Locked-in Syndrome Research Articles

Clinical and ethical challenges in decision-making for patients with disorders of consciousness and locked-in syndrome from Chinese neurologists' perspectives.

The diagnosis of and life-sustaining treatment (LST) for patients with disorders of consciousness (DoC) and locked-in syndrome (LIS) have been the subject of intense debate. We aim to investigate the application of diagnostic knowledge, opinions about the administration of LST, and ethical challenges related to DoC and LIS. A cross-sectional study. A survey was conducted among Chinese neurologists. Questionnaires included three vignettes (unresponsive wakefulness syndrome (UWS); minimally conscious state (MCS), and LIS). They were randomly distributed among neurologists from August 2018 to December 2019. A sample of 360 questionnaires was included (response rate: 78%). Overall, 63% of the participants chose the correct diagnostic category. The neurologists who received the MCS case chose the category more accurately than the neurologists with the UWS (p < 0.001) and LIS case (p = 0.002). Most neurologists preferred never to limit LST for their patients (47%, 63%, and 67% in UWS, MCS, and LIS groups, p = 0.052). A large group of neurologists believed UWS patients could feel pain (73%), with no difference from MCS and LIS patients (p > 0.05). Deciding for patients in the absence of surrogates was rated extremely challenging. A large proportion of Chinese neurologists in our study didn't apply the accurate diagnostic categories to the description of DoC and LIS patients. This calls for more education and training. Most Chinese neurologists were reluctant to limit LST for patients. This may indicate that there may be a need to emphasize the allocation of more resources toward long-term care in China.

Mindspeak: Empowering Communication with Brain Keyboard

Brain-Computer Interface (BCI) technology stands as a groundbreaking innovation, revolutionizing the way individuals with severe motor disabilities interact with the world. The integration of Electroencephalogram (EEG) sensors within applications like the Brain Keyboard marks a pivotal stride forward. By capturing and interpreting brain signals triggered by simple actions such as eye blinking, these sensors empower users to control a virtual keyboard, transcending the limitations imposed by traditional motor pathways. This direct channel between the human brain and external devices offers an unprecedented avenue for communication, particularly invaluable for those grappling with conditions like paralysis or locked-in syndrome. The profound impact of BCIs extends far beyond facilitating textual communication; they represent a lifeline, a bridge toward autonomy and engagement for individuals facing profound physical challenges. Through these interfaces, users can articulate thoughts, express emotions, and actively participate in social interactions, fundamentally enhancing their quality of life. This technological marvel not only breaks down communication barriers but also holds promise in broader applications. As BCIs evolve, their potential encompasses enabling control over robotic prosthetics, granting users the ability to accomplish tasks once deemed impossible. Moreover, the implications of BCIs stretch into the realm of neuroscience, offering a unique window into understanding cognitive processes and neurological disorders. The ability to decode and interpret brain activity not only aids in facilitating communication but also paves the way for groundbreaking research and potential therapies. Challenges persist, such as enhancing signal accuracy and streamlining usability, yet the remarkable benefits that BCIs offer to individuals with motor disabilities continue to fuel ongoing innovation in this dynamic field. Ultimately, the fusion of EEG sensors, processing units, and user interfaces in BCIs heralds a new era of inclusivity and empowerment, where individuals previously marginalized by physical limitations find newfound avenues for expression, interaction, and independence. This transformative technology not only unlocks communication but also holds the key to reshaping our understanding of the human brain and its intricate workings, promising a f uture where disabilities no longer confine one's ability to engage with the world.

Researching brain-computer interfaces for enhancing communication and control in neurological disorders

The paper provides a comprehensive exploration of brain-computer interfaces (BCIs) and their application in addressing communication and control challenges in neurological disorders like Amyotrophic Lateral Sclerosis (ALS), locked-in syndrome, Parkinson’s disease, and Spinal Cord Injury. It traces BCI advancements from foundational information theory principles to their current state. Neurological disorders severely impact communication and control abilities, with ALS causing muscle weakness and paralysis, and locked-in syndrome confining individuals within paralyzed bodies while maintaining cognitive functions. BCIs decode brain signals, enabling control of external devices like computers, offering hope for restoring communication and control in affected individuals. Employing data analysis and visualization techniques, this study evaluates BCI performance in improving communication and control across various disorders. Matplotlib generates informative graphs and performance metrics, quantifying BCI efficacy for users with differing motor impairments. The findings highlight BCI transformative potential, guiding clinicians and researchers toward personalized solutions for diverse patient populations. This research underscores the necessity for continued innovation and exploration in BCI technology, envisioning a more inclusive and adaptive future for individuals with neurological disorders

