Researchers at the Technical University of Munich systematically review 66 clinical studies on closed-loop neurotechnologies—adaptive DBS, responsive neurostimulation, and vagus nerve stimulation—and reveal that although safety and efficacy dominate reporting, deeper concerns like autonomy, mental privacy, and equity are rarely addressed, prompting evidence-based, community-led ethical standards.

Key points

• Thematic coding of 66 closed-loop neurotechnology trials reveals ethics figures mainly in procedural compliance rather than substantive analysis.
• Safety and efficacy metrics dominate discussions of beneficence and nonmaleficence; autonomy, mental privacy, justice, and lived experience remain underreported.
• Ten actionable recommendations propose interdisciplinary governance groups, stakeholder co-design, algorithmic transparency standards, and adaptive, evidence-based ethical frameworks.

Why it matters: By exposing ethical blind spots in AI-driven brain-stimulation trials, this review shapes a patient-centered governance paradigm for adaptive neurotechnology.