Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2017-0075
Trends in Psychiatry and Psychotherapy
Trend

Primum non nocere or primum facere meliorem? Hacking the brain in the 21st century

Primum non nocere ou primum facem meliorem? O cérebro pirateado do século 21

Lucas Borrione; Andre R. Brunoni

http://dx.doi.org/10.1590/2237-6089-2017-0075 Trends Psychiatry Psychother, vol.39, n4, p.232-238, 2017
PDF
SciELO
Downloads: 0
Views: 608

Abstract

Abstract Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that modulates cortical excitability. It is devoid of serious adverse events and exerts variable effects on cognition, with several research findings suggesting that it can improve memory, verbal and mathematical skills. Because tDCS devices are low-cost, portable and relatively easy to assemble, they have become available outside of the medical setting and used for non-medical (“cosmetic”) purposes by laypersons. In this sense, tDCS has become a popular technique aiming to improve cognition and the achievement of a better performance not only at work, but also in other fields such as sports, leisure activities (video games) and even the military. In spite of these unforeseen developments, there has been a general paralysis of the medical and regulatory agencies to develop guidelines for the use of tDCS for cosmetic purposes. Several challenges are present, most importantly, how to restrict tDCS use outside of the medical setting in face of variable and sometimes conflicting results from scientific research. This article aims to describe the popular use of tDCS, in light of the pillars of neuroethics, a branch of bioethics relative to brain research. Between two possible but extreme solutions – total release or total restriction of tDCS – it is paramount to develop a spectrum of alternatives, which may vary over time and in different cultural backgrounds.

Keywords

Transcranial direct current stimulation (tDCS), neuromodulation, neuroethics, bioethics, cosmetic cognitive enhancement

Resumo

Resumo A estimulação transcraniana por corrente contínua (ETCC) é uma técnica não invasiva de estimulação cerebral que modula a excitabilidade cortical. A ETCC é desprovida de efeitos adversos graves e exerce efeitos variáveis sobre a cognição, com vários achados de pesquisa sugerindo que a técnica pode promover melhora nas habilidades mnêmica, verbal e matemática. Devido ao seu baixo custo, portabilidade e facilidade de montagem, os aparelhos de ETCC tornaram-se disponíveis fora do contexto médico, sendo usados para fins não médicos (“cosméticos”) por indivíduos leigos. Nesse sentido, a ETCC tornou-se um procedimento popular para aprimoramento da cognição e a realização de melhor desempenho não somente no ambiente de trabalho, mas também em campos tais como o esporte, atividades de lazer ( video games ) e até no meio militar. Apesar desses acontecimentos imprevisíveis, há uma certa morosidade das agências médicas e regulatórias em desenvolver diretrizes para o uso de ETCC para fins cosméticos. Há muitos desafios presentes, principalmente, como restringir o uso da ETCC fora do contexto médico em face de resultados variáveis, e muitas vezes conflitantes, da pesquisa científica sobre o tema. Este artigo tem como objetivo descrever o uso popular da ETCC sob a luz da neuroética, um ramo da bioética que se dedica ao estudo do cérebro. Entre duas situações possíveis, mas extremas – liberação ou restrição totais da ETCC –, é primordial o desenvolvimento de um espectro de alternativas, que podem variar ao longo do tempo e depender de diversos contextos culturais.

Palavras-chave

Estimulação transcraniana por corrente contínua (ETCC), neuromodulação, neuroética, bioética, aprimoramento cognitivo cosmético

References

Zhao H, Qiao L, Fan D, Zhang S, Turel O, Li Y. Modulation of brain activity with noninvasive transcranial direct current stimulation (tDCS): clinical applications and safety concerns. Front Psychol. 2017;8.

Brunoni AR, Ferrucci R, Bortolomasi M, Vergari M, Tadini L, Boggio PS. Transcranial direct current stimulation (tDCS) in unipolar vs. bipolar depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2011;35:96-101.

