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January 10, 2011

Rethinking the thinking cap
Ethics of neural enhancement using noninvasive brain stimulation

January 11, 2011 issue
76 (2) 187-193

Abstract

Although a growing body of evidence suggests that noninvasive brain stimulation techniques such as transcranial magnetic stimulation and transcranial direct current stimulation have the capacity to enhance neural function in both brain-injured and neurally intact individuals, the implications of their potential use for cosmetic self-enhancement have not been fully explored. We review 3 areas in which noninvasive brain stimulation has the potential to enhance neurologic function: cognitive skills, mood, and social cognition. We then characterize the ethical problems that affect the practice of cosmetic neurology, including safety, character, justice, and autonomy, and discuss how these problems may apply to the use of noninvasive brain stimulation for self-enhancement.

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REFERENCES

1.
Chatterjee A. Cosmetic neurology: the controversy over enhancing movement, mentation and mood. Neurology 2004;63:968–974.
2.
Chatterjee A. The promise and predicament of cosmetic neurology. J Med Ethics 2006;32:110–113.
3.
Snyder AW, Mulcahy E, Taylor JL, Mitchell DJ, Sachdev P, Gandevia SC. Savant-like skills exposed in normal people by suppressing the left fronto-temporal lobe. J Integr Neurosci 2003;2:149–158.
4.
Hanuain D. Thinking cap or dunce's hat? Wired April 18, 2002.
5.
Maeda F, Pascual-Leone A. Transcranial magnetic stimulation: studying motor neurophysiology of psychiatric disorders. Psychopharmacology 2003;168:359–376.
6.
Priori A. Brain polarization in humans: a reappraisal of an old tool for prolonged non-invasive modulation of brain excitability. Clin Neurophysiol 2003;114:589–595.
7.
Nistche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol 2000;572:633–639.
8.
George MS, Aston-Jones G. Noninvasive techniques for probing neurocircuitry and treating illness: vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Neuropsychopharmacology 2010;35:301–316.
9.
Ohn SH, Park CI, Yoo WK. Time-dependent effect of transcranial direct current stimulation on the enhancement of working memory. Neuroreport 2008;19:43–47.
10.
Fregni F, Boggio PS, Nitsche M. Anodal transcranial direct current stimulation of prefrontal cortex enhances working memory. Exp Brain Res 2005;166:23–30.
11.
Kim YH, Park JW, Ko MH, Jang SH, Lee PK. Facilitative effect of high frequency subthreshold repetitive transcranial magnetic stimulation on complex sequential motor learning in humans. Neurosci Lett 2004;367:181–185.
12.
Nitsche MA, Schauenburg A, Lang N, et al. Facilitation of implicit motor learning by weak transcranial direct current stimulation of the primary motor cortex in the human. J Cogn Neurosci 2003;15:619–626.
13.
Kobayashi M, Hutchinson S, Théoret H, Schlaug G, Pascual-Leone A. Repetitive TMS of the motor cortex improves ipsilateral sequential simple finger movements. Neurology 2004;62:91–98.
14.
Flöel A, Rösser N, Michka O, Knecht S, Breitenstein C. Noninvasive brain stimulation improves language learning. J Cogn Neurosci 2008;20:1415–1422.
15.
de Vries MH, Barth AC, Maiworm S, Knecht S, Zwisterlood P, Flöel A. Electrical stimulation of Broca's area enhances implicit learning of an artificial grammar. J Cogn Neurosci Epub 2009 Nov 19.
16.
Mottaghy FM, Hungs M, Brügmann M, et al. Facilitation of picture naming after repetitive transcranial magnetic stimulation. Neurology 1999;53:1806–1812.
17.
Sparing R, Dafotakis M, Meister IG, Thirugnanasambandam N, Fink GR. Enhancing language performance with non-invasive brain stimulation: a transcranial direct current stimulation study in healthy humans. Neuropsychologia 2008;46:261–268.
18.
Iyer MB, Mattu U, Grafman J, Lomarev M, Sato S, Wassermann EM. Safety and cognitive effect of frontal DC brain polarization in healthy individuals. Neurology 2005;64:872–875.
19.
Cerruti C, Schlaug G. Anodal transcranial direct current stimulation of the prefrontal cortex enhances complex verbal associative thought. J Cogn Neurosci 2009;21:1980–1987.
20.
Hilgetag CC, Théoret H, Pascual-Leone A. Enhanced visual spatial attention ipsilateral to rTMS-induced ‘virtual lesions' of human parietal cortex. Nat Neurosci 2001;4:953–957.
21.
Snyder AW. Explaining and inducing savant skills: privileged access to lower level, less-processed information. Philos Trans R Soc Lond B Biol Sci 2009;364:1399–1405.
22.
Gallate J, Chi R, Ellwood S, Snyder AW. Reducing false memories by magnetic pulse stimulation. Neurosci Lett 2009;449:151–154.
23.
Oliveri M, Romero L, Papagno C. Left but not right temporal involvement in opaque idiom comprehension: a repetitive transcranial magnetic stimulation study. J Cogn Neurosci 2004;16:848–855.
24.
Pascual-Leone A, Catalá MD. Lateralized effect of rapid-rate transcranial magnetic stimulation of the prefrontal cortex on mood. Neurology 1996;46:499–502.
25.
George MS, Nahas Z, Molloy M, et al. A controlled trial of daily left prefrontal cortex TMS for treating depression. Biol Psychiatry 2000;48:962–970.
