What Is the Main Idea?

In addition to opening up new treatment options for people with neurological conditions, advances in wearable sensor and electrode technology have enabled the development of a new generation of neuromodulation devices. These may allow people who do not have neurological conditions to enhance their brain function. In the open-access review article “Electrical and Magnetic Neuromodulation Technologies and Brain-Computer Interfaces: Ethical Considerations for Enhancement of Brain Function in Healthy People – A Systematic Scoping Review”, published in the journal Stereotactic and Functional Neurosurgery, the authors investigated ethical research published to date on the use of neuromodulation by people who are considered to be healthy.

What Else Can You Learn?

In this blog post, different neuromodulation techniques are described. How nerves transmit signals around the body, and the differences between systematic and scoping reviews, are also discussed.

 Take-Home Message

Rapid advances in neuromodulation technology and direct-to-consumer marketing mean that neuromodulation may be readily available in some regions. However, a lack of information about its long-term effects means that the risks of harm may outweigh any potential benefits, and there are ethical concerns about its use.

What Is Neuromodulation?

Neuromodulation uses chemicals, a magnetic field, or an electric current to alter the activities of nerve cells in specific areas of the body. Nerves send electrical signals that control our senses, like pain and touch, and essential processes – such as breathing, digestion, and movement – from one part of the body to another.

When an electrical signal reaches the end of a nerve it is converted into a chemical signal. This causes molecules called neurotransmitters, such as dopamine and epinephrine (also known as adrenaline), to be released. By stimulating nerve cells, neuromodulation influences the release of these neurotransmitters. As an extension of this, brain–computer interfaces can be used to connect the brain’s electrical activity to support devices, such as wearable sensors.

What Conditions Are Treated with Neuromodulation?

Although the exact mechanisms of neuromodulation are not known, a range of treatments are already in use or in development. There is evidence that neuromodulation may be useful in treating epilepsy in cases where it cannot be managed with medication alone and conditions that cause chronic head pain.

Transcranial magnetic stimulation works non-invasively. An electromagnetic coil is placed against the scalp and delivers magnetic pulses to stimulate nerve cells in the brain. It is used to treat conditions such as major depressive disorder, migraines, and addiction.

Transcranial electrical stimulation is also non-invasive, and involves a low electric current being passed between two or more electrodes on the scalp to alter the electrical excitability of nerve cells in specific areas of the brain. There is increasing evidence that it is useful in the treatment of depression and schizophrenia.

Deep brain stimulation is an example of an invasive approach that involves surgery. Small holes are made in the skull, through which electrodes are inserted and positioned in deep brain structures. It can be used to treat movement-related symptoms of Parkinson’s disease and other neurological conditions, such as tremor.

How Does Neuromodulation Aim to Enhance Brain Function?

In addition to its potential as a treatment for medical conditions, there has been increasing interest in the possibility of using neuromodulation to enhance mental functioning beyond what is necessary for health in people who are well. Such enhancements include improved cognition (mental processing), motor functions (to improve physical performance) and mood (to improve the stability of a person’s moods).

What Did This Study Investigate?

Although neuromodulation technologies offer exciting possibilities, the speed at which they have come on to the market for healthy individuals, the likelihood of them being widely used, and direct-to-consumer marketing have raised concerns about access, the potential for misuse, and whether or not current regulatory frameworks are adequate to protect users.

The authors of this study conducted a scoping review to map studies published to date that discuss ethical challenges relating to the use of neuromodulation technologies and brain–computer interfaces to enhance brain function in healthy individuals, with the aim of guiding future research. Of the 159 articles initially identified for evaluation, 23 were included in the final analysis.

What Is a Scoping Review?

Scoping reviews have some similarities with systematic reviews. They both seek to comprehensively review and analyze all of the available research literature that has been published about a research question. However, unlike a systematic review, where the aim is to produce a statement that can guide decision-making on the basis of critical analysis of studies that have been assessed for risk of bias (for example, about the best type of treatment for a particular condition), a scoping review looks to present a descriptive overview of the literature, with the aim of informing policies and helping to identify priority areas for future research.

What Were the Findings of This Study?

The authors of the study found that studies looking at this area of research were lacking. The most common ethical concerns were linked to a lack of data about how safe and effective the new technologies are, as well as what constitutes an acceptable level of risk for a person undergoing a procedure. There were also concerns relating to:

  • potential loss of privacy, which could potentially lead to discrimination (for example, in the workplace or relating to the ability to get health insurance coverage if information has been recorded about psychological states and mental health risks) and
  • the possibility that procedures could result in people being fundamentally changed (for example, their ability to be sociable or their character/personality), and not necessarily in a desirable way. Relating to this, concerns were even raised by some researchers that neuromodulation technologies could be used for military purposes (for example, by causing people to become immune to traumatic harm).
  • potential socioeconomic consequences that already existing inequalities could be worsened or that new ones could be introduced, resulting in some individuals being disadvantaged. For example, high-cost technologies would likely only be available to those who can afford them.
  • the risk of people feeling societal pressure to have procedures and of implications relating to decision-making for children and their well-being.

What Did the Authors of the Study Conclude?

The authors concluded that the ethical debate about the neuroenhancement of healthy individuals is still developing and that there is a critical shortage of ethical research on these approaches. They also noted that the risks of invasive approaches may currently outweigh the potential benefits, and that there was very little information about the long-term effects of neuromodulation enhancement technologies or their effects on children, in whom the brain is still developing.

The authors expressed the view that there is an urgent need for the integration of ethical considerations into neuroscientific research to address significant gaps in knowledge and ensure equitable outcomes and access. In addition to pursuing the enhancement of human capabilities, it is critical that the development of neuromodulation technologies safeguards individual well-being and autonomy, and actively works against increasing social inequalities that already exist.

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