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Technological perspectives and reflections of neural engineering

The rapid evolution of the neurotechnology field, a Deep Tech segment with enormous economic potential, is rapidly contaminating research laboratories, clinical centers of advanced therapeutic applications. On the one hand, new neurotechnologies redefine what is possible in research, therapy, and human abilities. On the other hand, in-depth considerations are essential in relation to the profound legal, ethical problems and related social implications.

The human brain is an extremely complex organ, vital for the functioning and well-being of individuals. To date, the structure and functioning of this "gray matter" are not yet fully understood. Doctors, psychologists, neuroscientists (cognitive), philosophers, and jurists constantly try to understand how the brain works, what the mind is, how neurological or psychiatric diseases can arise, and be treated. The neurosciences are highly interdisciplinary field research in the study of the brain has seen exponential growth in recent decades. There are several technological developments, part of the driving forces behind this growth. There are many categories that make up cognitive neurotechnologies, in particular:

- robotics

- machine learning and artificial intelligence

- neural engineering, neuro devices, neuroimaging

- nutraceuticals

A glance together

Before the advent of brain imaging (such as magnetic resonance imaging) that made it possible to study the human brain in vivo, scientists had to rely on the study of the post-mortem human brain or the use of animals. Neuroimaging techniques (such as fMRI, PET, or CAT) are useful both for the study of the brain and in the clinical setting for diagnostic purposes (e.g., MRI or EEG).

The neuroimaging remains an important tool to increase the knowledge of the brain, but are conducted more and more attempts to be able to alter or assist the brain functioning through technology, neuro pharmaceutical and neural stem cells.

An approach to the study of the brain and its engineering is through reverse engineering, in which the models of (parts of) the human brain are artificially constructed to improve understanding or to facilitate the creation of more performing ICT devices. It is in the field of neuro devices that the convergence between biology and technology is more advanced.

Due to the effects of cross-pollination and knowledge spillover, the insights and technologies of neuroscience are increasingly used also in non-medical fields and practices.

Noninvasive, slightly invasive, invasive neuro-devices

The neurofeedback (EEG or fMRI neurofeedback) uses brain activity, which is recorded and displayed in real-time, to allow a person to learn to regulate their own brain activity. For example, two bars are shown; one represents the desired brain activity, and the other the measured activity.

The person must then train to adjust the second bar, which represents the measured brain activity to the first (reference) bar. Brain activity can be measured with EEG (electroencephalogram) or fMRI (functional magnetic resonance imaging). The neurofeedback EEG is already offered in clinical settings as a treatment for ' ADHD and various other diseases.

Transcranial magnetic stimulation (TMS)

The TMS devices generate a magnetic field above the skull -ad a depth of about 3.5 cm- that influences the electrical activity of neurons, altering the cognition or motor function. The TMS is used for the treatment of refractory depression and off-label for many other syndromes and diseases, including stroke. It is also used as a diagnostic and research tool. There is scientific evidence indicative of how this technology can be used for cognitive improvement.

The current continuous transcranial stimulation (TDC) is another important transcranial stimulation technology. It uses small electrodes for delivering a low current to the brain, with medical applications and empowerment neurocognitive. The brain-computer interfaces noninvasive (BCI) are devices that record brain activity and translate it into signals using external devices. The effects of this control can also be "returned" to the user of the system (in neuro-feedback), which can allow further applications.

The BCI can, therefore, be used to "enable a new real-time interaction between the user and the outside world. For example, when paralyzed patients are able to control a wheelchair or communicate via a computer, this allows them to continue communicating and controlling their surroundings. Brain activity can be recorded with EEG (portable) or with fMRI (non-portable). In noninvasive BCIs, training, and training is required for the patient to learn to use the BCI and to refine the translation algorithm for the individual patient.

