Summary

Neuroprosthetics is the use of direct electrical stimulation of the nervous system for functional performance. There are three types of neuroprosthetic: motor, sensory, (auditory with cochlear implants and visual with retinal implants), and cognitive. And four main types of techniques: Deep Brain Stimulation, spinal cord stimulation, peripheral nerves stimulation, and sacral nerves stimulation. A neuroprosthetic has four steps: i. collecting neural signals or sending signals (stimulation) to neurons, ii. processing signals iii. communicating with the neuroprosthetic, and iv. taking action. Note: A Brain-Computer Interfaces connects with computers rather than a device meant to replace missing biological functionality as with neuroprosthetics.

Viability (4) Technical viability

The first cardiac pacemakers arrived in the 1930s and now there are a wide variety of approved neuroprosthetics in the market in 2022 from cochlear implants to autonomic functions such as control of bladder and bowel. The research frontier is different in motor, sensory or cognitive fields. Motor neuroprosthetics is closely related to robotics and increasing dexterity and control. Sensory and cognitive neuroprosthetics in using Optogenetics for precise neural stimulation.

Drivers (5)

On the demand-side, an ageing global population and the growing incidence of neurological disorders and hearing loss. In 2016, neurological disorders were the leading cause of DALYs (276 million) and second leading cause of deaths (9 million) a burden that continues to rise. With 6.1% of the world population live with hearing loss, and by 2050, more than 900 million people will have a disabling hearing loss. On the supply-side, neuroprosthetics are rapidly improving benefitting from computing miniaturisation and cost declines. The recent developments of the self-charging neural implant and safer surgical procedures (see ‣) are decreasing costs and risk.

Novelty (5)

There are no alternatives for the direct electrical stimulation of the nervous system as a method. For motor or sensory-based disorders, neuroprosthetics have little competition because the nervous system must be directly stimulated. However, drugs and other therapies compete with cognitive neuroprosthetics to alleviate diseases such as Alzheimer's and other dementias, stroke, and Parkinson's disease. Relative advantages depend on efficiency, safety and cost for which Deep Brain Stimulation is generally most useful in cases where drugs don’t work effectively.

Diffusion (2)

On the implant side, diffusion patterns are a function of the cost, complexity and risk of surgery. For this reason, we’ve already seen sensory neuroprosthetics like cochlear implants most widely adopted because mastoidectomy with facial recess approach (MFRA) is a relatively simply surgery compared to implanting electrodes into brain tissue through the skull as is common for Deep Brain Stimulation. Better and cheaper prosthetics and safer surgical procedures will enable prosthetics to keep up with growing demand. Nevertheless, neuroprosthetics or simply surgery will continue to be expensive solutions relative to drugs and other non-invasive solutions. One catalyst for a massive cost reduction will be robot-assisted neurosurgery which continues to improve but requires progress in accuracy of intraoperative visualization and manipulation of tissue.

Impact (5) Medium certainty

The medium impact scenario sees the neuroprosthetic experience improve in particular with soft robotics for the prosthetic, Molecular Computing or Neuromorphic Computing for I/O parameter processing, and Haptic Technology for sensory feedback. With robotic surgery combined with better sensors and prosthetics, neuroprosthetics is an obvious pathway to “super-human” abilities tipping over into augmented humans and cyborgs. Certainly, the easiest pathway is via cochlear implants for “super-hearing” and retinal implants for “super-vision” allowing users to hear in low and infrasonic frequencies or allow the eye to “see” ultraviolet or infrared wavelengths. Assuming humans will slowly augment themselves (baring a major discontinuous event), neuroprosthetics are the gateway to transhumanism.

Timing (2025-2030) Low Certainty

Prosaically, the market is worth $5 billion in 2020 and estimated to be around $15B market by 2030 growing at 10% a year. There is a growing market for the treatment of neurological illnesses, hearing loss, diabetes, and amputation which will keep the market growing. This market is neuroprosthetic as healthcare not neuroprosthetic as enhancement. The big question is when we move from healthcare to enhancement. It’s hard to argue for a phase change before 2030+ considering the progress required to make surgery cheaper and neuroprosthetics more accurate. The market is nevertheless investible as a medical device market before 2030.