26.
Kim DR, Pesiridou A, O'Reardon JP. Transcranial magnetic stimulation in the treatment of psychiatric disorders. Curr Psychiatry Rep 2009;11:447–452.
27.
Boggio PS, Rigonatti SP, Ribeiro RB. A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Int J Neuropsychopharmacol 2008;11:249–254.
28.
Nistche MA, Boggio PS, Fregni F, Pascual-Leone A. Treatment of depression with transcranial direct current stimulation (tDCS): a review. Exp Neurol 2009;219:14–19.
29.
Maeda F, Keenan JP, Pascual-Leone A. Interhemispheric asymmetry of motor cortical excitability in major depression as measured by transcranial magnetic stimulation. Br J Psychiatry 2000;177:169–173.
30.
Mayberg HS. Frontal lobe dysfunction in secondary depression. J Neuropsychiatry Clin Neurosci 1994;6:428–442.
31.
Pascual-Leone A, Rubio B, Pallardó F, Catalá MD. Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression. Lancet 1996;348:233–237.
32.
George MS, Wassermann EM, Williams WA. Changes in mood and hormone levels after rapid-rate transcranial magnetic stimulation (rTMS) of the prefrontal cortex. J Neuropsychiatry Clin Neurosci 1996;8:172–180.
33.
Koenigs M, Ukueberuwa D, Campion P, Grafman J, Wassermann E. Bilateral frontal transcranial direct current stimulation: Failure to replicate classic findings in healthy subjects. Clin Neurophysiol 2009;120:80–84.
34.
Nitsche MA, Fricke K, Henschke U, et al. Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans. J Physiol 2003;553:293–301.
35.
Nitsche MA, Kuo MF, Karrasch R, Wächter B, Liebetanz D, Paulus W. Serotonin affects transcranial direct current-induced neuroplasticity in humans. Biol Psychiatry 2009;66:503–508.
36.
Young L, Camprodon JA, Hauser M, Pascual-Leone A, Saxe R. Disruption of the right temporoparietal junction with transcranial magnetic stimulation reduces the role of beliefs in moral judgements. Proc Natl Acad Sci USA 2010;107:6753–6758.
37.
Knoch D, Pascual-Leone A, Meyer K, Treyer V, Fehr E. Diminishing reciprocal fairness by disrupting the right prefrontal cortex. Science 2006;314:829–832.
38.
Fecteau S, Knoch D, Fregni F, Sultani N, Boggio P, Pascual-Leone A. Diminishing risk-taking behavior by modulating activity in the prefrontal cortex: a direct current stimulation study. J Neurosci 2007;27:12500–12505.
39.
Lo YL, Fook-Chong S, Tan EK. Increased cortical excitability in human deception. Neuroreport 2003;14:1021–1024.
40.
Priori A, Mameli F, Caogiamanian F, et al. Lie-specific involvement of dorsolateral prefrontal cortex in deception. Cereb Cortex 2008;18:451–455.
41.
Luber B, Fisher C, Appelbaum PS, Ploesser M, Lisanby SH. Non-invasive brain stimulation in the detection of deception: scientific challenges and ethical consequences. Behav Sci Law 2009;27:191–208.
42.
Buchanan A. Enhancement and the ethics of development. Kennedy Inst Ethics J 2008;18:1–34.
43.
Wassermann EM. 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. Electroencephalogr Clin Neurophysiol 1998;108:1–16.
44.
Been G, Ngo TT, Miller SM, Fitzgeral PD. The use of tDCS and CVS as methods of non-invasive brain stimulation. Brain Res Rev 2007;56:346–361.
45.
Schonfeld T. Parents of unhappy poets: fiduciary responsibility and genetic enhancements. Camb Q Healthc Ethics 2003;12:411–417.
46.
Keenan J, Gallup GG, Falk D. The Face in the Mirror: The Search for the Origins of Consciousness, 1st ed. New York: HarperCollins; 2003.
47.
Riis J, Simmons J, Goodwin G. Preferences for enhancement pharmaceuticals: the reluctance to enhance fundamental traits. J Consum Res 2008;35:495–508.
48.
Farah MJ, Illes J, Cook-Deegan R, et al. Neurocognitive enhancement: what can we do and what should we do? Nat Rev Neurosci 2004;5:421–425.
49.
Sandel MJ. The case against perfection: what's wrong with designer children, bionic athletes, and genetic engineering. Atl Mon 2004;292:50–54, 56 – 60, 62.
50.
Chatterjee A. “Cosmetic neurology” and the problem of pain. Cerebrum July 30, 2007.
51.
Ochsner KN, Zaki J, Hanelin J, et al. Your pain or mine? Common and distinct neural systems supporting the perception of pain in self and other. Soc Cogn Affect Neurosci 2008;3:144–160.
52.
Kramer PD. Listening to Prozac: The Landmark Book About Antidepressants and the Remaking of the Self, Revised Edition. New York: Penguin Group; 1997.
53.
Conrad P. Medicalization of Society: On the Transformation of Human Condition into Treatable Disorders. Baltimore: Johns Hopkins University Press; 2007.
54.
Scott CL, Holmberg T. Castration of sex offenders: prisoners' rights versus public safety. J Am Acad Psychiatry Law 2003;31:502–509.
55.
McCabe SE, Knight JR, Teter CJ, Wechsler H. Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction 2005;100:96–106.
56.
Sahakian B, Morein-Zamir S. Professor's little helper. Nature 2007;450:1157–1159.
57.
Chatterjee A. Cosmetic neurology and cosmetic surgery: parallels, predictions and challenges. Camb Q Healthc Ethics 2007;16:129–137.
58.
Illes J, Bird SJ. Neuroethics: a modern context for ethics in neuroscience. Trends Neurosci 2006;29:511–517.

