Neurotechnology

{{Main|Deep brain stimulation}}

Deep brain stimulation is currently used in patients with movement disorders to improve the quality of life in patients.

Transcrancial ultrasound stimulation (TUS) is a technique using ultrasound to modulate neural activity in the brain. It is an emerging technique that has shown therapeutic promise in a variety of neurological diseases. {{Cite web|title=TUS|url=https://www.biomedcentral.com/collections/transcranial-ultrasound-stimulation|website=BiomedCentral|language=en}}

{{Main|Transcranial magnetic stimulation|Pulsed electromagnetic field therapy}}

Transcranial magnetic stimulation (TMS) is a technique for applying magnetic fields to the brain to manipulate electrical activity at specific loci in the brain.{{cite journal | vauthors = Wassermann EM | title = Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996 | journal = Electroencephalography and Clinical Neurophysiology | volume = 108 | issue = 1 | pages = 1–16 | date = January 1998 | pmid = 9474057 | doi = 10.1016/S0168-5597(97)00096-8 | url = https://zenodo.org/record/1259909 }} This field of study is currently receiving a large amount of attention due to the potential benefits that could come out of better understanding this technology.{{cite journal | vauthors = Illes J, Gallo M, Kirschen MP | title = An ethics perspective on transcranial magnetic stimulation (TMS) and human neuromodulation | journal = Behavioural Neurology | volume = 17 | issue = 3–4 | pages = 149–57 | year = 2006 | pmid = 17148834 | pmc = 5471539 | doi = 10.1155/2006/791072 | doi-access = free }} Transcranial magnetic movement of particles in the brain shows promise for drug targeting and delivery as studies have demonstrated this to be noninvasive on brain physiology.{{cite journal | vauthors = Ramaswamy B, Kulkarni SD, Villar PS, Smith RS, Eberly C, Araneda RC, Depireux DA, Shapiro B | display-authors = 6 | title = Movement of magnetic nanoparticles in brain tissue: mechanisms and impact on normal neuronal function | journal = Nanomedicine | volume = 11 | issue = 7 | pages = 1821–9 | date = October 2015 | pmid = 26115639 | pmc = 4586396 | doi = 10.1016/j.nano.2015.06.003 }}

Transcranial magnetic stimulation is a relatively new method of studying how the brain functions and is used in many research labs focused on behavioral disorders, epilepsy, PTSD, migraine, hallucinations, and other disorders. Currently, repetitive transcranial magnetic stimulation is being researched to see if positive behavioral effects of TMS can be made more permanent. Some techniques combine TMS and another scanning method such as EEG to get additional information about brain activity such as cortical response.{{cite journal | vauthors = Veniero D, Bortoletto M, Miniussi C | title = TMS-EEG co-registration: on TMS-induced artifact | journal = Clinical Neurophysiology | volume = 120 | issue = 7 | pages = 1392–9 | date = July 2009 | pmid = 19535291 | doi = 10.1016/j.clinph.2009.04.023 | hdl-access = free | s2cid = 4496573 | hdl = 11572/145615 }}

