How Technologies of Imaging are Shaping Clinical Research and Practice in Neurology Content Type Journal Article Category Past & Present Pages 315-328 DOI 10.1007/s12376-010-0037-1 Authors Nicolas Kopp, Hôpital de l’HotelDieu Lyon University Hospitals, EspaceEthique Inter-régional 69288 Lyon, Cedex 02 France Journal Medicine Studies Online ISSN 1876-4541 Print ISSN 1876-4533 Journal Volume Volume 1 Journal Issue Volume 1, Number 4.
In an age of modern technology and an increasing movement towards a 24-h working culture, life for many is becoming more stressful and demanding. To help juggle these work commitments and an active social life, nootropic medication, (the so-called ‘smart pills’) have become a growing part of some people’s lives. Users claim that these drugs allow them to reach their maximal potential by becoming more efficient, smarter and requiring less sleep. The use of these medications and the role of health (...) professionals in their distribution raises many ethical questions. (shrink)
Treatment of diseases of the brain by drugs or surgery necessitates an understanding of its structure and functions. The philosophical neurosurgeon soon encounters difficulties when localising the abstract concepts of mind and soul within the tangible 1300-gram organ containing 100 billion neurones. Hippocrates had focused attention on the brain as the seat of the mind. The tabula rasa postulated by Aristotle cannot be localised to a particular part of the brain with the confidence that we can localise spoken speech to (...) Broca's area or the movement of limbs to the contralateral motor cortex. Galen's localisation of imagination, reasoning, judgement and memory in the cerebral ventricles collapsed once it was evident that the functional units-neurones-lay in the parenchyma of the brain. Experiences gained from accidental injuries (Phineas Gage) or temporal lobe resection (William Beecher Scoville); studies on how we see and hear and more recent data from functional magnetic resonance studies have made us aware of the extensive network of neurones in the cerebral hemispheres that subserve the functions of the mind. The soul or atman, credited with the ability to enliven the body, was located by ancient anatomists and philosophers in the lungs or heart, in the pineal gland (Descartes), and generally in the brain. When the deeper parts of the brain came within the reach of neurosurgeons, the brainstem proved exceptionally delicate and vulnerable. The concept of brain death after irreversible damage to it has made all of us aware of 'the cocktail of brain soup and spark' in the brainstem so necessary for life. If there be a soul in each of us, surely, it is enshrined here. (shrink)
In an editorial to a recent issue of Neurology, Richard Dees expresses the same criticism in an even more rigorous epistemic tone: Veikko Launis, Ph.D., is Professor of Medical Ethics and Adjunct Professor of Ethics and Social Philosophy at the University of Turku, Finland.FootnotesThis article is part of the Neuroethics of Brainreading research project (No 124633), directed by myself and funded by the Academy of Finland. I am grateful to Olli Koistinen, Pekka Louhiala, Helena Siipi, and an anonymous referee (...) for helpful comments, criticism, and suggestions. (shrink)
An important part of Grodzinsky's claim regarding the neurology of syntax depends on agrammatic data partitioned by the Trace Deletion Hypothesis (TDH), which is a combination of trace-deletion and default strategy. However, there is convincing evidence that the default strategy is consistently avoided by agrammatics. The TDH, therefore, is in no position to support claims about agrammatic data or the neurology of syntax.
