Brain Control: Developments in Therapy and Implications for by David Linden (auth.)

By David Linden (auth.)

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Some of the affected patients have an impaired ability to recognise fear in others and are also generally fearless themselves. The limbic system is also tightly coupled with the brain’s reward and motivation system. The neurotransmitter most strongly implicated in reward-based learning is dopamine. Dopamine is produced by a group of nerve cells, called dopaminergic neurons, that make up only a very small proportion of the brain’s cells. However, they are crucial for several key functions, including learning and motor control, and loss of these neurons can lead to Parkinson’s disease and other movement disorders.

28 This work was rightly hailed as providing an important new tool for the exploration and diagnosis of patients with disorders of consciousness (some of who may turn out to have no consciousness disorder at all, but just a severe disorder of communication, viz. the locked-in state). It may also open up the prospect of training patients to go beyond a simple imagery task and produce differential activation through which they can control a BCI and communicate, perhaps even use the Maastricht group’s sophisticated spelling device that allows them to pick one letter out of the whole alphabet in a single attempt.

The analogy would be that patients with MND who learn to regulate their EEG while still in control of some of their muscles maintain this skill after they have lost all motor control. At present it is not known whether this would work, but it may be one avenue to brain communication in the locked-in state. Another option to train brain responses for communication in completely locked-in patients may be the use of classical conditioning. 21 In training they paired correct statements, such as “Berlin is the capital of Germany”, with electrical stimulation of the left thumb.

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