{{Main|Transcranial direct current stimulation}}

Transcranial direct current stimulation (TDCS) is a form of neurostimulation which uses constant, low current delivered via electrodes placed on the scalp. The mechanisms underlying TDCS effects are still incompletely understood, but recent advances in neurotechnology allowing for in vivo assessment of brain electric activity during TDCS{{cite journal | vauthors = Soekadar SR, Witkowski M, Cossio EG, Birbaumer N, Robinson SE, Cohen LG | title = In vivo assessment of human brain oscillations during application of transcranial electric currents | journal = Nature Communications | volume = 4 | pages = 2032 | year = 2013 | pmid = 23787780 | pmc = 4892116 | doi = 10.1038/ncomms3032 | bibcode = 2013NatCo...4.2032S }} promise to advance understanding of these mechanisms. Research into using TDCS on healthy adults have demonstrated that TDCS can increase cognitive performance on a variety of tasks, depending on the area of the brain being stimulated. TDCS has been used to enhance language and mathematical ability (though one form of TDCS was also found to inhibit math learning),{{cite journal | vauthors = Grabner RH, Rütsche B, Ruff CC, Hauser TU | title = Transcranial direct current stimulation of the posterior parietal cortex modulates arithmetic learning | journal = The European Journal of Neuroscience | volume = 42 | issue = 1 | pages = 1667–74 | date = July 2015 | pmid = 25970697 | doi = 10.1111/ejn.12947 | url = https://www.zora.uzh.ch/id/eprint/113360/1/Grabner_EJN_2015.pdf | quote = Cathodal tDCS (compared with sham) decreased learning rates during training and resulted in poorer performance which lasted over 24 h after stimulation. Anodal tDCS showed an operation-specific improvement for subtraction learning. | s2cid = 37724278 }} attention span, problem solving, memory,{{cite journal | vauthors = Gray SJ, Brookshire G, Casasanto D, Gallo DA | title = Electrically stimulating prefrontal cortex at retrieval improves recollection accuracy | journal = Cortex; A Journal Devoted to the Study of the Nervous System and Behavior | volume = 73 | pages = 188–94 | date = December 2015 | pmid = 26457823 | doi = 10.1016/j.cortex.2015.09.003 | quote = We found that stimulation of dlPFC significantly increased recollection accuracy, relative to a no-stimulation sham condition and also relative to active stimulation of a comparison region in left parietal cortex. | s2cid = 19886903 }} coordination and relieve depression {{cite journal | vauthors = Nitsche MA, Boggio PS, Fregni F, Pascual-Leone A | title = Treatment of depression with transcranial direct current stimulation (tDCS): a review | journal = Exp Neurol | year = 2009 | volume = 219 | issue = 1 | pages = 14–19 | pmid = 19348793| doi = 10.1016/j.expneurol.2009.03.038 | s2cid = 695276 }}{{cite journal | vauthors = Brunoni AR, Moffa AH, Fregni F, Palm U, Padberg F, Blumberger DM, Daskalakis ZJ, Bennabi D, Haffen E, Alonzo A, Loo CK | title = Transcranial direct current stimulation for acute major depressive episodes: meta-analysis of individual patient data | journal = Br J Psychiatry | year = 2016 | volume = 208 | issue = 6 | pages = 522–531 | pmid = 27056623 | doi = 10.1192/bjp.bp.115.164715 | pmc = 4887722 }}{{cite journal | vauthors = Tecchio F, Bertoli M, Gianni E, L'Abbate T, Sbragia E, Stara S, Inglese M| title = Parietal dysfunctional connectivity in depression in multiple sclerosis | journal = Mult Scler | year = 2020 | volume = 27 | issue = 9 | pages = 1468–1469 | pmid = 33084529 | doi = 10.1177/1352458520964412 | s2cid = 224829189 }} and chronic fatigue.{{cite journal | vauthors = Gianni E, Bertoli M, Simonelli I, Paulon L, Tecchio F, Pasqualetti P | title = tDCS randomized controlled trials in no-structural diseases: a quantitative review | journal = Scientific Reports | year = 2021 | volume = 11 | issue = 1 | page = 16311 | pmid = 34381076| doi = 10.1038/s41598-021-95084-6 | pmc = 8357949 | bibcode = 2021NatSR..1116311G | hdl = 11573/1575485 | hdl-access = free }}{{cite journal | vauthors = Tecchio F, Cancelli A, Pizzichino A, L'Abbate T, Gianni E, Bertoli M, Paulon L, Zannino S, Giordani A, Lupoi D, Pasqualetti P, Mirabella M, Filippi MM| title = Home treatment against fatigue in multiple sclerosis by a personalized, bilateral whole-body somatosensory cortex stimulation | journal = Mult Scler Relat Disord | year = 2022 | volume = 63 | page = 103813 | pmid = 35597081 | doi = 10.1016/j.msard.2022.103813 | s2cid = 248967047 }}

Electroencephalography (EEG) is a method of measuring brainwave activity non-invasively. A number of electrodes are placed around the head and scalp and electrical signals are measured.{{cite book | vauthors = Purves D |title=Neuroscience, Fourth Edition |publisher=Sinauer Associates, Inc. |year=2007 |isbn=978-0-87893-697-7 |page=715}} Clinically, EEGs are used to study epilepsy as well as stroke and tumor presence in the brain. Electrocorticography (ECoG) relies on similar principles but requires invasive implantation of electrodes on the brain's surface to measure local field potentials or action potentials more sensitively.