In this paper, I consider V. S. Ramachandran's in-principle agnosticism concerning whether neurological studies of religious experience can be taken as support for the claim that God really does communicate with people during religious experiences. Contra Ramachandran, I argue that it is by no means obvious that agnosticism is the proper scientific attitude to adopt in relation to this claim. I go on to show how the questions of whether it is (1) a scientifically testable claim and (2) a plausible (...) hypothesis, serve to open up some important philosophical issues concerning interpretive backgrounds that are presupposed in the assessment of scientific hypotheses. More specifically, I argue that naturalism or scientific objectivism in its various forms is not simply a neutral or default methodological backdrop for empirical inquiry but involves acceptance of a specific ontology, which functions as an implicit and unargued constitutive commitment. Hence, these neurological studies can be employed as a lever with which to disclose something of the ways in which different frameworks of interpretation, both theistic and atheistic, serve differently to structure and give meaning to empirical findings. (shrink)
A new view of the functional role of the left anterior cortex in language use is proposed. The experimental record indicates that most human linguistic abilities are not localized in this region. In particular, most of syntax (long thought to be there) is not located in Broca's area and its vicinity (operculum, insula, and subjacent white matter). This cerebral region, implicated in Broca's aphasia, does have a role in syntactic processing, but a highly specific one: It is the neural home (...) to receptive mechanisms involved in the computation of the relation between transformationally moved phrasal constituents and their extraction sites (in line with the Trace-Deletion Hypothesis). It is also involved in the construction of higher parts of the syntactic tree in speech production. By contrast, basic combinatorial capacities necessary for language processing – for example, structure-building operations, lexical insertion – are not supported by the neural tissue of this cerebral region, nor is lexical or combinatorial semantics. The dense body of empirical evidence supporting this restrictive view comes mainly from several angles on lesion studies of syntax in agrammatic Broca's aphasia. Five empirical arguments are presented: experiments in sentence comprehension, cross-linguistic considerations (where aphasia findings from several language types are pooled and scrutinized comparatively), grammaticality and plausibility judgments, real-time processing of complex sentences, and rehabilitation. Also discussed are recent results from functional neuroimaging and from structured observations on speech production of Broca's aphasics. Syntactic abilities are nonetheless distinct from other cognitive skills and are represented entirely and exclusively in the left cerebral hemisphere. Although more widespread in the left hemisphere than previously thought, they are clearly distinct from other human combinatorial and intellectual abilities. The neurological record (based on functional imaging, split-brain and right-hemisphere-damaged patients, as well as patients suffering from a breakdown of mathematical skills) indicates that language is a distinct, modularly organized neurological entity. Combinatorial aspects of the language faculty reside in the human left cerebral hemisphere, but only the transformational component (or algorithms that implement it in use) is located in and around Broca's area. Key Words: agrammatism; aphasia; Broca's area; cerebral localization; dyscalculia; functional neuroanatomy; grammatical transformation; modularity; neuroimaging; syntax; trace deletion. (shrink)
The Brain and the Meaning of Life Paul Thagard Princeton: Princeton University Press, 2010 274 pages, ISBN: 9780691142722 (hbk): $29.95 This paper criticizes central arguments in Paul Thagard's The Brain and the Meaning of Life, concluding, contrary to Thagard, that there is very little that we can learn from brain research about the meaning of life. The paper offers a critical review of Thagard's argument against nihilism and his argument that it is love, work, and play, rather than other activities, (...) that make life meaningful. Moreover, the paper argues that the rich neurological information Thagard presents throughout the book does not contribute at all to his arguments and, more generally, that neurological research is irrelevant also to almost all other aspects of meaning of life research. (shrink)
It is often claimed, following Joseph Levine, that there is an ‘explanatory gap’ between ordinary physical facts and the way we perceive things, so that it is impossible to explain, among other things, why colours actually look the way they do. C.L. Hardin, by contrast, argues that there are sufficient asymmetries between colours to traverse this gap. This paper argues that the terms we use to characterize colours, such as ‘warm’ and ‘cool’, are not well understood, and that we need (...) to understand the neurological basis for such associations if we are even to understand what is fully meant by saying, for example, that red is a warm colour. This paper also speculates on how Hardin’s strategy can be generalized. A PowerPoint presentation that depicts inverted colour qualia is attached as an appendix. (shrink)
