Neuralink and Xuanwu Hospital Announce Major Breakthroughs in Brain-Computer Interface Technology

On January 30, 2024, Elon Musk posted on social media that Neuralink had successfully performed its first human brain-computer interface implantation surgery, and the patient was recovering well.

Several hours later, Xuanwu Hospital and Tsinghua University School of Medicine announced a phased breakthrough in brain-computer interface (BCI) technology: the world’s first patient with quadriplegia to receive an implantable epidural electrode BCI for assisted therapy achieved autonomous brain-controlled drinking.

As early as 1973, Jacques Vidal of the University of California, Los Angeles (UCLA) first proposed the concept of “brain-computer interface”; fifty years later, the dream of controlling objects with thought alone has finally become a reality.

This technology, which holds the promise of transforming and benefiting humanity, has attracted the attention of governments worldwide, garnered fervent interest from capital markets, and prompted strategic investments from industry leaders such as Tesla, Google, Facebook, and Apple. So, for brain-computer interfaces (BCIs), currently at the forefront of technological innovation, how long a road remains to be traveled to achieve the leap from mere usability to optimal performance and, ultimately, large-scale application?

As a transformative human-computer interaction technology, brain-computer interfaces (BCIs) bypass peripheral nerves and muscles to directly establish communication and control channels between the brain and external devices, offering the capabilities to monitor, replace, enhance, supplement, and restore impaired or disabled natural central nervous system output and input.

There exists a significant global population whose organ damage, stemming from various causes, results in speech or mobility impairments that hinder their integration into mainstream society. This group is substantial in size; for instance, according to statistics from the China Disabled Persons’ Federation, China currently has 24.72 million people with physical disabilities, nearly 18 million individuals with visual impairments, and 27.8 million people with hearing disabilities.

Technology for Good, Benefiting Humanity. The original intention behind initiating brain-computer interface (BCI) research was to help paralyzed and disabled individuals regain the ability to communicate with the outside world. “Brain-computer interfaces can help people suffering from paralysis, motor dysfunction, epilepsy, and other conditions return to normal life, thereby alleviating the burden on their families. This is a highly meaningful endeavor and a pressing issue that the government is eager to address,” said Min Dong, Deputy Director of the Cloud Computing and Big Data Research Institute at the China Academy of Information and Communications Technology (CAICT).

Moreover, brain-computer interfaces can provide assistance to patients with chronic conditions such as Parkinson’s disease, stroke, Alzheimer’s disease, disorders of consciousness, tinnitus and hearing impairment, and visual impairment, holding significant importance in addressing the challenges posed by an aging society.

From the perspective of technological development trends, brain-computer interfaces (BCIs) represent a groundbreaking technology. Min Dong analyzes that human intelligence and machine intelligence will gradually merge in the future, fully leveraging machines’ storage and computational capabilities while integrating the human brain’s thinking and innovative capacities, thereby advancing artificial intelligence to a higher level—namely, brain-machine intelligence fusion. A key technological component enabling this fusion is BCI technology. “In the long run, BCI technology has broad application scenarios, spanning healthcare, entertainment, smart living, education, military, and other fields, which will drive transformation in related industries and create vast market opportunities.” In Min Dong’s view, the prospects for brain-computer interface technology are extremely promising.

Helping every population group live healthy and happy lives without discrimination is the goal of nearly all governments; proactively planning for future technological and industrial high grounds is the inevitable consideration and action of forward-thinkers. To this end, the European Union, the United States, Japan, South Korea, Australia, and others have vigorously developed strategic plans for brain-computer interface (BCI) technology, launching major R&D programs and representative investment projects targeting this field.In China, in October 2022, the Ministry of Industry and Information Technology and the National Medical Products Administration announced the shortlisted entities for the Artificial Intelligence Medical Device Innovation Task Force. Multiple brain-computer interface projects were included, marking the transition of related products in China from the "laboratory" to the "application field."In January 2024, the Ministry of Industry and Information Technology and other departments released the “Implementation Opinions on Promoting the Innovative Development of Future Industries,” in which brain-computer interfaces were included among the ten landmark products.

Brain-Computer Interfaces Have Become a Strategic High Ground Competed for by Major National Governments.

With the rapid advancement of brain-computer interface technology, a significant amount of capital has flooded into this field. According to"White Paper on the Application of Brain-Computer Interface Technology in the Medical and Health Sector (2023)"Prominent venture capital firms such as Sequoia Capital, Andreessen Horowitz, Y Combinator, and Founders Fund began focusing on and investing in brain-computer interface (BCI) startups at an early stage, while tech giants like Google, Facebook, Apple, and Tesla have invested heavily in the research, development, and commercialization of BCI technology. According to statistics, by the first quarter of 2023, global financing for representative BCI companies had exceeded $10 billion.

Driven by market forces, supported by policies, and bolstered by capital, recent major breakthroughs in brain-computer interfaces achieved by Elon Musk’s Neuralink and by Xuanwu Hospital in collaboration with Tsinghua University were a natural outcome.

Two Flowers Bloom, Each Branch Told Separately: Herein, the ins and outs of the two major breakthroughs are detailed respectively.

Neuralink Corp, founded in 2016, is dedicated to developing invasive brain-computer interfaces for brain-related diseases, creating a whole-brain interface that enables a tighter connection between biology and artificial intelligence.

