Brain-computer interfaces (BCIs) integrate the brain with silicon-based hardware to treat a whole host of drug-resistant mental health conditions. These neural interfaces are also used to restore movement, sensory abilities, and communication in patients suffering from paralysis. Presently, much investment is underway to utilize these BCIs as future electroceuticals, bioelectronic medicine which delivers ‘doses’ of electrical impulses to treat medical conditions within our bodies.
In the not-so-distant future, neural interfaces marrying the nervous system to machines will become the mainstay of medical treatments as opposed to pharmaceutical entities. This is according to a seminal study from GlaxoSmithKline stating that soon, physicians will simply administer electrical impulses to the brain to treat a cornucopia of conditions as opposed to prescribing drugs.
Indeed, the very same experts have predicted that these neural interfaces or BCIs will target individual nerve fibers or specific brain circuits to treat any desired medical condition in the body with absolute precision.
It is well established that pharmaceuticals can have a whole host of side-effects ranging from death or serious harm to milder events such as weight gain or decreased libido. BCIs can also cause adverse events, however, it is well documented that side-effects associated with these neural devices are less severe than those of drugs. Additionally, some medications can prove ineffective as they affect the entire body, whereas interfaces can be trained on relevant areas of the brain to provide a honed treatment.
Furthermore, there is also the added hurdle of drug resistance, with many neurological conditions already becoming unreactive to drug regimes, rendering them untreatable. For instance, one-third of cases involving depression (the most common mental health condition, and the leading cause of disability worldwide) are regarded as treatment-resistant. Likewise, a staggering 20-30% of epilepsy cases globally are now estimated to be resistant to drugs.
This means that BCIs may offer a crucial and life-saving alternative to treat mental health conditions that have been deemed drug-resistant or may denote the use of harsh, untargeted therapeutics.
How neural interfaces work
Neural interfaces can be classed under the broader discipline of electroceuticals or bioelectronic medicine. This is where electrical impulses target the nervous system to treat a multitude of medical conditions. According to Kris Famm, the president of Galvani Bioelectronics, it is estimated that electroceuticals will become the preferred mode of medical treatment over the next two decades, benefiting up to 2 billion people who are suffering from chronic diseases. A report from McKinsey & Company predicts even bigger returns stating the bioelectronic market will represent a multi-billion-dollar opportunity even with “modest penetration”.
Specifically, BCIs connect the central nervous system to artificial intelligence (AI) via interfaces that may be implanted in the brain, known as invasive systems. In contrast, these interfaces can also be worn on the body externally in the form of wearables or non-invasive systems. In turn, these invasive or non-invasive sensors, usually electrodes, harness complex algorithms to analyze brain signals and extract relevant brain patterns to treat multiple mental health conditions.
To illustrate, some neural interfaces record physiological activity, such as brain signals or the sequential activity of networks of neurons, whilst others stimulate the specific parts of the brain to produce an action, such as communication or the movement of a limb. There are even smart ‘closed-loop’ BCIs that can record complex brain activity and deliver stimulation to the desired area automatically, with AI continually updating and integrating with the brain. Work has already begun on Nextgen closed-loop systems with non-invasive sensors to detect signs of traumatic brain injury, dementia, and schizophrenia. The researchers have stressed that they already plan to integrate their sensor into an electroceutical close-looped system to automatically detect and treat various mental disorders and conditions.
Neural interfaces are already used to treat some medical conditions
Indeed, electroceuticals have a long history in medicine (think pacemakers for the heart or tens machines for back pain). The most widespread electroceutical is the cochlear implant, which substitutes damaged parts of the ear to provide hearing for around 400,000 impaired people worldwide. According to a leading report from the Royal Society, many other transformative sensory implants are at an earlier stage of development. One notable example is the retinal implant already approved for use in the USA and Europe, which provides people who have lost their sight with a form of vision.
BCIs have also been used to treat people who have suffered catastrophic insults to the nervous system such as stroke or a spinal cord injury. For example, newly demonstrated spinal implants have enabled people to walk again by boosting signals sent down the spinal cord from the brain. In the same way, BCIs have been used to integrate bionic limbs into the nervous system for quite some time. Running alongside this are trials involving tetraplegics where neuroprostheses have been successfully integrated into patient’s nervous systems. Moreover, patients with paralysis have been treated with interfaces in efforts to restore physical movement, bladder voiding, and communication.
In the same way, the quality of life of many paralyzed patients has been improved by wearable interfaced robots, such as the Hybrid Assistive Limb (HAL) from Cyberdyne. The HAL exoskeleton works by detecting the brain signals responsible for leg movements from the skin of users and conveying them to artificial limbs attached to the person’s legs, bypassing the injured spine. I’m happy to report that this non-invasive system was successfully upgraded in 2012 to grant assistive control of paralyzed arms, legs, and torso to its users.
Moving on from the decades-old TENS machine, chronic pain management has also been updated by harnessing signal tracts within the spinal cord. Another new target involves sacral neuromodulation in the treatment of bowel weakness and urinary incontinence. This works well, however, we are intricate bio-computers whose natural urinary control is an elegant, compact, and well-evolved process poorly mimicked by today’s devices… For now.
A bridge of communication for the silent, BrainGate, an invasive cortical implant, has enabled immobile people to use brain signals alone to move cursors, type on an electronic keyboard, and grasp using a robotic hand. The immobilized are being augmented through wearable interfaces too. This is being achieved through electroencephalography enabling them to type by mentally selecting the desired letter from a sequence on a screen.
