Deep Brain Stimulation: Inducing Self-Estrangement

Despite growing evidence that a significant number of patients living with Parkison’s disease experience neuropsychiatric changes following Deep Brain Stimulation (DBS) treatment, the phenomenon remains poorly understood and largely unexplored in the literature. To shed new light on this phenomenon, we used qualitative methods grounded in phenomenology to conduct in-depth, semi-structured interviews with 17 patients living with Parkinson’s Disease who had undergone DBS. Our study found that patients appear to experience postoperative DBS-induced changes in the form of self-estrangement. Using the insights from patients’ subjective perceptions of postoperative self-change provides a potent explanation of potential DBS-induced self-estrangement.

[1]  Erik Rietveld,et al.  Effects of Deep Brain Stimulation on the Lived Experience of Obsessive-Compulsive Disorder Patients: In-Depth Interviews with 18 Patients , 2015, PloS one.

[2]  Lars Timmermann,et al.  Deep Brain Stimulation and the Search for Identity , 2011, Neuroethics.

[3]  Frédéric Bretzner,et al.  Target populations for first-in-human embryonic stem cell research in spinal cord injury. , 2011, Cell stem cell.

[4]  E. Dietrichs,et al.  Personality Changes after Deep Brain Stimulation in Parkinson's Disease , 2015, Parkinson's disease.

[5]  Mike R. Schoenberg,et al.  Five‐Months‐Postoperative Neuropsychological Outcome From a Pilot Prospective Randomized Clinical Trial of Thalamic Deep Brain Stimulation for Tourette Syndrome , 2015, Neuromodulation : journal of the International Neuromodulation Society.

[6]  F. Gilbert,et al.  Involuntary & Voluntary Invasive Brain Surgery: Ethical Issues Related to Acquired Aggressiveness , 2013 .

[7]  Leon de Bruin,et al.  Situating the self: understanding the effects of deep brain stimulation , 2015, Phenomenology and the Cognitive Sciences.

[8]  F. Gilbert,et al.  Deep Brain Stimulation and Postoperative Suicidality Among Treatment Resistant Depression Patients: Should Eligibility Protocols Exclude Patients with a History of Suicide Attempts and Anger/Impulsivity? , 2013 .

[9]  Françoise Baylis,et al.  “I Am Who I Am”: On the Perceived Threats to Personal Identity from Deep Brain Stimulation , 2011, Neuroethics.

[10]  Y. Agid,et al.  Neurosurgery in Parkinson's disease: the doctor is happy, the patient less so? , 2006, Journal of neural transmission. Supplementum.

[11]  Jens Clausen,et al.  Ethical brain stimulation – neuroethics of deep brain stimulation in research and clinical practice , 2010, The European journal of neuroscience.

[12]  F. Gilbert,et al.  Deep Brain Stimulation for Treatment Resistant Depression: Postoperative Feelings of Self-Estrangement, Suicide Attempt and Impulsive–Aggressive Behaviours , 2013, Neuroethics.

[13]  F. Gilbert,et al.  A Threat to Autonomy? The Intrusion of Predictive Brain Implants , 2015, AJOB neuroscience.

[14]  Felicitas Kraemer Me, Myself and My Brain Implant: Deep Brain Stimulation Raises Questions of Personal Authenticity and Alienation , 2011, Neuroethics.

[15]  Erik Rietveld,et al.  The phenomenology of deep brain stimulation-induced changes in OCD: an enactive affordance-based model , 2013, Front. Hum. Neurosci..

[16]  W. Glannon Neuropsychological Aspects of Enhancing the Will , 2012 .

[17]  M. Jahanshahi,et al.  Patients' perceptions of life shift after deep brain stimulation for primary dystonia—A qualitative study , 2011, Movement disorders : official journal of the Movement Disorder Society.

[18]  Markus Christen,et al.  Deep Brain Stimulation in Parkinsonian Patients—Ethical Evaluation of Cognitive, Affective, and Behavioral Sequelae , 2011 .

[19]  S. Gallagher Phenomenology and Experimental Design: Toward a Phenomenologically Enlightened Experimental Science , 2003 .

[20]  B. Schmand,et al.  Predictors of cognitive and psychosocial outcome after STN DBS in Parkinson's Disease , 2009, Journal of Neurology, Neurosurgery & Psychiatry.

[21]  L. Timmermann,et al.  Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach , 2013, Journal of Neurology, Neurosurgery & Psychiatry.

[22]  F. Gilbert,et al.  Self-Estrangement & Deep Brain Stimulation: Ethical Issues Related to Forced Explantation , 2015 .

[23]  Adrian Carter,et al.  I Miss Being Me: Phenomenological Effects of Deep Brain Stimulation , 2017 .

[24]  Jens Volkmann,et al.  Neuropsychiatric effects of subthalamic neurostimulation in Parkinson disease , 2010, Nature Reviews Neurology.

[25]  H. J. Streubert,et al.  Qualitative Research in Nursing: Advancing the Humanistic Imperative , 1995 .

[26]  F. Gilbert,et al.  Currents of memory: recent progress, translational challenges, and ethical considerations in fornix deep brain stimulation trials for Alzheimer's disease , 2017, Neurobiology of Aging.

[27]  F. Gilbert,et al.  The burden of normality: from ‘chronically ill’ to ‘symptom free’. New ethical challenges for deep brain stimulation postoperative treatment , 2012, Journal of Medical Ethics.

[28]  Pim Haselager,et al.  Did My Brain Implant Make Me Do It? Questions Raised by DBS Regarding Psychological Continuity, Responsibility for Action and Mental Competence , 2010, Neuroethics.

[29]  Y Agid,et al.  Neurosurgery in Parkinson disease , 2006, Neurology.

[30]  A. de Rugy,et al.  Different mechanisms contributing to savings and anterograde interference are impaired in Parkinson's disease , 2013, Front. Hum. Neurosci..

[31]  M. Schechtman Philosophical Reflections on Narrative and Deep Brain Stimulation , 2010, The Journal of Clinical Ethics.

[32]  F. Gilbert,et al.  Ethical Considerations for Deep Brain Stimulation Trials in Patients with Early-Onset Alzheimer's Disease. , 2017, Journal of Alzheimer's disease : JAD.