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Ethical and Legal Aspects of Neuromodulation: on the Road to Guidelines: Fourth Meeting of the Benelux Neuromodulation Society, Chapter of the International Neuromodulation Society: November 17–18, 2006, Maastricht, The Netherlands

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Legal-Ethical Principles as a Tool for Normative Analysis in Neuromodulation

Reinhard Merkel

Faculty of Law, Hamburg University, Hamburg, Germany

The aim of this presentation is to show how the analytical strength of basic legal and ethical principles may contribute to making transparent the complexity of new normative problems that accompany the development of new methods of brain interventions. After a brief overview of some common methods in neuromodulation, the presentation will focus on three exemplary problems.

  • 1.

    The distinction between treatment and enhancement. Most

Ethics of Vagal Nerve Stimulation for Epilepsy and Depression

Steffen K. Rosahl

Department of Neurosurgery, Helios Klinikum Erfurt, Germany

Clinical Guidance in Neuromodulation: Keeping Track of the Process and the Patient

Loes Gabriëls*, Paul Cosyns*, Bart Nuttin

*Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Belgium; Department of Neurosurgery, University of Leuven, Belgium

Ethical Aspects of Neuromodulation for Pain

Bart J. Morlion

The Leuven Center for Algology & Pain Management, Leuven, Belgium

Neuromodulation can lead to significant relief of symptoms and improvement of quality of life in carefully selected patients with persistent pain. However, several fundamental ethical principles and issues should be addressed regarding the direct interaction of man, central nervous system, and implant (1,2). The principle that human dignity is inviolable and must be respected and protected provides the essential

Ethical Aspects of Neurostimulation for Epilepsy

Kristl Vonck, Veerle De Herdt, Evelien Carrette, Paul Boon

Reference Center of Refractory Epilepsy, Laboratory of Clinical and Experimental Neurophysiology, Ghent, Belgium

Neurostimulation is an emerging treatment for various neurologic diseases. It is being explored in various modalities in the treatment of epilepsy, and more specifically, in the treatment of patients with refractory seizures.

Vagal nerve stimulation (VNS) is an extracranial modality of stimulation, developed in the 1980s and

Should Stimulation of the Subthalamic Nucleus in Parkinson’s Disease Be Abandoned Because of Potential Risks for Behavior and Cognition?

Rob M. A. de Bie

Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands

In patients with advanced Parkinson’s disease, bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) can improve functioning and health-related quality of life dramatically (1). The positive effects may last up to five years (2). Recently, concerns about adverse effects of DBS of STN are increasing, especially regarding cognitive, mood, and behavioral features. However, the results of cohort

On the Edge Between Movement Disorder Surgery and Psychosurgery: Guidelines for Deep Brain Stimulation in Tourette Syndrome

Veerle Visser-Vandewalle (on behalf of the Dutch-Flemish Tourette Surgery Study Group)

Maastricht University Hospital, Maastricht, The Netherlands

Guidelines for Electrical Brain Stimulation in Psychiatric Disorders

Bart Nuttin*, Loes Gabriëls, Paul Cosyns

*Department of Neurosurgery, University Hospital Leuven, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Belgium

Ethical and Regulatory Hurdles in the Realization of Deep Brain Stimulation in Refractory Depression. A Case Report

H. P. J. Buschman*, D. Buiten, P. Poels, M. van Houten§, M. Lenders, H. E. van der Aa*

*Institute for Neuromodulation (TWIN), Departments of Psychiatry, Neurology,§ Clinical Psychology and Neurosurgery, Medisch Spectrum Twente Hospital, Enschede, The Netherlands

The Importance of Mental Competence in Neuromodulation: An Ethicist’s Point of View

Ron L. P. Berghmans

Department of Health Ethics and Philosophy, Maastricht University, The Netherlands

In medical treatment and research, the informed consent of the patient/research subject is considered as a moral precondition. In order to be morally valid, the consent of the person should be informed, voluntarily given, and the person should have mental competence. Mental competence matters morally because it enables the patient/subject to make a well-considered decision about treatment or

Future Aspects of Neuromodulation: From Treatment to Enhancement?

Alim Louis Benabid, Stephan Chabardes, Eric Seigneuret, Napoleon Torres

Department of Neurosurgery and INSERM U 318 “Preclinical Neurosciences,” University Hospital, Grenoble, France

For 20 years, the use of deep brain stimulation at high frequency (HF-DBS, 100–200 pulses/sec) has replaced the neuroablative methods. This has revived functional neurosurgery, particularly for movement disorders, including Parkinson’s disease (PD), essential tremor, and dystonia. The subthalamic nucleus (STN)

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