Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 709-716 |
| Number of pages | 8 |
| Journal | Parkinsonism and Related Disorders |
| Volume | 21 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - Jul 1 2015 |
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Keywords
- Deep brain stimulation
- Ethics
- Moral decision
- Parkinson's disease
- Subthalamus
ASJC Scopus subject areas
- Geriatrics and Gerontology
- Clinical Neurology
- Neurology
Cite this
Ethical safety of deep brain stimulation : A study on moral decision-making in Parkinson's disease. / Fumagalli, Manuela; Marceglia, Sara; Cogiamanian, Filippo; Ardolino, Gianluca; Picascia, Marta; Barbieri, Sergio; Pravettoni, Gabriella; Pacchetti, Claudio; Priori, Alberto.
In: Parkinsonism and Related Disorders, Vol. 21, No. 7, 01.07.2015, p. 709-716.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Ethical safety of deep brain stimulation
T2 - A study on moral decision-making in Parkinson's disease
AU - Fumagalli, Manuela
AU - Marceglia, Sara
AU - Cogiamanian, Filippo
AU - Ardolino, Gianluca
AU - Picascia, Marta
AU - Barbieri, Sergio
AU - Pravettoni, Gabriella
AU - Pacchetti, Claudio
AU - Priori, Alberto
PY - 2015/7/1
Y1 - 2015/7/1
N2 - 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.
AB - 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.
KW - Deep brain stimulation
KW - Ethics
KW - Moral decision
KW - Parkinson's disease
KW - Subthalamus
UR - http://www.scopus.com/inward/record.url?scp=84930765167&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84930765167&partnerID=8YFLogxK
U2 - 10.1016/j.parkreldis.2015.04.011
DO - 10.1016/j.parkreldis.2015.04.011
M3 - Article
C2 - 25976985
AN - SCOPUS:84930765167
VL - 21
SP - 709
EP - 716
JO - Parkinsonism and Related Disorders
JF - Parkinsonism and Related Disorders
SN - 1353-8020
IS - 7
ER -