Deflating the “DBS causes personality changes” bubble

Abstract

The idea that deep brain stimulation (DBS) induces changes to personality, identity, agency, authenticity, autonomy and self (PIAAAS) is so deeply entrenched within neuroethics discourses that it has become an unchallenged narrative. In this article, we critically assess evidence about putative effects of DBS on PIAAAS. We conducted a literature review of more than 1535 articles to investigate the prevalence of scientific evidence regarding these potential DBS-induced changes. While we observed an increase in the number of publications in theoretical neuroethics that mention putative DBS-induced changes to patients' postoperative PIAAAS, we found a critical lack of primary empirical studies corroborating these claims. Our findings strongly suggest that the theoretical neuroethics debate on putative effects of DBS relies on very limited empirical evidence and is, instead, reliant on unsubstantiated speculative assumptions probably in lieu of robust evidence. As such, this may reflect the likelihood of a speculative neuroethics bubble that may need to be deflated. Nevertheless, despite the low number of first-hand primary studies and large number of marginal and single case reports, potential postoperative DBS changes experienced by patients remain a critical ethical concern. We recommend further empirical research in order to enhance theoretical neuroethics work in the area. In particular, we call for the development of better instruments capable of capturing potential postoperative variations of PIAAAS.

Neuroethics of neuromodulation: An update

“…More generally, a recent literature review found only relatively limited evidence that DBS affects identity, agency, authenticity, and related aspects of the individual. The authors conclude that additional empirical work is therefore needed to inform normative theorizing about these topics in neuroethics [29]. …”

‘Woe Betides Anybody Who Tries to Turn me Down.’ A Qualitative Analysis of Neuropsychiatric Symptoms Following Subthalamic Deep Brain Stimulation for Parkinson’s Disease

“…The stimulation-dependent nature of psychiatric symptoms has been contested by Gilbert et al [23], who suggest that they may reflect a worsening of preexisting psychiatric disorders or aggravation of difficult family relationships in the setting of major surgery, less related to electrical stimulation than to premorbid psychiatric, personality and psychosocial functioning. In particular, these authors propose that debate regarding the neuroethical consequences of DBS relies largely upon speculative assumptions rather than empirical evidence.…”

Proceedings of the Seventh Annual Deep Brain Stimulation Think Tank: Advances in Neurophysiology, Adaptive DBS, Virtual Reality, Neuroethics and Technology

“…Control, Personality, and Neuroethical Issues in the Use of DBS for PD Gisquet (2008) have claimed that DBS is a disruptive experience for some patients due to the associated loss of control of the illness and of one's life, and the possibility of undesired personality changes incurred by the use of this technology. These concerns generated considerable conceptual neuroethical discourse, however, most publications addressing this topic were not based on empirical data (Frederic Gilbert and Ineichen, 2018). Thus, efforts are underway to employ empirical methods to re-examine assertions that DBS results in diminished control and undesired personality changes.…”