Magnetoencephalography (MEG) is another method of measuring activity in the brain by measuring the magnetic fields that arise from electrical currents in the brain.{{cite web | vauthors = Hämäläinen M |date=November 2007 |title=Magnetoencephalography (MEG) |publisher=Athinoula A. Martinos Center for Biomedical Imaging |url=http://www.nmr.mgh.harvard.edu/martinos/research/technologiesMEG}} The benefit to using MEG instead of EEG is that these fields are highly localized and give rise to better understanding of how specific loci react to stimulation or if these regions over-activate (as in epileptic seizures).

There are potential uses for EEG and MEG such as charting rehabilitation and improvement after trauma as well as testing neural conductivity in specific regions of epileptics or patients with personality disorders. EEG has been fundamental in understanding the resting brain during sleep. Real-time EEG has been considered for use in lie detection.{{cite journal | vauthors = Farwell LA, Smith SS | title = Using brain MERMER testing to detect knowledge despite efforts to conceal | journal = Journal of Forensic Sciences | volume = 46 | issue = 1 | pages = 135–43 | date = January 2001 | pmid = 11210899 | doi = 10.1520/JFS14925J | s2cid = 45516709 }}

Similarly, real-time fMRI is being researched as a method for pain therapy by altering how people perceive pain if they are made aware of how their brain is functioning while in pain. By providing direct and understandable feedback, researchers can help patients with chronic pain decrease their symptoms.{{cite journal |author1-link=Christopher deCharms

|author3-link=Gary H. Glover | vauthors = deCharms RC, Maeda F, Glover GH, Ludlow D, Pauly JM, Soneji D, Gabrieli JD, Mackey SC | display-authors = 6 | title = Control over brain activation and pain learned by using real-time functional MRI | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 102 | issue = 51 | pages = 18626–31 | date = December 2005 | pmid = 16352728 | pmc = 1311906 | doi = 10.1073/pnas.0505210102 | doi-access = free | bibcode = 2005PNAS..10218626D }}

{{Main|Brain–computer interface|Surface chemistry of neural implants|Neuroprosthetics}}

Neurotechnological implants can be used to record and utilize brain activity to control other devices which provide feedback to the user or replace missing biological functions.{{cite journal | vauthors = Hochberg LR, Serruya MD, Friehs GM, Mukand JA, Saleh M, Caplan AH, Branner A, Chen D, Penn RD, Donoghue JP | display-authors = 6 | title = Neuronal ensemble control of prosthetic devices by a human with tetraplegia | journal = Nature | volume = 442 | issue = 7099 | pages = 164–71 | date = July 2006 | pmid = 16838014 | doi = 10.1038/nature04970 | s2cid = 4347367 | bibcode = 2006Natur.442..164H }} The most common neurodevices available for clinical use are deep brain stimulators implanted in the subthalamic nucleus for patients with Parkinson's disease.{{cite journal | vauthors = Gross RE | title = What happened to posteroventral pallidotomy for Parkinson's disease and dystonia? | journal = Neurotherapeutics | volume = 5 | issue = 2 | pages = 281–93 | date = April 2008 | pmid = 18394570 | pmc = 5084170 | doi = 10.1016/j.nurt.2008.02.001 }}

{{Main|Neuropsychopharmacology}}

Pharmaceuticals play a vital role in maintaining stable brain chemistry, and are the most commonly used neurotechnology by the general public and medicine. Drugs like sertraline, methylphenidate, and zolpidem act as chemical modulators in the brain, and they allow for normal activity in many people whose brains cannot act normally under physiological conditions. While pharmaceuticals are usually not mentioned and have their own field, the role of pharmaceuticals is perhaps the most far-reaching and commonplace in modern society. Movement of magnetic particles to targeted brain regions for drug delivery is an emerging field of study and causes no detectable circuit damage.

