Now in print, a paper with @hegdenothedge & Vikram Rao @UCSFepilepsy on closed-loop neurotechnology, a new paradigm for neuropsychiatric treatment. We examine current experience with such devices in epilepsy & implications for other conditions. 1/8 https://doi.org/10.1212/WNL.0000000000011834

“Closed-loop” metaphor refers to device’s ability to sense (purple →) brain activity & deliver targeted stimulation (blue →) in response, unlike prevailing DBS that is preprogrammed without a neural control signal. A major research focus of #BRAINInitiative @NIH & globally.

A computer that monitors & modulates your brain sounds like sci-fi (or a Neuralink demo), but this has been used in US for years to detect and stop seizures. Real-world experience indicates new clinical/ethical challenges to consider, especially as new applications are developed:

1. Electroclinical Correlation. The device stores an “objective record” of patient’s illness, which may not match with patient’s experience. May alter/destabilize patient conceptions of illness, & also of evidentiary interest to law (driving, culpability), employers, educators.

2. Patient Concerns. Some patients express worries about a device reading their thoughts or other capacities. While many are not now within scope of device abilities, our approaches to signal detection are still evolving including future possibilities like seizure prediction.

3. Clinician Burdens. Huge amounts of real-time physiologic data, much more than usually gathered in epilepsy practice. What are reasonable expectations for clinicians to manage? Also new opportunities and challenges for surgical decision-making given new ways of capturing data.

4. Data Ownership. Devices present unique opportunities to study brain function in natural settings, potentially of great scientific and commercial interest. Who should control & access? Should patients be empowered to request and review their own brain data?

We expect closed-loop tech to play a growing role in clinical practice. We hope this paper spurs broader discussion of how practice, law & ethics can adjust to accommodate. Thx to #NIHBRAIN for support; our group has empirical work forthcoming on patient experiences of treatment.

...oh, and thanks of course to @GreenJournal @AANMember for providing this venue to discuss!