The future of brain-computer interfaces (BCIs) is moving closer to the present. BCI is a technology that turns electrical activity from neurons into commands to control external devices, allowing people to use, type, and communicate through computers with their thoughts.

Mullin E. The Race to Put Brain Implants in People Is Heating Up. Wired. December 23, 2023.

Versions of the technology have been examined for years to determine whether they can improve communication for people with brain signaling impairments. While they have been used on patients in clinical trials, BCIs have not yet been approved by the Food and Drug Administration (FDA) for wider use.

U.S. Food and Drug Administration. Implanted Brain-Computer Interface (BCI) Devices for Patients with Paralysis or Amputation - Non-clinical Testing and Clinical Considerations. May 2021.

 

One of the latest BCI attempts comes from Elon Musk’s startup Neuralink: a device called Telepathy.

Mullin E. Neuralink’s First User Is “Constantly Multitasking” With His Brain Implant. Wired. May 22, 2024.

Neuralink was founded in 2016 and implanted Telepathy into its first patient this January. Now, the patient is using the device to browse websites, play computer games, and more. The FDA recently greenlit Neuralink to implant Telepathy into a second patient, with some proposed changes.

Winkler R. Exclusive: Musk's Neuralink Gets FDA Green Light for Second Patient, as First Describes His Emotional Journey. The Wall Street Journal. May 20, 2024.

 

 

What are the risks and benefits of BCIs?

 

Santosh Kesari, MD, PhD, a board-certified neurologist at Providence Saint John’s Health Center in Santa Monica, CA, and Regional Medical Director for the Research Clinical Institute of Providence Southern California, calls BCIs an “exciting area of science.”

“It's a cutting-edge, exciting area of medicine and science to help patients that really have no options to communicate,” Dr. Kesari says.

For people with spinal cord injuries, ALS, or other conditions that impair their communication abilities, “brain-computer interface is a substitute for our normal neural connections,” Dr. Kesari says.

People who are best-suited for these devices are those who feel that their conditions severely impact their quality of life, and whose cognitive function is intact, he adds.

“The brain is intact, but the signals are not getting to the extremities, the arms or legs, or the patient is not able to do their daily activities: communicating, using a computer, sipping a glass of water, things like that,” Dr. Kesari says. “Because of the injury, they're not able to do those things or, sometimes, even simple communication through typing or talking.”

However, the procedure should not be looked at as a quick fix and is not for everyone, Dr. Kesari says. 

“Because it does involve brain surgery, obviously, the risks and benefits have to be weighed,” Dr. Kesari says.

Though it has been made safer and less invasive over the years, brain surgery remains a serious and risky operation. As such, while this offers patients who have lost brain signaling capabilities “an amazing opportunity to be able to communicate on their own,” Dr. Kesari says that people with intact signaling or mild impairments should not be vying for a BCI.

 

Changes before second BCI implant

 

While Neuralink’s first implantation of Telepathy appears to have been largely successful, the surgery was not seamless. The company reported that tiny wires used in the device retracted from the patient’s brain, resulting in fewer electrodes that could measure, and thus transmit, brain activity.

Levy R. Exclusive: Musk's Neuralink has faced issues with its tiny wires for years, sources say. Reuters. May 15, 2024.

Now, with the FDA’s green light for the second patient, Neuralink has said that it will be making some changes to reduce chances of wire retraction. 

 

Future trials will tell if an FDA approval is on the horizon. If and when that happens, Dr. Kesari says, Telepathy and other BCI devices have great potential for helping people with spinal cord injuries. Years down the line, it may pave the way for even more advanced brain-body communication, he adds.

“Fundamentally, the Neuralink device is translating thought into action,” Dr. Kesari says. “While currently the thoughts are moving cursors on a computer screen, we can imagine in the future that these thoughts will be connected to bioelectronics to enable people with spinal cord injury to walk and do physical tasks that they are unable to do otherwise.”