Why Neuromodulation is the Future of Recovery
Photo by Steve Baer | FireDog Photos
If we can do this now, what may the future bring? The next horizon: Symptom relief, long-term recovery, and how to support innovation through awareness and funding
Part 4 of a 5-part series
For a firefighter, a “career-ender” used to be a definitive and devastating sentence. A massive stroke, a severe spinal injury, or the relentless grind of chronic back pain would often mean the end of the mission.
These conditions interrupt the complex functioning of the brain, the spinal cord, and the sprawling network of nerves. Fixing such deeply complex, structural problems requires a great many tools in the box.
As a neurosurgeon, I spend my days focused on the most intricate tool any of us will ever own: the human nervous system. At UConn, much of my clinical work revolves around the delicate process of placing microscopic wires and advanced batteries to fundamentally alter how that nervous system works. Until very recently, these revolutionary treatments would have seemed like pure science fiction.
The Problem – Injuries That Don’t Heal
Our brains and spines are incredibly delicate and notoriously unforgiving. Healing these injuries is not quick, and all too often, the damage becomes a chronic, lifelong burden. The nervous system is exceptionally poor at regenerating, unlike a broken bone that naturally knits back together or skin that easily forms a scar.
For decades, treatment options in these scenarios have been strictly limited to physical therapy and preventative care. Truly regaining lost function has been completely out of grasp and is a deeply frustrating reality for both patients and medical providers.
Changing that reality requires breaking down the two fundamental functions our brains rely on to interact with the world around us: input and output. Inputs are all the complex information we take in through our senses. Outputs manifest as a direct response to that information, primarily through movement and speech. Successfully helping our patients depends on which of those systems is broken and where the core problem is located within their nervous system.
The Present – Rehabilitation and Modulation
If the problem lies in the output system, deep brain stimulation (DBS) has become an increasingly reliable answer. As one of the most highly successful neuromodulation treatments, originating in the 1990s, it has significantly helped patients struggling with a wide variety of debilitating conditions, most notably Parkinson’s disease and severe essential tremor. Deep brain stimulation acts like a cardiac pacemaker for the brain. These highly calibrated devices disrupt the erratic electrical signals that cause tremors, decreasing the amount of tremors, and making previously jagged movement much smoother.
Another neuromodulation procedure having a similarly profound impact on patients’ lives is known as spinal cord stimulation (SCS). Unlike DBS, this procedure caters to those with chronic pain that stems from an input problem. The neurological systems that are normally in place for touch end up incorrectly transmitting signals to the brain, resulting in debilitating, constant pain.
In these cases, chronic pain stimulators can be implanted to physically target the distinct pathways of that pain. They intercept or completely scramble the rogue signals long before they can ever reach the brain to be felt.
A third type of neuromodular intervention, vagus nerve stimulation (VNS), is life changing for those who have recently suffered a stroke. For a very long time, stroke recovery followed a highly predictable, and often deeply frustrating, path. After the initial, intensive window of physical and occupational therapy, many motivated patients would simply hit a hard plateau where progress stalled entirely.
Now, we can implant a device by the name of Vivistim. The device works by sending targeted electricity to stimulate the vagus nerve, allowing the brain to fundamentally rewire and adapt to its new circumstances. Engaging the specific areas of the brain that naturally boost wakefulness and neurological adaptation is an extraordinary feat. The undeniable success of this treatment has not only jump started massive interest in the broader field, but has unequivocally proven that real progress against these conditions is, in fact, possible.
The Future – Treating the Untreatable
Despite these incredible advances in present-day medicine, our historically poor understanding of the complete nervous system has limited the scope of available treatments. However, recent and rapid breakthroughs mean we are now standing on the cusp of entirely new therapies – ones that turn classic tropes of science fiction into the beginning of a new clinical reality.
It would be nearly impossible to talk about the current excitement surrounding neuromodulation without explicitly mentioning Neuralink, a high-profile company that’s been aggressively at the forefront of developing the “brain-computer interface (BCI).” These are devices that augment human life via deep integration of tech and biology. More specifically, they record electrical activity from the brain/nerves, and then seamlessly translate those signals into commands that can control external systems like computers or prosthetic systems.
People are hungry for this type of advancement. Ongoing trials with human patients continue to garner monumental public attention, proving there is so much power in these developments, both clinically and societally.
Another company, Science Corp, is working on an innovative device called PRIMA. This implant carefully places a tiny, advanced chip directly at the back of the eye in patients suffering with total blindness. The device targets specific nerves that normally carry visual information to the brain, stimulating them and often restoring very meaningful levels of functional vision.
We can now even place tiny implants inside blood vessels to accurately record the brain’s signals, without the need for large and highly invasive open surgeries. Take the ambitious startup Synchron, for example. They are actively making a much less invasive brain-computer interface. This remarkable technology places a small, flexible wire directly into a vein at the top of the head, and can accurately record electrical signals from the brain.
Finally, Onward Arc is closely working to restore lost movement from devastating spinal cord injuries. That ambitious process involves interpreting what paralyzed patients intend to do based on recorded brain signals, then uses targeted electrical stimulation to prompt the spinal cord and surrounding nerves to carry out those movements.
Artificially reconnecting the brain and the body is widely understood as the central goal of the BCI field, and this progress shows that these engineered systems are already beginning to bridge that extraordinarily complex gap.
Our Path Forward
Physical injuries represent a significant yet hardly comprehensive set of applications for this technology. “Invisible” injuries, such as post-traumatic stress and treatment-resistant depression will likely also benefit. Beyond stroke, we are exploring how Vivistim can be used for traumatic brain injuries (TBI) and even systemic inflammation — the hidden killer that contributes to high rates of cardiac events and cancer in first responders.
The future of neuromodulation is about treating the nervous system at every level. It creates a world where disabilities and chronic illness no longer define the limits of what’s possible, and where the trauma of the job doesn’t have to follow you into retirement.
By supporting the labs, startups, and clinical trials driving these breakthroughs, we make this future possible. The new horizon is here. Let’s cross it together.