In July 2019, Neuralink released its first product, the N1 Link (named Telepathy). That same year, Neuralink tested the device on monkeys. In 2020, Neuralink implanted the updated device into the brains of pigs. In 2021, Neuralink implanted chips into the brains of macaques, enabling them to play video games without a controller or keyboard. In September 2023, Neuralink recruited paralyzed patients for its first human clinical trial of the brain implant. This January, the first implantation in a human brain achieved initial success. Neuralink stated that it aims to help paralyzed patients walk again and even treat mental disorders such as depression through brain chip implants.

According to available data, the clinical trial of the wireless minimally invasive brain-computer interface conducted by Tsinghua University and Xuanwu Hospital passed the ethical review of Xuanwu Hospital in April 2023, and was registered for clinical trials of implantable medical devices both internationally and domestically. On October 24, 2023, Xuanwu Hospital performed the implantation on a patient with spinal cord injury.

This patient suffered a complete cervical spinal cord injury (ASIA Grade A) resulting from a motor vehicle accident and has been in a state of quadriplegia for 14 years. The patient was discharged home 10 days post-surgery. After three months of home-based brain-computer interface (BCI) rehabilitation training, the patient achieved brain-controlled functions, such as autonomous drinking, by driving a pneumatic glove via electroencephalographic (EEG) activity, with a grasping accuracy exceeding 90%. Both the ASIA clinical score and somatosensory evoked potential responses showed significant improvement.

It is reported that, unlike Neuralink’s brain-computer interface (BCI), the BCI developed by Tsinghua University and Xuanwu Hospital places electrodes in the epidural space. Developed through long-term animal trials, this approach does not damage neural tissue. It employs near-field wireless power delivery and signal transmission, eliminating the need for an implanted battery. Industry experts consider this BCI a balanced compromise among signal quality, implementation feasibility, and invasiveness, and anticipate that it may achieve commercialization earlier than Neuralink’s BCI, which requires craniotomy. Nevertheless, it is undeniable that Neuralink’s intracortical implantation yields more precise neural signals.

Behind the two major highlights lies the support of a vast industrial chain. The brain-computer interface (BCI) industry chain mainly includes upstream raw material and component suppliers, midstream equipment manufacturers, and downstream application service providers. Close collaboration among these sectors jointly drives the development and application of BCI technology.

Min Dong stated that, from a technical perspective, brain-computer interfaces (BCIs) are categorized into non-invasive and invasive types, each with its own advantages and disadvantages. The non-invasive approach requires no surgery; electrodes for acquiring brain signals are simply attached to the scalp. This method carries lower risks but yields relatively lower precision in detected brain signals, making control or operation comparatively simpler. In contrast, the invasive approach involves surgically implanting electrodes directly into the cerebral cortex. Being closer to neurons, it enables the acquisition of higher-quality neural signals. However, due to the need for surgical intervention, it entails greater risks and higher costs.

“Therefore, current brain-computer interface (BCI) products are predominantly non-invasive. Due to multiple constraints, including technical and ethical considerations, the number of research institutions and enterprises developing invasive BCIs is far smaller than those focused on non-invasive approaches,” summarized Min Dong. “Invasive BCI medical devices are classified as Class III medical devices, and the long-term efficacy and safety of their implanted components still require further validation through extended timeframes and additional experiments.”

From the perspective of ecological development, thanks to the joint efforts of all sectors, China is forming a complete brain-computer interface (BCI) industry chain covering the foundational, technological, and application layers. Notably, in October 2022, multiple BCI projects were selected as winners of the AI Medical Device Innovation Task Force announced by the Ministry of Industry and Information Technology and other authorities, marking the transition of related products in China from the “laboratory” to the “application arena.”

Min Dong believes that although brain-computer interfaces (BCIs) are currently primarily focused on the medical field, they hold significant promise for future development in education, industry, entertainment, and other sectors. For instance, in education, measuring students’ electroencephalogram (EEG) signals can help assess their mastery of knowledge, standardize the evaluation of learning outcomes, and design personalized learning plans. In the industrial sector, EEG-based devices can control production lines, eliminating the need for manual operations such as pulling levers or pressing buttons; operators could simply sit and “think” to execute commands. In the entertainment industry, BCIs can provide more immersive and intuitive interactive experiences for gaming.

While brain-computer interfaces bring exciting advancements, concerns regarding privacy protection, security, and ethical safeguards have also emerged.

“Precise application of brain-computer interface (BCI) technology requires the acquisition of cerebral cortical data to generate appropriate behavioral guidance, which raises concerns regarding privacy protection. However, excessive protection may compromise therapeutic and operational efficacy,” stated Min Dong. “We need to establish requirements for data collected by BCIs, clarifying what types of data should be acquired, for what purposes the data will be used, and who has access to it. These aspects require regulatory oversight to maximize the potential of BCI technology while safeguarding patients’ privacy rights.”

Regarding safety, three key aspects require particular attention: first, the biocompatibility of brain-computer interfaces (BCIs), particularly the stability and biocompatibility of implanted components in invasive BCIs; second, the cybersecurity capabilities of BCIs. Given the frequent occurrence of cyber security incidents in recent years and the unique nature of BCI products, any data security breach could lead to severe consequences. Therefore, robust cybersecurity measures are essential to safeguard patients' lives; third, the application safety of BCIs, ensuring that the products do not cause harm to patients during use. Protective and emergency measures must be prepared in advance.

Furthermore, from an ethical perspective, issues such as the privacy of neural data following brain-computer interface (BCI) applications, fairness concerning cognitive enhancement, and the rights to informed consent also warrant careful consideration.

Accordingly, the industry believes that the period from 2023 to 2032 will be a decade-long phase of widespread adoption for brain-computer interfaces (BCIs), during which BCIs are expected to achieve the goal of “delivering effective application solutions and maturing diverse solutions for commercial deployment.”

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