{{See also|Neuroethics|Brain implant#Concerns and ethical considerations}}

Like other disruptive innovations, neurotechnologies have the potential for profound social and legal repercussions, and as such their development and introduction to society raise a series of ethical questions.{{Cite news| vauthors = Al-Rodhan N |date=27 May 2021|title=The Rise of Neurotechnology Calls for a Parallel Focus on Neurorights|work=Scientific American|url=https://www.scientificamerican.com/article/the-rise-of-neurotechnology-calls-for-a-parallel-focus-on-neurorights/|access-date=25 Oct 2021}}{{cite journal | vauthors = Bublitz C, Wolkenstein A, Jox RJ, Friedrich O | title = Legal liabilities of BCI-users: Responsibility gaps at the intersection of mind and machine? | journal = International Journal of Law and Psychiatry | volume = 65 | pages = 101399 | date = 2019-07-01 | pmid = 30449603 | doi = 10.1016/j.ijlp.2018.10.002 | url = https://www.sciencedirect.com/science/article/pii/S0160252718300852 | series = Neuroscience, Law, and Ethics | s2cid = 53950001 | url-access = subscription }}

Key concerns include the preservation of identity, agency, cognitive liberty and privacy as neurorights. While experts agree that these core features of the human experience stand to benefit from the ethical use of neurotechnology, they also make a point of emphasizing the importance of preventively establishing specific regulatory frameworks and other mechanisms that protect against inappropriate or unauthorized uses.{{cite journal | vauthors = Yuste R, Goering S, Arcas BA, Bi G, Carmena JM, Carter A, Fins JJ, Friesen P, Gallant J, Huggins JE, Illes J, Kellmeyer P, Klein E, Marblestone A, Mitchell C, Parens E, Pham M, Rubel A, Sadato N, Sullivan LS, Teicher M, Wasserman D, Wexler A, Whittaker M, Wolpaw J | display-authors = 6 | title = Four ethical priorities for neurotechnologies and AI | journal = Nature | volume = 551 | issue = 7679 | pages = 159–163 | date = November 2017 | pmid = 29120438 | pmc = 8021272 | doi = 10.1038/551159a | bibcode = 2017Natur.551..159Y }}

Identity in this context refers to personal continuity, described as bodily and mental integrity and their persistence over time. In other words, it is the individual's self-narrative and concept of self.

While disruption of identity is not a common goal for neurotechnologies, some techniques can create unwanted shifts that range in severity. For instance, deep brain stimulation is commonly used as treatment for Parkinson's disease but can have side effects that touch on the concept of identity, such as loss of voice modulation, increased impulsivity or feelings of self-estrangement.{{cite journal | vauthors = Pham U, Solbakk AK, Skogseid IM, Toft M, Pripp AH, Konglund AE, Andersson S, Haraldsen IR, Aarsland D, Dietrichs E, Malt UF | display-authors = 6 | title = Personality changes after deep brain stimulation in Parkinson's disease | journal = Parkinson's Disease | volume = 2015 | pages = 490507 | date = 2015-01-29 | pmid = 25705545 | pmc = 4325225 | doi = 10.1155/2015/490507 | doi-access = free }}{{cite journal | vauthors = Pugh J, Maslen H, Savulescu J | title = Deep Brain Stimulation, Authenticity and Value | journal = Cambridge Quarterly of Healthcare Ethics | volume = 26 | issue = 4 | pages = 640–657 | date = October 2017 | pmid = 28937346 | pmc = 5658726 | doi = 10.1017/S0963180117000147 }}{{Cite journal| vauthors = Gilbert F, Goddard E, Viaña JN, Carter A, Horne M |date=2017-04-03|title=I Miss Being Me: Phenomenological Effects of Deep Brain Stimulation |journal=AJOB Neuroscience|volume=8|issue=2|pages=96–109|doi=10.1080/21507740.2017.1320319|s2cid=55652038|issn=2150-7740|doi-access=free}} In the case of neural prostheses and brain-computer interfaces, the shift may take the form of an extension of one's sense of self, potentially incorporating the device as an integral part of oneself or expanding the range of sensory and cognitive channels available to the user beyond the traditional senses.{{cite journal | vauthors = Hildt E | title = Multi-Person Brain-To-Brain Interfaces: Ethical Issues | journal = Frontiers in Neuroscience | volume = 13 | pages = 1177 | date = 5 Nov 2019 | pmid = 31827418 | pmc = 6849447 | doi = 10.3389/fnins.2019.01177 | doi-access = free }}