Treatment of Severe Trismus during Locked-In Syndrome Secondary to Central Pontine Myelinolysis Using Onabotulinum Toxin-A: Case Report

Trismus in adults has a wide range of known causes, though few cases have ever been reported secondary to central pontine myelinolysis (CPM). This report describes a case of severe trismus without clear etiology successfully treated with onabotulinum toxin-A following development of CPM.

Transient Locked-in Syndrome after Aneurysmal Subarachnoid Bleeding due to Spasm Hypoxemia?

How to cite this article: Finsterer J. Transient Locked-in Syndrome after Aneurysmal Subarachnoid Bleeding due to Spasm Hypoxemia? Indian J Crit Care Med 2024;28(1):86.

A Brain-Controlled Quadruped Robot: A Proof-of-Concept Demonstration.

Coupling brain-computer interfaces (BCIs) and robotic systems in the future can enable seamless personal assistant systems in everyday life, with the requests that can be performed in a discrete manner, using one's brain activity only. These types of systems might be of a particular interest for people with locked-in syndrome (LIS) or amyotrophic lateral sclerosis (ALS) because they can benefit from communicating with robotic assistants using brain sensing interfaces. In this proof-of-concept work, we explored how a wireless and wearable BCI device can control a quadruped robot-Boston Dynamics' Spot. The device measures the user's electroencephalography (EEG) and electrooculography (EOG) activity of the user from the electrodes embedded in the glasses' frame. The user responds to a series of questions with YES/NO answers by performing a brain-teaser activity of mental calculus. Each question-answer pair has a pre-configured set of actions for Spot. For instance, Spot was prompted to walk across a room, pick up an object, and retrieve it for the user (i.e., bring a bottle of water) when a sequence resolved to a YES response. Our system achieved at a success rate of 83.4%. To the best of our knowledge, this is the first integration of wireless, non-visual-based BCI systems with Spot in the context of personal assistant use cases. While this BCI quadruped robot system is an early prototype, future iterations may embody friendly and intuitive cues similar to regular service dogs. As such, this project aims to pave a path towards future developments in modern day personal assistant robots powered by wireless and wearable BCI systems in everyday living conditions.

Delayed Neurotoxic Paralysis with Confounding Hypokalaemia

Snakebite is a major health issue in India and developing nations across the globe. Common krait bites are associated with delayed paralysis and locked-in syndrome. Locked-in syndrome has been documented among patients of snakebite. Our case is unique due to the confounding effect of hypokalaemia which may confuse the physician as hypokalaemic periodic paralysis (HPP), a rare genetic condition which can also be precipitated by a stressful event such as snakebite. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. As krait bite are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP. We urge our fellow researchers to look out for similar findings in their patients. Key messages: Locked-in syndrome in snakebites can be due to the effect of the venom in blood onto the ventral pons. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. We presume this hypokalaemia to be nutritional in origin. As krait bites are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP. Keywords: Case report, Hypokalaemia, Neurotoxic, Snake envenomation

Long-Term Neurocognitive Outcomes in Pediatric Nonfatal Drowning: Results of a Family Caregiver Survey