A broad range of evidence regarding the functional organization of the vertebrate brain – spanning from comparative neurology to experimental psychology and neurophysiology to clinical data – is reviewed for its bearing on conceptions of the neural organization of consciousness. A novel principle relating target selection, action selection, and motivation to one another, as a means to optimize integration for action in real time, is introduced. With its help, the principal macrosystems of the vertebrate brain can be seen to (...) form a centralized functional design in which an upper brain stem system organized for conscious function performs a penultimate step in action control. This upper brain stem system retained a key role throughout the evolutionary process by which an expanding forebrain – culminating in the cerebral cortex of mammals – came to serve as a medium for the elaboration of conscious contents. This highly conserved upper brainstem system, which extends from the roof of the midbrain to the basal diencephalon, integrates the massively parallel and distributed information capacity of the cerebral hemispheres into the limited-capacity, sequential mode of operation required for coherent behavior. It maintains special connective relations with cortical territories implicated in attentional and conscious functions, but is not rendered nonfunctional in the absence of cortical input. This helps explain the purposive, goal-directed behavior exhibited by mammals after experimental decortication, as well as the evidence that children born without a cortex are conscious. Taken together these circumstances suggest that brainstem mechanisms are integral to the constitution of the conscious state, and that an adequate account of neural mechanisms of conscious function cannot be confined to the thalamocortical complex alone. (Published Online May 1 2007) Key Words: action selection; anencephaly; central decision making; consciousness; control architectures; hydranencephaly; macrosystems; motivation; target selection; zona incerta. (shrink)
Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)
Sherwood Anderson's Winesburg, Ohio, published in 1919, is an episodic collection of character sketches based mostly around the perspective of George Willard, a small-town journalist who listens to the stories of various characters, often described in grotesque terms, whose passionate inner lives contrast with their limited outwardly lived existences. The initial critical response to these stories was to regard Anderson as a sort of cheap Freudian who was making an obvious criticism of American Puritanism and conformity. One reviewer, Regis Michaud, (...) wrote that Winesburg, Ohio was "entirely in keeping with the most recent contributions of American literature to psychoanalysis";1 another reviewer, H. W. Boynton .. (shrink)
Clinical neuroethics and neuroskepticism are recent entrants to the vocabulary of neuroethics. Clinical neuroethics has been used to distinguish problems of clinical relevance arising from developments in brain science from problems arising in neuroscience research proper. Neuroskepticism has been proposed as a counterweight to claims about the value and likely implications of developments in neuroscience. These two emergent streams of thought intersect within the practice of neurology. Neurologists face many traditional problems in bioethics, like end of life care in (...) the persistent vegetative state, determination of capacity in progressive dementia, and requests for assisted suicide in cognition-preserving neurodegenerative disease (like amyotrophic lateral sclerosis). Neurologists also look to be at the forefront of downstream clinical applications of neuroscience, like pharmacological enhancement of mental life. At the same time, the practice of neurology, concerned primarily with the structure, function, and treatment of the nervous system, has historically fostered a kind of skeptical attitude toward its own subject matter. Not all problems that appear primarily neurological are primarily neurological. This disciplinary skepticism is generally clinical in orientation and limited in scope. The rise of interest in clinical neuroethics and in neuroskepticsim generally suggests a possible broader application. The clinical skepticism of neurology provides impetus for thinking about the appropriate role for skepticism in clinical areas of neuroethics. After a brief review of neuroskepticism and clinical neuroethics, a taxonomy of clinical neuroskepticism is offered and reasons why a stronger rather than weaker form of clinical neuroskepticism is currently warranted. (shrink)
The mind cannot be an object. An object can be conceived only as that which may possibly become an object to something else. Now what can the mind become an object to? Not to me for I am it and not to something else. Not to something else without again being denuded of consciousness.And how could we descend into the depths of our nervous system to ascertain what is the nature of the psychical correlative of the physiological bottom? If we (...) could, we could only describe that correlative psychical in terms of object-consciousness, which would be a pseudo description of it.John Hughlings-Jackson.If Charles Scott Sherrington (1857-1952) was the most philosophically aware neurophysiologist of the late 19th to early 20th .. (shrink)
This commentary makes a case for a connection between the hierarchically organized skills emphasized in Greenfield's (1991t) target article and rhythmic skills utilized in music. It also links hierarchical organization with automated processing. Implicit is the notion that lower levels of a hierarchy become automatic, as they go under control of higher levels of organization.