In the case of a passive BCI, brain activity can be recorded for reasons other than medical ones, for example, to monitor a cognitive state. Although noninvasive neuro devices are being tested, or even already offered in clinics, much work is still needed to explore the full potential of these technologies. However, it should be noted that, even in case of further important progress, not all these technologies will reach the mass market i.e., the functioning of fMRI.

Invasiveness

The brain-computer interfaces (BCI) can also be invasive; brain activity is recorded within the skull - both on the outer part of the cortex both within the brain tissue, using electrocorticography. The invasive BCI generally increases the performance (accuracy and speed) with respect to BCI noninvasive but is obviously riskier. Also, the long-term effects are not yet sufficiently studied. A related research field is that of neuroprosthetics, which ranges from cochlear implants (already well established) to artificial limbs controlled by the brain (still in the initial research phase). Finally, a new group of technologies for invasive brain engineering is represented by therapies with neural stem cells.

This approach aims to replace neurons lost due to illness (Parkinson's disease, Alzheimer's disease) or injury (e.g., a stroke or accident). Some approaches to neural replacement therapy through the use of stem cells have already entered the clinical trial phase of research, but it should be stressed how complex and not risk-free.

The new neurons should grow sufficiently to be integrated into the brain: if they do not develop properly, they could cause seizures or pain. On the other hand, they could also grow too well and develop into a cancerous form.

Technology-based on EEG neurofeedback for enhancement and entertainment

In both clinical and laboratory settings, EEG neurofeedback technology is offered and studied as a (possible) treatment for conditions such as ADHD or insomnia, as already anticipated. However, this technology has also attracted attention outside the medical field.

Several neuroheadsets that use EEG technology to record brain activity can be purchased both to monitor responsiveness or relaxation status, and for recreational purposes games based on brain activity. It is necessary to underline that if EEG neurofeedback devices are placed on the market for a non-medical purpose (play, relaxation, etc.). They are not considered medical devices and must therefore not comply with current regulations on medical devices, in particular on the new MDR regulations. However, since EEG neurofeedback technology for the game, the improvement of concentration and relaxation is very similar (or even equivalent) to the clinical one. 

It is logically foreseeable that the same side effects and acceptable risks may occur. Side effects include both headache and difficulty falling asleep following the use of EEG neurofeedback. It 'also at risk of verifying the induction of crisis epileptic, particularly when the neurofeedback EEG technology is used incorrectly, although it is not very clear etiological dynamics. This necessarily entails questions and reflections on the safety of neurotechnologies, especially if used by subjects without adequate training.

Invasive neuro devices

In deep brain stimulation (DBS), the electrodes are positioned deep inside the brain in order to alter the functioning of the brain; they are connected to a pulse generator via conductors (wires), implanted in the body. The pulse generator is placed under the clavicle or in the abdomen. The DBS is primarily used to treat the symptoms of Parkinson's disease and is used experimentally for psychiatric conditions such as obsessive-compulsive disorder or depression. The DBS is only the symptoms of the disease and not cure the disease. Due to the risks and side effects involved, DBS is currently a therapy of last resort. It should be noted that potential cognitive improvement effects have also been reported.

Deep stimulation and deep reflections

In the treatment of motor disorders and experimental treatments for psychiatric disorders, incidental discoveries have led to critical reflections relating to the body, mind, and behavior. Brain electrical stimulation can lead to unexpected cognitive side effects. For an instant, the case of a person who has become bipolar due to his treatment with DBS for Parkinson's disease is reported. The therapy led him (among other things) to embark on a relationship with a married woman, to squander the family patrimony, to buy real estate, to compile an autobiography. These activities were in no way compatible with personality and pre-treatment behavior and led to inevitable legal and financial repercussions.

In a follow-up, the patient decided to be admitted to a psychiatric hospital during the administration of the deep stimulation therapeutic cycle. The case studies also report potential non-medical applications of DBS, humoral (for happiness)neural engineering, and mnemonic (more detailed memory) improvement. These effects on the mind raise many types of reflections in the psychological and psychiatric area to explore the extent to which our emotions and cognitions can be manipulated.


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