BackgroundDrowning is a leading cause of brain injury in children. Long-term outcome data for drowning survivors are sparse. This study reports neurocognitive outcomes for 154 children hospitalized following drowning. MethodsA survey for parent caregivers was distributed online. Likert scale items assessed 10 outcome variables in four domains: motor (three), perception (three), language (three), and social/emotional (one). Cluster analysis, outcome relative risk, and descriptive statistics were applied. ResultsOf 208 surveys received, 154 met inclusion criteria. Coma was the most common admission status (n = 137). Cluster analysis identified three outcome groups: Mild (n = 39), Moderate (n = 75), and Severe (n = 40). Motor impairment with cognitive and perceptual sparing (deefferentation) was present in Moderate (P < 1 × 10−26) and Severe (P < 1 × 10−12) but absent in Mild. Locked-in state was endorsed in both Moderate (83%) and Severe (70%). The strongest predictor of good outcome (Mild) was hospitalization with no medical intervention (relative risk [RR] = 6.7). Responsivity on admission (RR = 4.2) or discharge (RR = 12.22) also predicted good outcome. In-hospital prognostication and counseling predicted outcome weakly (RR = 1.3) or not at all. ConclusionsLong-term outcomes in pediatric drowning ranged widely. Overall, motor impairments exceeded perceptual or cognitive (P < 1 × 10−18), with “locked-in state” endorsed in most (93 of 154). The strongest predictors of good outcome were the lack of necessity for interventions and responsivity on admission or discharge. The eponym “Conrad syndrome” is proposed for locked-in state following nonfatal drowning in children.

Osmotic Demyelination Syndrome: A Rare Clinical Image.

The term "Osmotic Demyelination Syndrome" (ODS) is synonymous with central pontine myelinolysis (CPM), denoting a condition characterised by brain damage, particularly affecting the white matter tracts of the pontine region. This damage arises due to the rapid correction of metabolic imbalances, primarily cases of hyponatremia. Noteworthy triggers encompass severe burns, liver transplantations, anorexia nervosa, hyperemesis gravidarum, and hyperglycaemia, all linked to the development of CPM. Clinical manifestations encompass a spectrum of signs and symptoms, including dysphagia, dysarthria, spastic quadriparesis, pseudobulbar paralysis, ataxia, lethargy, tremors, disorientation, catatonia, and, in severe instances, locked-in syndrome and coma. A recent case involving a 45-year-old woman illustrates these complexities. Upon admission to the Medicine Intensive Care Unit, she presented with symptoms indicative of diminished responsiveness and bilateral weakness in the upper and lower limbs. Of significance, the patient had a pre-existing medical history of hyperthyroidism. Extensive diagnostic investigations were undertaken, revealing compelling evidence of profound hyponatremia through blood analyses. Furthermore, magnetic resonance imaging (MRI) was performed, unveiling conspicuous areas of abnormal hyperintensity located in the central pons, intriguingly accompanied by spared peripheral regions. These radiological findings align with the characteristic pattern associated with osmotic demyelination syndrome, illuminating the underlying pathology.

The lockdown of the locked-in: experiences of persons with Locked-in Syndrome during COVID-19 pandemic

Effects of COVID-19 lockdown for people with disabilities have been examined in the social and health sciences regarding both access to health and caregiving services, and their personal experiences. This article adds to such scholarship by investigating the lived experience of the lockdown in persons diagnosed with Locked-in Syndrome (LIS) by drawing on testimonies of confinement provided between March and June 2020 by members of the French Locked-in Syndrome Association (ALIS), and responses to a qualitative questionnaire during the same period by Spanish participants of our research project. Thematic analysis was performed; through inductive coding, five major themes were identified. By the time the pandemic broke out, some persons with LIS had long led a largely locked-in life. Studying their experience will allow us promote awareness of the resources needed to ensure the rights of people with disabilities and improve their quality of life and wellbeing.