Investigating the relative severity of emotion recognition deficit across different clinical and high-risk populations has potential implications not only for the prevention, diagnosis and treatment of these diseases, but also for our understanding of the neurobiological mechanisms of emotion perception itself. We reanalyzed data from 4 studies in which we examined facial expression and gender recognition using the same tasks and stimuli. We used a standardized and bias-corrected measure of effect size (Cohen’s D) to assess the extent of impairments in (...) frontotemporal dementia (FTD), Parkinson’s disease treated by L-DOPA (PD-ON) or not (PD-OFF), amnestic Mild Cognitive Impairment (aMCI), Alzheimer’s disease at mild dementia stage (AD), major depressive disorder (MDD), remitted schizophrenia (SCZ-rem), first-episode schizophrenia before (SCZ-OFF) and after (SCZ-ON) medication, as well as unaffected siblings of partients with schizophrenia (SIB). Analyses revealed a pattern of differential impairment of emotion (but not gender) recognition, consistent with the extent of impairment of the fronto-temporal neural networks involved in the processing of faces and facial expressions. Our transnosographic approach combining clinical and high-risk populations with the impact of medication brings new information on the trajectory of impaired emotion perception in neuropsychiatric conditions, and on the neural networks and neurotransmitter systems subserving emotion perception. (shrink)
Reports in the popular press suggest that smart drugs or “nootropics” such as methylphenidate, modafinil and piracetam are increasingly being used by the healthy to augment cognitive ability. Although current nootropics offer only modest improvements in cognitive performance, it appears likely that more effective compounds will be developed in the future and that their off-label use will increase. One sphere in which the use of these drugs may be commonplace is by healthy students within academia. This article reviews the ethical (...) and pragmatic implications of nootropic use in academia by drawing parallels with issues relevant to the drugs in sport debate. It is often argued that performance-enhancing drugs should be prohibited because they create an uneven playing field. However, this appears dubious given that “unfair” advantages are already ubiquitous and generally tolerated by society. There are concerns that widespread use will indirectly coerce non-users also to employ nootropics in order to remain competitive. However, to restrict the autonomy of all people for fear that it may influence the actions of some is untenable. The use of potentially harmful drugs for the purposes of enhancement rather than treatment is often seen as unjustified, and libertarian approaches generally champion the rights of the individual in deciding if these risks are acceptable. Finally, whether the prohibition of nootropics can be effectively enforced is doubtful. As nootropics use becomes widespread among students in the future, discussion of this issue will become more pressing in the years to come. (shrink)
Introduction: Neuropsychiatry has generally been regarded as a hybrid discipline that lies in the borderland between the disciplines of psychiatry and neurology. There is much debate on its current and future identity and status as a discipline. Materials and Methods: Taking a historical perspective, the future of neuropsychiatry is placed within the context of recent developments in clinical neuroscience. Results: The authors argue that with the maturation of the discipline, it must define its own identity that is not dependent (...) entirely upon the parent disciplines. The requirements for this are the claiming of neuropsychiatric territory, a strong training agenda, an emphasis on treatments that are uniquely neuropsychiatric, and a bold embrace of new developments in clinical neuroscience. Conclusion: The exponential growth in neuroscientific knowledge places neuropsychiatry in an excellent position to carve out a strong identity. It is imperative that the leaders of the discipline seize the moment. (shrink)
This paper considers the impact which developments in neuroscience seem likely to have on our inherited, intuitive psychology ? the system of beliefs called ?folk psychology? by enthusiasts for its elimination. The paper argues that while closer relations between a developing genuinely scientific cognitive psychology and a burgeoning neurological understanding are to be welcomed, physiology will not reduce psychology, and the concepts belonging to intuitive psychology will be transformed and enriched, but not discredited or discarded, when psychology, in its cognitive (...) form, emerges as a science with genuine explanatory power. The analogy between belief and desire, on one hand, and witches and phlogiston, on the other, is rejected. So is the parallel between folk psychology and folk physics. We face the choice, on Churchland's principles, between the rejection of historical, literary, and moral culture, and accepting a dualism in human thought which despairs of a comprehensively naturalistic vision of ourselves. (shrink)
Increased BOLD sensitivity at 7 T offers the possibility to increase the reliability of fMRI, but ultra-high field is also associated with an increase in artifacts related to head motion, Nyquist ghosting and parallel imaging reconstruction errors. In this study, the ability of Independent Component Analysis (ICA) to separate activation from these artifacts was assessed in a 7 T study of neurological patients performing chin and hand motor tasks. ICA was able to isolate primary motor activation with negligible contamination by (...) motion effects. The results of General Linear Model (GLM) analysis of these data were, in contrast, heavily contaminated by motion. Secondary motor areas, basal ganglia and thalamus involvement were apparent in ICA results, but there was low capability to isolate activation in the same brain regions in the GLM analysis, indicating that ICA was more sensitive as well as more specific. A method was developed to simplify the assessment of the large number of independent components. Task-related activation components could be automatically identified via intuitive and effective features. These findings demonstrate that ICA is a practical and sensitive analysis approach in high field fMRI studies, particularly where motion is evoked. Promising applications of ICA in clinical fMRI include presurgical planning and the study of pathologies affecting subcortical brain areas. (shrink)