involve, (3) the feasibility of moral bioenhancement and the status of current scientific research, (4) means and processes of arriving at moral improvement matter ethically, (5) arguments related to the freedom, identity and autonomy of the individual, and (6) arguments related to social/group effects and dynamics. We discuss each argument separately, and assess the debate as a whole. First, there is little discussion on what distinguishes moral bioenhancement from treatment of pathological deficiencies in morality. Furthermore, remarkably little attention has been paid so far to the safety, risks and side-effects of moral enhancement, including the risk of identity changes. Finally, many authors overestimate the scientific as well as the practical feasibility of the interventions they discuss, rendering the debate too speculative.SummaryBased on our discussion of the arguments used in the debate on moral enhancement, and our assessment of this debate, we advocate a shift in focus. Instead of speculating about non-realistic hypothetical scenarios such as the genetic engineering of morality, or morally enhancing ‘the whole of humanity’, we call for a more focused debate on realistic options of biomedical treatment of moral pathologies and the concrete moral questions these treatments raise.

Mindreading in individuals with an empathizing versus systemizing cognitive style: An fMRI study

Our fMRI study compares the neural correlates of face-based mindreading in healthy individuals with an empathizing (n=12) versus systemizing cognitive style (n=12). The empathizing group consists of individuals that score high on empathizing and low on systemizing, while the systemizing group consists of individuals with an opposite cognitive pattern. We hypothesize that the empathizing group will show stronger simulation-type neural activity (e.g., in mirror neuron areas, medial prefrontal cortex, anterior cingulate cortex) or simulation-related neural activity (e.g., in areas involved in perspective taking and experiential processing) compared to the systemizing group. As hypothesized, our study reveals that the empathizing group shows significantly stronger activity in mirror neuron areas of the brain, such as the left inferior frontal gyrus and inferior parietal lobe, and in temporal areas involved in perspective taking and autobiographical memory. Moreover, the empathizing group, but not the systemizing group, shows activity in the medial prefrontal cortex and anterior cingulate cortex which have been related to simulation-type neural activity in the brain and are central to mindreading. Also, the systemizing group shows significantly stronger activity in the left parahippocampal gyrus. In conclusion, both the empathizing and systemizing individuals show simulation-type and simulation-related neural activity during face-based mindreading. However, more neural activity indicative of simulation-based processing is seen in the empathizing individuals, while more neural activity indicative of non-simulation-based processing is seen in the systemizing individuals.

Rethinking responsibility in offenders with acquired paedophilia: punishment or treatment?

This article reviews the current neurobiological literature on the aetiology of developmental and acquired paedophilia and examines what the consequences could be in terms of responsibility and treatment for the latter. Addressing the question of responsibility and punishment of offenders with acquired paedophilia from a neurobiological perspective is controversial. Consequently it is essential to avoid hasty conclusions based strictly on neurobiological abnormality justifications. This study establishes a distinction between developmental and acquired paedophilia. The article investigates whether offenders who fulfil the diagnosis of acquired paedophilia should be held fully responsible, particularly in cases where the offenders conduct appears to result from volitionally controlled behaviour that is seemingly incompatible with a neurological cause. Moreover, the article explores how responsibility can be compromised when offenders with acquired paedophilia have (partially) preserved moral knowledge despite their sexual disorder. The article then examines the option of offering mandatory treatment as an alternative to imprisonment for offenders with acquired paedophilia. Furthermore, the article addresses the ethical issues related to offering any form of quasi-coercive treatment as a condition of release. This study concludes that decisions to fully or partially excuse an individual who fulfil the diagnosis of acquired paedophilia should take all relevant information into account, both neurobiological and other environmental evidence, and should proceed on a careful case by case analysis before sentencing or offering treatment.

An Evolutionary Cognitive Neuroscience Perspective on Human Self-awareness and Theory of Mind

The evolutionary claim that the function of self-awareness lies, at least in part, in the benefits of theory of mind (TOM) regained attention in light of current findings in cognitive neuroscience, including mirror neuron research. Although certain non-human primates most likely possess mirror self-recognition skills, we claim that they lack the introspective abilities that are crucial for human-like TOM. Primate research on TOM skills such as emotional recognition, seeing versus knowing and ignorance versus knowing are discussed. Based upon current findings in cognitive neuroscience, we provide evidence in favor of an introspection-based simulation theory account of human mindreading.