Part of the difficulty in determining which changes constitute a threat to identity is rooted in its dynamic nature: since one's personality and concept of self is expected to change with time as a result of emotional development and lived experience, it is not easy to identify clear criteria and draw a line between acceptable shifts and problematic changes.{{cite journal | vauthors = Baylis F | title = "I Am Who I Am": On the Perceived Threats to Personal Identity from Deep Brain Stimulation | journal = Neuroethics | volume = 6 | issue = 3 | pages = 513–526 | date = 2013-12-01 | pmid = 24273621 | pmc = 3825414 | doi = 10.1007/s12152-011-9137-1 }} This becomes even harder when dealing with neurotechnologies aimed at influencing psychological processes—such as those designed to recude the symptoms of depression or post-traumatic stress disorder (PTSD) by modulating emotional states or saliency of memories to ease a patient's pain.{{cite journal | vauthors = Steinert S, Friedrich O | title = Wired Emotions: Ethical Issues of Affective Brain-Computer Interfaces | journal = Science and Engineering Ethics | volume = 26 | issue = 1 | pages = 351–367 | date = February 2020 | pmid = 30868377 | pmc = 6978299 | doi = 10.1007/s11948-019-00087-2 }}{{cite journal | vauthors = Bassil KC, Rutten BP, Horstkötter D | title = Biomarkers for PTSD Susceptibility and Resilience, Ethical Issues | journal = AJOB Neuroscience | volume = 10 | issue = 3 | pages = 122–124 | date = 2019-07-03 | pmid = 31361197 | doi = 10.1080/21507740.2019.1632964 | s2cid = 198982833 | url = https://cris.maastrichtuniversity.nl/en/publications/789df5c5-dfda-44be-b7cb-12fb371e4742 }} Even helping a patient remember, which would seemingly help preserve identity, can be a delicate question: "Forgetting is also important to how a person navigates the world, since it allows the opportunity for both losing track of embarrassing or difficult memories, and focusing on future-oriented activity. Efforts to enhance identity through memory preservation thus run the risk of inadvertently damaging a valuable, if less consciously-driven cognitive process."

Although the nuances of its definition are debated in philosophy and sociology,{{Cite book| vauthors = Wilson G, Shpall S |title=The Stanford Encyclopedia of Philosophy|publisher=Metaphysics Research Lab, Stanford University|year=2016| veditors = Zalta EN |edition=Winter 2016|chapter=Action|chapter-url= https://plato.stanford.edu/archives/win2016/entries/action/}} agency is commonly understood as the individual's ability to consciously make and communicate a decision or choice. While identity and agency are distinct, an impairment in agency can in turn undermine personal identity: the subject may no longer be able to substantially modify their own self-narrative, and may therefore lose their ability to contribute to the dynamic process of identity formation.