Pereira M, Rafiq B, Chowdhury E, Babayev J, Boo H, Metwaly R. Anodal cerebellar tDCS modulates lower extremity pain perception. NeuroRehabilitation. 2017;40:195-200.

Brunoni AR, Ferrucci R, Fregni F, Boggio PS, Priori A. Transcranial direct current stimulation for the treatment of major depressive disorder: a summary of preclinical, clinical and translational findings. Prog Neuropsychopharmacol Biol Psychiatry. 2012;39:9-16.

Jwa A. Early adopters of the magical thinking cap: a study on do-it-yourself (DIY) transcranial direct current stimulation (tDCS) user community. J Law Biosci. 2015:292-335.

Borducchi DM, Gomes JS, Akiba H, Cordeiro Q, Borducchi JH, Valentin LS. Transcranial direct current stimulation effects on athletes’ cognitive performance: an exploratory proof of concept trial. Front Psychiatry. 2016;7.

Looi CY, Duta M, Brem AK, Huber S, Nuerk HC, Cohen Kadosh R. Combining brain stimulation and video game to promote long-term transfer of learning and cognitive enhancement. Sci Rep. 2016;6.

DARPA’s accelerated learning. .

Wexler A. A pragmatic analysis of the regulation of consumer transcranial direct current stimulation (TDCS) devices in the United States. J Law Biosci. 2015;2:669-96.

Fregni F, Nitsche MA, Loo CK, Brunoni AR, Marangolo P, Leite J. Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): review and recommendations from an expert panel. Clin Res Regul Aff. 2015;32:22-35.

Figueroa G. Neuroethics: the pursuit of transforming medical ethics in scientific ethics. Biol Res. 2016;49.

Talsma LJ, Kroese HA, Slagter HA. Boosting cognition: effects of multiple-session transcranial direct current stimulation on working memory. J Cogn Neurosci. 2017;29:755-68.

Sparing R, Thimm M, Hesse MD, Kust J, Karbe H, Fink GR. Bidirectional alterations of interhemispheric parietal balance by non-invasive cortical stimulation. Brain. 2009;132:3011-20.

Cattaneo Z, Pisoni A, Papagno C. Transcranial direct current stimulation over Broca’s region improves phonemic and semantic fluency in healthy individuals. Neuroscience. 2011;183:64-70.

Hauser TU, Rutsche B, Wurmitzer K, Brem S, Ruff CC, Grabner RH. Neurocognitive effects of transcranial direct current stimulation in arithmetic learning and performance: a simultaneous tDCS-fMRI study. Brain Stimul. 2016;9:850-8.

Pisoni A, Cerciello M, Cattaneo Z, Papagno C. Phonological facilitation in picture naming: When and where? A tDCS study. Neuroscience. 2017;352:106-21.

Kelley NJ, Eastwick PW, Harmon-Jones E, Schmeichel BJ. Jealousy increased by induced relative left frontal cortical activity. Emotion. 2015;15(5):550.

Civai C, Miniussi C, Rumiati RI. Medial prefrontal cortex reacts to unfairness if this damages the self: a tDCS study. Soc Cogn Affect Neurosci. 2015;10:1054-60.

Kuehne M, Heimrath K, Heinze HJ, Zaehle T. Transcranial direct current stimulation of the left dorsolateral prefrontal cortex shifts preference of moral judgments. PLoS One. 2015;10.

Mameli F, Mrakic-Sposta S, Vergari M, Fumagalli M, Macis M, Ferrucci R. Dorsolateral prefrontal cortex specifically processes general - but not personal - knowledge deception: Multiple brain networks for lying. Behav Brain Res. 2010;211:164-8.

Dubljevic V, Saigle V, Racine E. The rising tide of tDCS in the media and academic literature. Neuron. 2014;82:731-6.

Sellers KK, Mellin JM, Lustenberger CM, Boyle MR, Lee WH, Peterchev AV. Transcranial direct current stimulation (tDCS) of frontal cortex decreases performance on the WAIS-IV intelligence test. Behav Brain Res. 2015;290:32-44.