Plenary E: Learning from patients: people who have changed my way of thinking

Abstract &amp; Learning Objectives:This presentation discusses six patients with different problems, referred for rehabilitation, who challenged my views on how to apply neuropsychological principles to their treatment. We begin with Derek, who had sustained a traumatic brain injury from a gunshot wound. I was asked to reduce his weight, but he could not read or write because of the brain injury so I had to find another way to achieve the weight loss. This made me realize that neuropsychologists have to "think on their feet" and be flexible. The second patient is Kate, who developed brain stem encephalitis. Expected to die, and unable to speak, she convinced me that, however severe the injury, we should not give up and recovery can continue for many years. Kate, managed to speak intelligibly fourteen years after her illness! The next patient, Claire, a school nurse, had herpes simplex encephalitis which left her with prosopagnosia and extreme anxiety. Her story made me realize the personal consequences of prosopagnosia that is typically overlooked by most neuropsychologists. The fourth patient, Gary, was attacked by a gang while saving his father. He remained in a state of unconsciousness for 19 months and, thus, had a very poor prognosis. Nevertheless, he defied the predictions of all medical staff, woke up and did very well. The penultimate patient is Natasha, who, as far as we know is the only person in the world to have two syndromes, "Sheehans Syndrome" which is very rare in developed countries and "Sickle cell disease" which is not rare. As a result of the Sheehan's she developed Balint's Syndrome. Her case made me learn about Sheehan's Syndrome and accept that Natasha's main goal in life, was not what I expected it to be. The final patient is Paul, an opera singer, who was diagnosed with" Locked-in Syndrome" following a brain stem stroke. Not only was he a good communicator once a good system was found, but he felt he had a good quality of life by" living within his head". Although many of us feel that to be fully conscious but totally dependent on others, is a very cruel situation to be in, Paul did not feel this. All these patients taught me a great deal and I thank them for this.Upon conclusion of this course, learners will be able to: 1.Describe the main purposes of neuropsychological rehabilitation2.Discuss about six patients who challenged typical concepts about neuropsychological rehabilitation3.Gain some knowledge about Sheehan's syndrome4.Explain the three components of Balint's syndrome5.Summarize the difference between Locked-in syndrome and the minimally conscious state6.Recognize some of the anatomy associated with these syndromes

Somatosensory pathway dysfunction in patients with amyotrophic lateral sclerosis in a completely locked-in state

ObjectiveTo investigate somatosensory pathway function in patients with amyotrophic lateral sclerosis (ALS) dependent on invasive ventilation and in a completely locked-in state (CLIS). MethodsWe examined median nerve somatosensory evoked potentials (SEPs) in 17 ALS patients in a CLIS, including 11 patients with sporadic ALS, one with familial ALS with genes not examined, four with a Cu/Zn superoxide-dismutase-1 (SOD1) gene variant (Val118Leu, Gly93Ser, Cys146Arg), and one with a fused-in-sarcoma gene variant (P525L). We evaluated N9, N13, N20 and P25, and central conduction time (CCT); the data were compared with those of 73 healthy controls. ResultsN20 and N13 were abolished in 12 and 10 patients, and their latencies was prolonged in four and three patients, respectively. The CCT was prolonged in five patients with measurable N13 and N20. Two patients with SOD1 gene mutations had absent or slightly visible N9. Compared to the CCT and latencies and amplitudes of N13 and N20 in the controls, those in the patient cohort were significantly abnormal. ConclusionsThe central somatosensory pathway is severely involved in patients with ALS in a CLIS. SignificanceOur findings suggest that median nerve SEP cannot be utilized for communication in patients with ALS in a CLIS.

Locked-in Syndrome

Objective ‒ to sharpen the attention of doctors to a rare, little-known pathology of damage to the ventral parts of the pons, the upper parts of the medulla oblongata ‒ the locked-in syndrome. The extremely important value of this syndrome can be in determining the prognosis of the disease and solving issues of rehabilitation and patient care.Locked-in syndrome is a rare, complex clinical and neurological symptom complex, the basis of which is a lesion of the front parts of the pons with intact functioning of the nuclei and afferents of the brain stem cover. The locked-in syndrome occurs when blood circulation is disturbed in the ventral parts of the brain stem and pons. According to the criteria of the American Congress of Rehabilitation Medicine, the locked-in syndrome is a combination of: 1) stable opening of the eyes; 2) safety of basic cognitive abilities; 3) aphonia or severe hypophonia; 4) tetraplegia or tetraparesis; 5) the main method of communication, used by the patient – movement of the eyes in a vertical or horizontal plane or blinking of the upper eyelid.The definition of this syndrome and the localization of its injuries, which cause it, became possible when long-term lung ventilation and neuroimaging methods ‒ spiral computer tomography and magnetic resonance imaging ‒ were introduced into clinical practice. Three personal observations of the occurrence of the locked-in syndrome of different etiology are given: with ischemic damage to the ventral parts of the pons of the brain, with hemorrhage in the ventral parts of the pons, with traumatic damage to the ventral parts of the brain stem.The dynamics of neurological disorders, their adequate assessment during neuroimaging allow timely diagnosis of the localization of the process and the prognosis of the disease, and therefore the choice of methods of treatment, rehabilitation or long-term care for the patient.

