Neural Engineering Meets Clinical Neuropsychiatry – Recent Successes, Some Failures, and a Peek into the Near Future

Abstract

Approximately 30 years ago, when I began my career, we could finally begin to view the living human brain without sacrificing people. CT, then PET, then MRI allowed us to see and understand the brain, much like the rest of medicine had long been able to view other less interesting organs like the heart or liver. Adventurous scientists quickly quickly started using these brain maps enabled by the brain imaging revolution to guide tools to stimulate the brain. The fields of brain stimulation and neural engineering were born. Both invasive and non-invasive brain stimulation methods are now rapidly proliferating, with the technological advances far outstripping our clinical knowledge of where to apply them and in which diseases.

In this talk, I will outline the main brain stimulation methods in place and a few that are on the drawing board. I will talk largely about lessons learned in getting FDA approval for transcranial magnetic stimulation (TMS) for treating depression, and vagus nerve stimulation for treating epilepsy, depression and now other disorders. The rapid growth of brain stimulation startup companies in some ways resembles the California Gold Rush. I will use several examples to make the case that whether a technique makes it to FDA approval and general clinical use depends on many factors, only some of which are scientific. The future is bright for neural engineering and brain stimulation.