Pediatric deep brain stimulation: a cautionary approach

Today, deep brain stimulation (DBS) is performed to treat dystonia in children as young as 7 years of age (Roubertie et al., 2000). For a variety of reasons, timely intervention in childhood dystonia is important: (1) to prevent irreversible damage, (2) to obtain optimal treatment outcomes, since severity and duration of the disease are negative prognostic factors for successful DBS treatment, and (3) to prevent long-term social costs due to social isolation (Isaias et al., 2008; Mehrkens et al., 2009; Clausen, 2010). Individual cases of DBS for neuropsychiatric disorders in adolescents have been published over the last 3 years (e.g., Shaded et al., 2007). Considering the investigational nature of DBS for psychiatric disorders, this is unsettling to say the least. n nA group of experts recently proposed guidelines for the use of DBS for disorders of mood, behavior and thought (Rabins et al., 2009). Due to the investigational nature of DBS for psychiatric disorders, they defend the position that, at present, DBS for mood, behavior and thought disorders should be reserved for adults. However, they also put forward that “if DBS is found to be safe and effective for adults, then it might be appropriate to investigate its benefits for a younger population with severe, treatment-refractory symptoms” (p. 933). Their opinion is quite different from the statement made by another group of experts on the use of DBS for Tourette syndrome (TS) in children (Mink et al., 2006). They argue that patients should be at least 25 years old, with rare potential exceptions involving younger patients. Bloch and Leckman (2009) similarly claim that “invasive interventions for TS such as DBS and neurosurgery are strongly discouraged until well into adulthood, even for patients with impairing tics” (p. 499). n nIs it ethical to categorically exclude children and adolescent patients from receiving DBS for treatment-refractory disorders such as TS? If clear scientific criteria exist why specific pediatric disorders need to be excluded, then yes. However, if no such criteria exist for a given disorder, then surely it is unethical to categorically exclude children and adolescent patients from receiving the only treatment available that could dramatically increase their quality of life. Experts that oppose the use of DBS for pediatric TS (Mink et al., 2006; Porta et al., 2009) defend their position based upon the nature of childhood TS. According to a recent review, by early adulthood, approximately three quarters of children with TS will have greatly diminished tics and more than one-third will be tic free (Bloch and Leckman, 2009). A recent follow-up study on childhood and adolescent OCD found that 60% of children and adolescents did not have a full clinical disorder at follow-up, and two-thirds of participants rated themselves as much improved (Micali et al., 2010). According to the authors, many young people adapt to their illness and can lead a fairly normal life despite their symptoms. These are indeed important findings that highlight the exceptional caution that is needed when considering pediatric DBS for disorders that may spontaneously disappear or become subclinical over time. However, do they warrant the categorical exclusion of child patients? As Mink et al. (2006) themselves put forward: “Remission of tics may occur in the third decade of life in up to 50% of patients, but to date, there are no prognostic features that predict which patients will have a remission in their symptoms”(p.1832), and according to experts, the situation remains the same today. Which means that we do not possess clear scientific criteria to warrant the categorical exclusion of all child patients. n nChildren with severe treatment-refractory diseases are an extremely vulnerable group, and they should not be exposed to an invasive intervention like DBS unless successful treatment outcomes have been established in adults. However, if treatment success for neurological or psychiatric disorders is established in adults, and provided no clear scientific criteria exist to categorically exclude minors, then children and adolescents can be involved in small-scale, early-phase studies provided these are done in research centers. Children with treatment-refractory disorders should not be categorically excluded from receiving DBS treatment, and this holds for any disorder for which treatment success has been established in adults and for which no clear scientific criteria exist that warrant their exclusion. Moreover, it is crucial that the decision-making process is a shared process between the child patient, the medical experts and the parents or parental guardians to maximally protect the vulnerable child patient. The decision-making process should involve a dual consent procedure with parents giving informed consent and children giving explicit assent. Medical experts should not start treatment in those cases where the only benefit to incur would be relief of caregiver burden. Unless clear scientific data can show that a child patient would benefit by receiving DBS treatment and would be harmed if not given treatment (e.g., cases of severe childhood dystonia), DBS treatment should not be performed if the child patient dissents. If successful, timely DBS treatment for dystonia benefits both the child patient (by preventing irreversible harm and long-term social costs due to social isolation, and providing optimal treatment outcomes) and the caregiver. Hence, we have strong reasons to consider DBS treatment in a timely fashion, and potentially even in those cases where the child patient dissents. This is not so for certain other disorders. If DBS treatment is performed for childhood TS or OCD that might have spontaneously remitted or become subclinical with time, then the dissenting child patient is harmed because an unnecessary invasive procedure was forced upon him/her, and the only benefit that occurred is a third-party benefit (i.e., caregiver relief). In fact, treatment compliance is a patient selection requirement according to the Italian DBS group treating TS (Porta et al., 2009). Indeed, it is crucial that the decision-making procedure is a shared process between child patients, medical experts and parents: (a) to ensure the best possible care and support during the treatment process, (b) to preserve family intimacy, and (c) to stimulate childrens development of autonomy.

Autism spectrum traits in normal individuals: a preliminary VBM analysis

In light of the new DSM-5 autism spectrum disorders diagnosis in which the autism spectrum reflects a group of neurodevelopmental disorders existing on a continuum from mild to severe expression of autistic traits, and recent empirical findings showing a continuous distribution of autistic traits in the general population, our voxel based morphometry study compares normal individuals with high autistic traits to normal individuals with low autistic traits. We hypothesize that normal individuals with high autistic traits in terms of empathizing and systemizing [high systemizing (HS)/low empathizing (LE)] share brain irregularities with individuals that fall within the clinical autism spectrum disorder. We find differences in several social brain network areas between our groups. Specifically, we find increased gray matter (GM) volume in the orbitofrontal cortex, the cuneus, the hippocampus and parahippocampus and reduced GM volume in the inferior temporal cortex, the insula, and the amygdala in our HS/LE individuals relative to our HE/LS (low autistic traits in terms of empathizing and systemizing) individuals.

Outstanding questions concerning the regulation of cognitive enhancement devices

The authors (Maslen et al., 2014) propose to regulate cognitive enhancement devices (CEDs) as medical devices. Extending medical device regulations to CEDs raises some important questions that need to be adequately addressed before it makes sense to pursue this path. A first problem concerns the definition of ‘cognitive enhancement’ and ‘CEDs’. Where does treatment end and enhancement begin? Secondly, since most CEDs such as neurofeedback and transcranial direct current stimulation are currently performed by non-medical health care providers, how will this regulation impact the current practice, and which requirements need to be put in place to regulate their use? Thirdly, distributive justice issues present an obvious ethical limitation. Fourthly, if CEDs are indeed prescribed off-label similar to the off-label prescription of psychopharmacological enhancers by MDs, this will pose problems regarding a lack of sufficient knowledge and expertise due to the highly specialized nature of CEDs. And finally, are we faced with unnecessary worries and unrealistic hopes when it comes to CEDs? In sum, we propose to regulate them regarding product safety and restrict them to competent adult use including professional oversight where indicated.