Palliative care for people with long term neurological conditions: practices and reflections based on comprehensive care

The care for people with Long Term Neurological Conditions (LTNC) isn´t recognized as a major practice in Palliative Care (PC) scientific production; in daily basis, the assistance is focused on hygiene´s care and clinical observation. However, from the perspective of PC, the health professionals´ role is to promote the dignity of the human person. The concept of LTNC covers neurological diseases with a prognosis of long-time life with significant disabilities, end-of-life stage that is difficult to identify, with many symptoms and physical and cognitive impairments. In this paper, we considered the following situations: persistent vegetative state, minimal consciousness state and locked-in syndrome. This is a theoretical study of a qualitative nature, which aims to describe a new kind of PC practice with this population, based on first author PHD study. The concept of Comprehensive Care is the main theoretical framework for the paper. It is proposed a practice reconstruction based on the person´s biography occurs by several perspectives, especially through sensory stimuli related to prior patient´s occupational repertoire. Along with the detailed evaluation, the therapist does a careful and continuous monitoring, proposing activities, giving special attention to their reactions, being able to discriminate what pleases or not, and expanding the possibilities of encounter of people with LTNC and the environment which surround them. Therapist should also provide support and guidance to the family, which is in a vulnerable situation. Regardless of neurological reactions presented by the patients this practice helps reconstructing the meanings of the daily life of person with so severe disability. Sensory stimuli are shown as potential tools for a rehabilitation practice. Memory, history, identity, dignity, and subjectivity qualify the assistance for people with LTNC.

A review on the performance of brain-computer interface systems used for patients with locked-in and completely locked-in syndrome.

Patients with locked-in syndrome (LIS) and complete locked-in syndrome (CLIS) own a fully functional brain restricted within a non-functional body. In order to help LIS patients stay connected with their surroundings, brain-computer interfaces (BCIs) and related technologies have emerged. BCIs translate brain activity into actions that can be performed by external devices enabling LIS patients to communicate, leading to an increase in their quality of life. The past decade has seen the rapid development of BCIs that have the potential to be used for patients with locked-in syndrome, from which a great deal is tested only on healthy subjects and not on actual patients. This study aims to (1) provide the readers with a comprehensive study that contributes to this growing area of research by exploring the performance of BCIs tested specifically on LIS and CLIS patients, (2) give an overview of different modalities and paradigms used in different stages of the locked-in syndrome, and (3) discuss the contributions and limitations of BCIs introduced for the LIS and CLIS patients in the state-of-the-art and lay a groundwork for researchers interested in this field.

Using fMRI to localize target regions for implanted brain-computer interfaces in locked-in syndrome

ObjectiveElectrocorticography (ECoG)-based brain-computer interface (BCI) systems have the potential to improve quality of life of people with locked-in syndrome (LIS) by restoring their ability to communicate independently. Before implantation of such a system, it is important to localize ECoG electrode target regions. Here, we assessed the predictive value of functional magnetic resonance imaging (fMRI) for the localization of suitable target regions on the sensorimotor cortex for ECoG-based BCI in people with locked-in syndrome. MethodsThree people with locked-in syndrome were implanted with a chronic, fully implantable ECoG-BCI system. We compared pre-surgical fMRI activity with post-implantation ECoG activity from areas known to be active and inactive during attempted hand movement (sensorimotor hand region and dorsolateral prefrontal cortex, respectively). ResultsResults showed a spatial match between fMRI activity and changes in ECoG low and high frequency band power (10 – 30 and 65 – 95 Hz, respectively) during attempted movement. Also, we found that fMRI can be used to select a sub-set of electrodes that show strong task-related signal changes that are therefore likely to generate adequate BCI control. ConclusionsOur findings indicate that fMRI is a useful non-invasive tool for the pre-surgical workup of BCI implant candidates. SignificanceIf these results are confirmed in more BCI studies, fMRI might be used for more efficient surgical BCI procedures with focused cortical coverage and lower participant burden.