Sarkar A, Dowker A, Cohen Kadosh R. Cognitive enhancement or cognitive cost: trait-specific outcomes of brain stimulation in the case of mathematics anxiety. J Neurosci. 2014;34:16605-10.

Mancuso LE, Ilieva IP, Hamilton RH, Farah MJ. Does transcranial direct current stimulation improve healthy working memory? A meta-analytic review. J Cogn Neurosci. 2016;28:1063-89.

Horvath JC, Forte JD, Carter O. Quantitative review finds no evidence of cognitive effects in healthy populations from single-session transcranial direct current stimulation (tDCS). Brain Stimul. 2015;8:535-50.

Lefaucheur JP. A comprehensive database of published tDCS clinical trials (2005-2016). Neurophysiol Clin.. 2016;46:319-98.

Horvath JC, Carter O, Forte JD. Transcranial direct current stimulation: five important issues we aren’t discussing (but probably should be). Front Syst Neurosci. 2014;8.

To WT, Hart J, Ridder D, Vanneste S. Considering the influence of stimulation parameters on the effect of conventional and high-definition transcranial direct current stimulation. Expert Rev Med Devices. 2016;13:391-404.

Brunoni AR, Ferrucci R, Bortolomasi M, Scelzo E, Boggio PS, Fregni F. Interactions between transcranial direct current stimulation (tDCS) and pharmacological interventions in the Major Depressive Episode: findings from a naturalistic study. Eur Psychiatry. 2013;28:356-61.

Katz B, Au J, Buschkuehl M, Abagis T, Zabel C, Jaeggi SM. Individual differences and long-term consequences of tDCS-augmented cognitive training. J Cogn Neurosci. 2017:1-11.

Aparicio LV, Guarienti F, Razza LB, Carvalho AF, Fregni F, Brunoni AR. A Systematic review on the acceptability and tolerability of transcranial direct current stimulation treatment in neuropsychiatry trials. Brain Stimul. 2016;9:671-81.

Li MS, Chen YY, Hung GC. Rapid onset of hypomania associated with transcranial direct current stimulation in a patient with bipolar depression. Brain Stimul. 2016;9:955-6.

Galvez V, Alonzo A, Martin D, Mitchell PB, Sachdev P, Loo CK. Hypomania induction in a patient with bipolar II disorder by transcranial direct current stimulation (tDCS). J ECT. 2011;27:256-8.

Steenbergen L, Sellaro R, Hommel B, Lindenberger U, Kuhn S, Colzato LS. “Unfocus” on foc.us: commercial tDCS headset impairs working memory. Exp Brain Res. 2016;234:637-43.

Harari Y. Homo Deus: a brief history of humankind. 2016.

Lavazza A. Can neuromodulation also enhance social inequality? Some possible indirect interventions of the state. Front Hum Neurosci. 2017;11.

Resolução CFM nº 1.982/2012. 2012.

Resolução CFM nº 1.986/2012. 2012.

Maslen H, Douglas T, Cohen Kadosh R, Levy N, Savulescu J. The regulation of cognitive enhancement devices: extending the medical model. J Law Biosci. 2014;1:68-93.

Fitz NS, Reiner PB. The challenge of crafting policy for do-it-yourself brain stimulation. J Med Ethics. 2015;41:410-2.

Wexler A. Recurrent themes in the history of the home use of electrical stimulation: Transcranial direct current stimulation (tDCS) and the medical battery (1870-1920). Brain Stimul. 2017;10:187-95.

Wexler A. The social context of “do-it-yourself” brain stimulation: neurohackers, biohackers, and lifehackers. Front Hum Neurosci. 2017;11.

6169d9a2a9539559561345c4 trends Articles
Links & Downloads
2238-0019 (Electronic)
Trends Psychiatry Psychother ©2024 All rights reserved.

Trends Psychiatry Psychother

Share this page
Page Sections