Stem cell grafting for epilepsy: clinical promise and ethical concerns.
The recent explosion of research on stem cells and neural grafting holds great promise for many neurological conditions, including epilepsy. Potential roles for cell grafting in epilepsy include remodeling of dysfunctional neuronal circuits and local delivery of neuromodulatory or neuroprotective factors. While many basic questions remain to be answered, initial human trials are underway in epilepsy as well as Parkinson's disease, Alzheimer's disease, stroke, and other conditions. It is not too early to begin ethical reflection on this dynamic field. Donor cells are often derived from human embryos, raising scarcity concerns as well as opposition from anti-abortion forces. Alternative donor sources are being actively developed. Safety concerns, adequate consent, and equitable access to care will also become important issues. Ethical issues most unique to neural grafting will revolve around redefining self-identity when personality and cognition may be altered by therapy. Views of selfhood and of being human have evolved in a historically contingent process, so that neural grafting and other consequences of the genetic revolution fall within a series of reductionist scientific developments that lead to an increasing instrumentation of our self-image. Neuroscientists and clinicians must interact with other cultural, religious, and academic groups to promote mutual understanding and richer, but scientifically accurate, views of what it means to be human. A good starting point may come by telling patients' stories, connecting scientific knowledge with the density of lived experience.
Santiago Grisolía
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Section of Neurology, Scripps--Mercy Hospital, San Diego, California, 92103; Department of Neurosciences, UCSD School of Medicine, San Diego, California, 92093.