Factors Mediating Public Perceptions of Therapeutic Closed-Loop Brain Implants for Epilepsy and Mood Disorders (P6-9.002)

Abstract

<h3>Objective:</h3> To examine perceptions of implanted neural devices among groups underserved by prevailing neuropsychiatric treatment approaches. <h3>Background:</h3> “Closed-loop” devices that both sense and modulate brain activity represent a new paradigm for neuropsychiatric treatment. However, neurotechnologists and even neuroethicists are not demographically representative of U.S. society, so the concerns of groups most in need of new paradigms may not be reflected in current neurotechnology development. <h3>Design/Methods:</h3> We fielded a nationally representative survey (n=1047) oversampling non-Hispanic Black (n=214), Hispanic (n=210), and rural Americans (n=219), eliciting treatment preferences in scenarios comparing (1) a therapeutic closed-loop brain implant versus surgical resection for refractory epilepsy, and (2) an investigational closed-loop brain implant versus medications for mood disorders. We asked respondents to rate the importance of differing considerations favoring either the implanted device or traditional treatment. We examined whether such considerations mediate demographic differences in treatment preferences using survey-weighted logistic regression models. <h3>Results:</h3> In both scenarios, non-Hispanic Black Americans were less likely to prefer the implanted neural device than non-Hispanic White Americans (epilepsy OR 0.28, p&lt;0.001; mood OR 0.23, p=0.008); there was no main effect contrasting Hispanic with non-Hispanic White Americans, or contrasting rural with urban/suburban Americans. In the epilepsy scenario the difference between non-Hispanic Black and non-Hispanic White Americans’ treatment preferences was partially mediated by preference for established treatments, concerns about privacy, and concerns about hacking. In the mood scenario the difference between non-Hispanic Black and non-Hispanic White Americans’ treatment preferences was partially mediated by indifference to temporally specific action of a closed-loop device, concerns about changes to core traits, and preference for established treatments. <h3>Conclusions:</h3> Black Americans are less likely than White Americans to prefer closed-loop brain implants to traditional treatment, with specific concerns that may be informed by the history of unethical medical experimentation targeting Black people. <b>Disclosure:</b> Mr. Dada has received personal compensation for serving as an employee of Dreem Health. The institution of Mr. Chen has received research support from the National Institutes of Health (NIH). The institution of Dr. Haeusermann has received research support from the National Institutes of Health (NIH). Ms. Fong has nothing to disclose. Dr. Hamilton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion Pharmaceuticals. Dr. Hamilton has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Highland Instruments. Dr. Hamilton has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology (Journal). The institution of Dr. Hamilton has received research support from NIH. The institution of Dr. Hamilton has received research support from Department of Defense. The institution of Dr. James has received research support from National Institute of Health. The institution of Dr. James has received research support from Society of Family Planning . The institution of Dr. James has received research support from Greenwall Foundation. Prof. Dohan has nothing to disclose. The institution of Dr. Chiong has received research support from the National Institutes of Health. The institution of Dr. Chiong has received research support from the Dana Foundation. Dr. Chiong has received personal compensation in the range of $500-$4,999 for serving as a member, NeuroEthics Working Group with National Institutes of Health.