The interplay between agency and neurotechnology can have implications for moral responsibility and legal liability.{{Cite journal| vauthors = Haselager P |date=2013-08-01|title=Did I Do That? Brain–Computer Interfacing and the Sense of Agency|journal=Minds and Machines|language=en|volume=23|issue=3|pages=405–418|doi=10.1007/s11023-012-9298-7|s2cid=7199782|issn=1572-8641|hdl=2066/116450|hdl-access=free}} As with identity, devices aimed at treating some psychiatric conditions like depression or anorexia may work by modulating neural function linked with desire or motivation, potentially compromising the user's agency.{{Cite journal| vauthors = Goering S, Klein E, Dougherty DD, Widge AS |date=2017-04-03|title=Staying in the Loop: Relational Agency and Identity in Next-Generation DBS for Psychiatry |journal=AJOB Neuroscience|volume=8|issue=2|pages=59–70|doi=10.1080/21507740.2017.1320320|s2cid=6176406|issn=2150-7740}} This can also be the case, paradoxically, for those neurotechnologies designed to restore agency to patients, such as neural prostheses and BCI-mediated assistive technology like wheelchairs or computer accessibility tools.{{cite journal | vauthors = Sellers EW, Vaughan TM, Wolpaw JR | title = A brain-computer interface for long-term independent home use | journal = Amyotrophic Lateral Sclerosis | volume = 11 | issue = 5 | pages = 449–55 | date = October 2010 | pmid = 20583947 | doi = 10.3109/17482961003777470 | s2cid = 4713118 }}{{cite journal | vauthors = Ajiboye AB, Willett FR, Young DR, Memberg WD, Murphy BA, Miller JP, Walter BL, Sweet JA, Hoyen HA, Keith MW, Peckham PH, Simeral JD, Donoghue JP, Hochberg LR, Kirsch RF | display-authors = 6 | title = Restoration of reaching and grasping movements through brain-controlled muscle stimulation in a person with tetraplegia: a proof-of-concept demonstration | journal = Lancet | volume = 389 | issue = 10081 | pages = 1821–1830 | date = May 2017 | pmid = 28363483 | pmc = 5516547 | doi = 10.1016/s0140-6736(17)30601-3}} Because these devices often operate by interpreting sensory inputs or the user's neural data in order to estimate the individual's intention and respond according to it, estimation margins can lead to inaccurate or undesired responses that may threaten agency: "If the agent's intent and the device's output can come apart (think of how the auto-correct function in texting sometimes misinterprets the user's intent and sends problematic text messages), the user's sense of agency may be undermined."

Finally, when these technologies are being developed society must understand that these neurotechnologies could reveal the one thing that people can always keep secret: what they are thinking. While there are large amounts of benefits associated with these technologies, it is necessary for scientists, citizens and policy makers alike to consider implications for privacy.{{cite journal | vauthors = Wolpe PR, Foster KR, Langleben DD | title = Emerging neurotechnologies for lie-detection: promises and perils | journal = The American Journal of Bioethics | volume = 5 | issue = 2 | pages = 39–49 | year = 2005 | pmid = 16036700 | doi = 10.1080/15265160590923367 | url = https://repository.upenn.edu/cgi/viewcontent.cgi?article=1005&context=neuroethics_pubs | s2cid = 219640810 }} This term is important in many ethical circles concerned with the state and goals of progress in the field of neurotechnology (see neuroethics). Current improvements such as "brain fingerprinting" or lie detection using EEG or fMRI could give rise to a set fixture of loci/emotional relationships in the brain, although these technologies are still years away from full application. It is important to consider how all these neurotechnologies might affect the future of society, and it is suggested that political, scientific, and civil debates are heard about the implementation of these newer technologies that potentially offer a new wealth of once-private information. Some ethicists are also concerned with the use of TMS and fear that the technique could be used to alter patients in ways that are undesired by the patient.

Cognitive liberty refers to a suggested right to self-determination of individuals to control their own mental processes, cognition, and consciousness including by the use of various neurotechnologies and psychoactive substances. This perceived right is relevant for reformation and development of associated laws.

• Biotechnology
• Neural engineering
• Neuroimaging
• Neuromodulation
• Neuroscience
• Neurostimulation
• Neurotherapy

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