Unlocking the Clinical Manifestations and Classifications of Locked-In Syndrome: A Comprehensive Review

Locked-in syndrome is a rare neurological condition characterized by complete paralysis of all voluntary muscles except for the muscles controlling eye movement. It is caused by damage to the ventral part of the brainstem, often resulting from vascular events. The syndrome is devastating, as patients are fully conscious but unable to communicate verbally or move any body part except for vertical eye movements and blinking. LIS can be classified into subtypes based on the extent of motor involvement, including classic, incomplete, total, and total with anarthria. Diagnosis is challenging but relies on clinical presentation and neuroimaging studies. Differential diagnosis is essential to distinguish LIS from similar conditions with altered consciousness. Prognosis varies depending on the underlying cause, with younger age associated with better outcomes at the onset. Rehabilitation can improve motor function and communication capabilities, leading to a higher quality of life for LIS patients. Early recognition and accurate diagnosis are crucial for implementing appropriate management strategies and improving patient outcomes. Further research is needed to explore therapeutic interventions for enhancing recovery and functional independence in LIS patients.

Human-Behavior-Based Personalized Meal Recommendation and Menu Planning Social System

The traditional dietary recommendation systems are basically nutrition or health-aware where the human feelings on food are ignored. Human affects vary when it comes to food cravings, and not all foods are appealing in all moods. It takes a lot of effort to learn people’s food preferences and make recommendations based on their affects and nutrition. A questionnaire-based and preference-aware meal recommendation system can be a solution. However, automated recognition of social affects on different foods and planning the menu considering nutritional demand and social affect has some significant benefits over the questionnaire-based and preference-aware meal recommendations. A patient with severe illness, a person in a coma, or patients with <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">locked-in syndrome</i> and <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">amyotrophic lateral sclerosis</i> (ALS) cannot express their meal preferences. Therefore, the proposed framework includes a social-affective computing module to recognize the affects of different meals where the person’s affect is detected using electroencephalography (EEG) signals. EEG allows to capture the brain signals and analyze them to anticipate affective state toward a food. In this study, we have used a 14-channel wireless Emotiv Epoc <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$+$</tex-math> </inline-formula> to measure affectivity for different food items. A hierarchical ensemble method is applied to predict affectivity upon multiple feature extraction methods and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) is used to generate a food list based on the predicted affectivity. In addition to the meal recommendation, an automated menu planning approach is also proposed considering a person’s energy intake requirement, affectivity, and nutritional values of the different menus. The bin-packing algorithm is used for the personalized menu planning of breakfast, lunch, dinner, and snacks. The experimental findings reveal that the suggested affective computing, meal recommendation, and menu planning algorithms perform well across a variety of assessment parameters.

Altered brain dynamics index levels of arousal in complete locked-in syndrome

Complete locked-in syndrome (CLIS) resulting from late-stage amyotrophic lateral sclerosis (ALS) is characterised by loss of motor function and eye movements. The absence of behavioural indicators of consciousness makes the search for neuronal correlates as possible biomarkers clinically and ethically urgent. EEG-based measures of brain dynamics such as power-law exponent (PLE) and Lempel-Ziv complexity (LZC) have been shown to have explanatory power for consciousness and may provide such neuronal indices for patients with CLIS. Here, we validated PLE and LZC (calculated in a dynamic way) as benchmarks of a wide range of arousal states across different reference states of consciousness (e.g., awake, sleep stages, ketamine, sevoflurane). We show a tendency toward high PLE and low LZC, with high intra-subject fluctuations and inter-subject variability in a cohort of CLIS patients with values graded along different arousal states as in our reference data sets. In conclusion, changes in brain dynamics indicate altered arousal in CLIS. Specifically, PLE and LZC are potentially relevant biomarkers to identify or diagnose the arousal level in CLIS and to determine the optimal time point for treatment, including communication attempts.

Brain–Computer Interfaces, Completely Locked-In State in Neurodegenerative Diseases, and End-of-Life Decisions

In the future, policies surrounding end-of-life decisions will be faced with the question of whether competent people in a completely locked-in state should be enabled to make end-of-life decisions via brain-computer interfaces (BCI). This article raises ethical issues with acting through BCIs in the context of these decisions, specifically self-administration requirements within assisted suicide policies. We argue that enabling patients to end their life even once they have entered completely locked-in state might, paradoxically, prolong and uphold their quality of life.