This summer, doctors in St Louis, Missouri, shaved away a small part of a person’s skull and replaced it with electrodes. The technology is intended to alleviate severe depression by sending tiny electric pulses to the brain.
Inner Cosmos, the start-up behind the surgery, is one of a growing cadre of tech companies working on implanted devices for the brain.
The trial, the first of its kind using implants in the bone of the skull to treat depression, represents a step forward for scientists’ efforts to treat mood disorders with hardware. It is also a sign of progress for implants that sit within the skull.
“Any time you get a technology in a patient is a major milestone,” said Benjamin Rapoport, a New York-based brain surgeon who works with another company in the field.
Other high-profile brain-related start-ups are focused on helping people cope with paralysis. Elon Musk says his company, Neuralink Corp, has enabled monkeys to play video games with their minds. Synchron Inc recently started its first US human trial, which it hopes will let a person send e-mails and texts using only thoughts.
Unlike these companies, Inner Cosmos is focused on moods. It also uses a different type of surgery. It is less invasive than the technique planned by Neuralink, which has raised more than US$360 million, and aims to place electrodes deeper inside the brain.
The simpler the surgery, the more people are likely to be open to it, Inner Cosmos chief executive officer Meron Gribetz said.
That is helpful for the company’s goal of creating a new mass-market tool for treatment-resistant depression, which affects an estimated 2.8 million US adults.
As the technology around brain implants develops, more companies have pursued methods of embedding a device that do not require piercing the brain.
“Whether it penetrates brain tissue or not is a deep divide” when it comes to next-generation neuromodulation surgery, said Rapoport, who is cofounder of brain-computer interface company Precision Neuroscience Corp, which is focused on placing electrodes just inside the skull, on top of the brain.
In Los Angeles, Kernel has moved away from deeper brain implants and is building an electrode-studded helmet that accomplishes similar goals, but requires no surgery. New York-based Synchron, which has raised more than US$60 million, avoids brain surgery by sending electrodes to the brain through blood vessels, in a stent.
The overall idea is not new: Implanted electrodes have a years-long track record of treating epilepsy and Parkinson’s.
What is noteworthy about Inner Cosmos is its ability to capture what scientists call high-resolution local field potentials — localized electrical potential from the surface of the brain that overcome the randomness of individual neuron recordings — while not penetrating into the brain itself. If it works, the technique could eventually treat a much broader range of cognitive disorders.
Inner Cosmos said surgery went well for its first patient. Once a day for about 15 minutes, the implant sends pulses to the person’s left dorsalateral prefrontal cortex while measuring neuronal activity to gauge and adjust the correct amount of stimulation. The trial is to last for one year, and might add one or two more patients.
Neuroscientists have debated which part of the brain to target to achieve the best results in depression treatments. The area Inner Cosmos targets is similar to that of another technique, known as transcranial magnetic stimulation, which does not require surgery, but takes longer to implement than the Inner Cosmos device.
There are trade-offs for brain devices that do not go deeper into people’s heads.
Stanford University neurosurgeon Jaimie Henderson, a consultant to Neuralink, works with neuron-by-neuron data from deep within the brain, with his research enabling a paralyzed man to type using his thoughts.
By remaining within or outside of the skull, Henderson said, devices do not receive the same level of detailed data as they could by using more aggressive techniques that penetrate brain tissue.
“Rather than a fine-grained representation of what is happening at the individual neuron level, the information they capture is an average of the electrical activity within a certain brain area,” he said.
Inner Cosmos chief technology officer Jesse Wheeler said that might actually make the data more useful, as the broader sweep of information is less prone to distortions that might come from individual neurons.
Most scientists in the field say that because the brain affects so many health areas, there is room for a spectrum of strategies.
“There are definitely more companies trying to do less and less invasive things, because that always makes a product easier to adopt and the path to market shorter,” said Max Hodak, the former chief operating officer of Neuralink, who is now running his own optics-based brain-computer start-up, Science Inc. “But I think that long term, the most astonishing products will require an implant.”
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