Information & Authors

Information

Published In

Neurology®
Volume 76Number 2January 11, 2011
Pages: 187-193
PubMed: 21220723

Publication History

Received: May 26, 2010
Accepted: August 30, 2010
Published online: January 10, 2011
Published in print: January 11, 2011

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Disclosure

Dr. Hamilton receives research support from the NIH/NINDS (1K01NS060995 [PI]) and the Robert Wood Johnson Foundation/Harold Amos Faculty Development Program. S. Messing holds stock in Medical Information Technology Inc. Dr. Chatterjee serves as an Associate Editor for the Journal of Cognitive Neuroscience and receives research support from the NIH (RO1 DC004817 [PI] and RO1 DC008779 [PI]) and the National Science Foundation.

Authors

Affiliations & Disclosures

Roy Hamilton, MD, MS
From the Department of Neurology (R.H., A.C.), Center for Cognitive Neuroscience (R.H., S.M., A.C.), and Laboratory for Cognition and Neural Stimulation (R.H., S.M.), University of Pennsylvania, Philadelphia.
Samuel Messing, BA
From the Department of Neurology (R.H., A.C.), Center for Cognitive Neuroscience (R.H., S.M., A.C.), and Laboratory for Cognition and Neural Stimulation (R.H., S.M.), University of Pennsylvania, Philadelphia.
Anjan Chatterjee, MD
From the Department of Neurology (R.H., A.C.), Center for Cognitive Neuroscience (R.H., S.M., A.C.), and Laboratory for Cognition and Neural Stimulation (R.H., S.M.), University of Pennsylvania, Philadelphia.

Notes

Address correspondence and reprint requests to Dr. Roy H. Hamilton, 3 Gates Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 [email protected]

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