Neuroethics

Anosognosia: Is Vestibular Stimulation Ethical?

Mallika Pajjuri


Introduction

Anosognosia, a severe symptom associated with mental illness,  is the inability of a patient to perceive his or her own neurological disorder. Caused by the deterioration of the frontal lobe by illnesses such as dementia and bipolar disorder, anosognosia is highly detrimental to society’s well-being and upkeep since anosognosia sufferers lack insight, potentially equating to disruption or impediment to the safety of a community. Even though prescription medications are available to alleviate this condition, researchers have turned towards utilizing vestibular stimulation by means of cold water caloric irrigation in order to vastly, if not completely, alter the presence of the symptom. However, this process does not aid the eradication of the neurological disorders themselves, and this inevitably results in the patient becoming aware of his or her condition. This highly controversial practice has been subject to scrutiny by various external sources trying to answer one universal question: Would it be better to corrupt the innocence of a patient or to steer society into harm’s way?

 

Anosognosia

In 1914, French neurologist Joseph François Babinski was accredited with the coinage of the term anosognosia, combining three Greek word stems to create this comprehensive word. With “a” meaning without, “nosos” meaning disease, and “gnosis” meaning knowledge, the term anosognosia had been defined as the lack of  knowledge regarding one’s own disease [1]. Soon after Babinski developed the term, discussions erupted over its supposed symptom: Is anosognosia merely denial of one’s disease? However, this is not at all the case since anosognosia sufferers do actually experience alterations of their neurons in the right hemisphere’s frontal lobe and parietal lobe. Denial involves the rejection of negatively associated events, ideas, thoughts, and items in order to alleviate the emotional weight something may carry. Anosognosia, on the other hand, involves the unintentional rejection of a patient’s own disorder due to neuronal damage.

Despite being a relatively unknown term, understanding Anosognosia is extremely integral to successfully appreciating the plights of victims of neurological disease: Anosognosia is reported in fifty percent of stroke victims and eighty-one percent of progressive dementia patients {2}. In order to diagnose this symptom, health practitioners utilize the four leveled self-awareness rating scale, determining the severity of the patient’s symptoms. However, it is often difficult to diagnose a patient because of the nebulous difference between denial and anosognosia. Thus, practitioners look for alternative diagnosis markers, such as confabulation, in order to recognize true anosognosia [1]. Confabulation occurs when a response made by a patient is false due to misremembering rather than being on purpose. For example, a patient may state that Practitioners will ultimately call for close friends and family to aid the diagnosis process: they will determine whether or not the facts stated by the patient are veracious, and if the facts are veracious, then the patient is ultimately characterized as a patient with anosognosia symptoms.

 

Vestibular Stimulation

Vestibular stimulation is the process utilized in treating many--if not most--neurological disorders with no physiological explanation [1]. There are two main vestibular stimulation processes, caloric and galvanic stimulation, and both can cater to a wide variety of neurological disorders [4]. Caloric vestibular stimulation is more commonly acclaimed for the remission of a variety of cognitive functions, manipulating another person by physical means by using cold or hot water or air in order to stimulate the external auditory canal [1]. Galvanic vestibular stimulation, on the other hand, requires the usage of low voltage electric current in order to stimulate the same nerve [5]. Regardless of the process, vestibular stimulation can aid the development of infants, the remission of various cognitive functions, and, in the case of anosognosia, the remission of a neurological disorder’s symptoms.

Image of Galvanic Vestibular Stimulator as per Soterix Medical [3]

 

What’s the Problem?

Vestibular stimulation is becoming increasingly popular amongst vastly different groups of people, from parents to researchers. As it has gained notoriety for its simplicity and effectiveness, its usage has become universal; however, it has not been integrated completely to treat symptoms of neurological disorders due to its ethical limitations. Some people regard it as the Holy Grail of medical treatments: Since it is quick and relatively inexpensive, some believe that it will revolutionize the treatments utilized to cure symptoms of neurological disorders. However, others believe that it comes at the expense of morality: when treating neurological disorders, the eradication of anosognosia is inevitable, making the patient’s awareness of their own disorder entirely dependent on the choice of another person. This entails human control of another human, which has implications that may very well be condemned by the general public [5]. As the scientific community makes its decision on whether or not to utilize vestibular stimulation to treat anosognosia, we must take into account the positives and negatives on this highly controversial procedure.


References


  1. Kageyama, Yuri. (25/10/2005). A remote control that controls humans. NBC News. http://www.nbcnews.com/id/9816703/ns/technology_and_science-innovation/#.WA2SMOArI2x. Retrieved: 19/10/2016.

  2. Lena Schmidt, Lena; Utz, Kathrin; Depper, Lena; Adams, Michaela; Schaadt, Anna-Katharina; Reinhart, Stefan; Kerkhoff, Georg. (20/03/2013). Now You Feel both: Galvanic Vestibular Stimulation Induces Lasting Improvements in the Rehabilitation of Chronic Tactile Extinction. National Institutes of Health.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602932/. Retrieved: 21/10/2016.

  3. Galvanic Vestibular Stimulation. Soterix Medical. http://soterixmedical.com/vestibular. Retrieved: 23/10/2016.

  4. http://serendip.brynmawr.edu/bb/neuro/neuro03/web2/cstearns.html Stearns, Cordelia. (26/04/2003). Anosognosia for Hemiplegia: A Window into Self-Awareness. Serendip. http://serendip.brynmawr.edu/bb/neuro/neuro03/web2/cstearn. Retrieved: 19/10/2016

  5. Noll-Hussong, Michael; Holzapfel, Sabrina; Pokorny, Dan; Herberger, Simone. (02/06/2014). Caloric Vestibular Stimulation as a Treatment for Conversion Disorder: A Case Report and Medical Hypothesis. National Institutes of Health. http://alzonline.phhp.ufl.edu/en/reading/anosognosia.pdf . Retrieved: 17/10/2016.

Mallika Pajjuri

Mallika Pajjuri


hey! my name is mallika pajjuri, and i am currently a junior at dublin high school. you can find me on instagram @malliaka.paijjuri. looking forward to meeting you all!