Another commonly used cybermedicine comprises invasive deep brain stimulation (DBS) to counteract tremors caused by Parkinson’s disease. DBS is also the gold-standard for drug-resistant epilepsy with closed-looped systems used for many years to monitor, record, and treat seizures automatically over a long period. Likewise, DBS has been successful in small-scale trials among people with anorexia and obsessive-compulsive disorder.
Future electroceuticals to treat medical conditions
Things are progressing with remarkable speed. The Royal Society, one of the leading authorities on the subject, predicts that these neural interfaces under the guise of electroceuticals will have the capacity to modulate neural impulses controlling every part of the body, repair lost function, and restore health. As a result, cybermedicine is now being applied to physiological conditions and targets all over the body.
To illustrate the latent dormancy of this promising technology, the Royal Society expects electroceuticals to be able to coax insulin from cells to treat diabetes, regulate food intake to treat obesity or even correct balances in smooth-muscle tone to treat hypertension and pulmonary diseases. Fast becoming a reality, the Royal Society reports that hypertension has indeed been controlled by harnessing signals in the carotid-sinus and renal nerves.
Another futuristic inroad concerns the control of inflammatory molecules in rheumatoid arthritis. These molecules were modified in a study from the University of Minnesota through the non-invasive stimulation of the splenic and vagus nerve. By extension, a range of cardiovascular, metabolic, respiratory, inflammatory, and autoimmune conditions are likely to have similarly accessible intervention points, given that they involve organs and functions that are under neural control.
The McKinsey & Company report states there is much interest in controlling multiple medical conditions via the vagus nerve, known to control a vast array of crucial bodily functions. This large nerve runs from the brain to the abdomen interfacing with the parasympathetic control of the heart, lungs, and digestive tract. It also helps regulate immune pathways and cells. Consequently, it is a common target for many drug-based interventions. An example of one of these therapeutics is Humira in the treatment of rheumatoid arthritis and Crohn’s disease.
As can be imagined the ability to target a specific myriad of nerve fibers, cells, and tracts within this massive nerve bundle would be most advantageous. So far stimulation of the vagus to treat rheumatoid arthritis as well as Chrohn’s disease has won initial approval with other inflammatory conditions now being trialed. Most recently non-invasive, handheld vagal nerve stimulators to ease cluster headaches and migraines have gained approval from the US Food and Drug Administration. This highly connected nerve has also been tapped in trials to treat drug-resistant epilepsy, depression, and substance abuse.
How future electroceuticals will be developed and operated
Electrical impulses, otherwise known as action potentials, control our bodies. Technically, all bodily organs and functions are regulated through circuits of neurons in the brain via these impulses. Even the endocrine system is under the control of the brain via a complex array of feedback mechanisms and signaling pathways.
GlaxoSmithKline predicts that two features make these circuits excellent targets for therapeutic intervention. First, they comprise interconnected cells, fiber tracts, and nerve bundles which enable precise intervention. Second, they are controlled by patterns of action potentials, that can easily be recorded and altered for treatment by an implantable device. Specialists from the Royal Society state that even Alzheimer’s disease, which has proved resistant to all conventional therapies, might be halted or even reversed.
To evolve future electroceuticals, researchers need to map disease-associated nerves and brain areas and identify the best points and timed impulse patterns for treatment. A BCI can then be developed to control the action potential of these nerve fibers and their resulting outcome. Experts predict that in all probability miniaturized invasive implants will be used at the beginning, acting in a pacemaker capacity to alter and normalize electrical impulses to organs and pathways disrupted by disease.
This miniaturization is aided by the fact our nervous system is an amazing piece of machinery. Our neural tissue is incredibly compact with many unrelated circuits running in tandem through brain regions and in peripheral nerves.
At present, electrical devices activate or inhibit cells in an area of tissue indiscriminately, muddying clinical effects. However, electrodes are being developed on the micro-and nanoscale in readiness for single-cell electroceutical stimulation.
Many other disease-specific electroceuticals are now being explored in the laboratory. An almost limitless list, this technology brings with it much hope. This aspiration is not just weighted on the precise control this technique could afford, or even the number of patients’ lives it has transformed, it’s also the ease and lack of effort BCIs could extend. This is because you can alter an electrical current far more easily than the concentration of a drug in the blood. Patients can simply increase or reduce electrical currents, and in time AI will evolve to read and monitor their health status to do this for them. This is all married with the fact that the effects of stimulation are reversible if desired, unlike many surgical procedures.
The electroceutical industry is rapidly expanding amid serious investments from the biggest names in healthcare. As can be seen, many large technology companies and investor intelligence groups are now taking the lead, releasing open-source studies and data. Perhaps, the most highly exposed investment to-date is from Elon Musk in the guise of Neuralink, an invasive electrode array placed under the skin to ‘write’ brain data for a given function.
By tallying investments, it can be extrapolated that electroceutical researchers are on the cusp of great discovery and innovations. They are set to give a voice to the silent around the world, to restore limbs to the paralyzed, and to augment the human race in ways never before seen. Millions of patients could be freed from crippling drug regimens that are losing potency at an alarming rate and offered precision cybermedicine capable of targeting individual nerve cells in organs and disease. Lending a spark of ingenuity and hope in these difficult times, electroceuticals are fast becoming a cheaper and far more symbiotic reality in all of our futures. Things are looking up.
Michelle is a health industry veteran who taught and worked in the field before training as a science journalist.
Featured by numerous prestigious brands and publishers, she specializes in clinical trial innovation--expertise she gained while working in multiple positions within the private sector, the NHS, and Oxford University.