NBR Editors Interview BCI Researchers at Neuroscience 2025
by James Cavuoto, editor and Jeremy Koff, senior consulting editor
November 2025 issue
At the recent Society for Neuroscience meeting in San Diego, CA earlier this month, a panel of BCI researchers and clinicians participated in a press conference devoted to restoring touch, speech, and movement to paralyzed individuals. The press conference was moderated by Gregoire Courtine, director of the Neuro-X Institute at EPFL and founder of ONWARD Medical. Other panelists included Robert Gaunt, associate professor at the University of Pittsburgh, and David Brandman, assistant professor of neurological surgery at UC Davis and co-director of the Neuroprosthetics Lab.
During the press conference, NBR editors James Cavuoto and Jeremy Koff engaged in a Q&A with the panelists.
JC: Many years ago, Christopher Reeve attended this event, passionately advocating for a cure for paralysis. In those early days, he was not a major promoter of neurotechnology approaches— what he was looking for was a pill that you could swallow that would cure paralysis. Having witnessed the evolution of neural prosthetics and contributed to restoring movement in paralyzed individuals, what would you have done differently, or what advice would you have given Christopher Reeve 20 years ago regarding funding, research directions, and the balance between pharma and medtech approaches?
Gregoire Courtine: Christopher Reeve was seeking a cure, but what neurotechnology currently offers is hope for a better quality of life, not a cure. While some individuals can stand and take steps, many still rely on wheelchairs, and although some sensation has been restored, it’s not yet fully integrated into daily life. Neurotech is evolving and can significantly improve quality of life, and I believe it will be the first technology widely adopted by people with paralysis. However, the true cure will likely come from biological approaches, possibly combined with neurotech and rehabilitation. Back when Christopher Reeve was advocating for spinal cord injury research, there was a somewhat naive belief that a single molecule could fix the problem, but we now know it’s far more complex. Significant progress has been made in regeneration and repair, and eventually, these advances will be combined with neurotech for a real impact on recovery.
JK: Given the tremendous valuations of BCI companies—Neuralink at $9 billion for a pre-commercial device, and the recent $3.7 billion acquisition of Axonics by Boston Scientific—how quickly can the market adopt these technologies, considering the limited number of neurosurgeons available to perform implants? Will we ever see these technologies reach the consumer level, and how far away are we from that?
David Brandman: Those valuations reflect the hope, promise, and excitement demonstrated over the past decades. Where things will ultimately end up is uncertain, but I’m optimistic that we’ll learn the answer in the coming years. Five years ago, I worried that our lab work would remain academic, affecting only a few clinical trial participants. Now, I believe we’ll see where the real value lies. There are significant challenges—logistics, payment, reimbursement, and global issues—but it’s encouraging that resources are being directed toward exploring what’s possible.
Robert Gaunt: To address your question, it’s important to consider who will benefit from these technologies and what expertise is needed. When deep brain stimulation was first introduced, surgeries took most of a day and were performed by hyperspecialists in a few centers. Today, DBS is a half-day procedure available in hundreds of centers worldwide. As clinicians gain experience, the barrier to entry for neurotechnology decreases. I foresee brain-computer interface technology progressing similarly, with specialized centers initially, followed by broader adoption as expertise grows. Our job as academicians is to identify who can benefit most—whether it’s people with paralysis, stroke, aphasia, cerebral palsy, or Parkinson’s disease. Early clinical trials will help determine who benefits, and companies will use these insights to run larger trials and bring devices to those who need them. There’s decades of work from basic science to clinical trials, and now multiple companies are developing fully implantable wireless medical devices for paralysis, building on these insights.
Gregoire Courtine: There’s always the reality of economics. The trade-off between efficacy and cost is challenging. DBS works well and is relatively straightforward once the electrode placement is known. BCI is more complex and still in its early stages, requiring skilled engineers. Once a “killer app” is identified—an application that works very well and is effective—scaling up becomes feasible. When a technology is validated and accepted by regulators and clinicians, expansion can happen rapidly, as seen with neuromodulation. The same will likely occur with BCI.
JC: David, your work in decoding speech and speech restoration is impressive. However, speech isn’t the only means of human communication. Many Americans, and a few non-human primates, communicate using American Sign Language. Has anyone investigated using BCI technology to decode gestures by focusing on the motor cortex involved in ASL, as an alternative to speech decoding for humans and perhaps monkeys?
David Brandman: That’s a wonderful question. I’ll admit I don’t know the answer specifically regarding ASL for communication. However, I do know about gesture decoding. Our group, as well as others, has spent considerable effort trying to understand how the brain encodes gestures. There is indeed a rich signal that can be used for ASL, but I don’t know the specific answer about its use for communication.
JC: Rob, can you discuss the differences in approach between your lab’s work to restore sensation and the work being done by other groups, such as those at Hopkins and Dustin Tyler’s group at Case Western?
Robert Gaunt: Great question. Broadly, approaches can be divided between those targeting the brain and those targeting peripheral nerves. There’s been significant work over decades to restore sensation, especially for people with amputations. Many groups, including Dustin Tyler’s at Case Western, focus on peripheral nerve interfaces—placing fine electrodes in different parts of the peripheral nerves in the limbs and stimulating them to restore sensation. When moving to the brain, most efforts have focused on spinal cord injury. Several groups, including ours, Richard Anderson’s group at Caltech, Case Western, Hopkins APL, and the Feinstein Institute, have been working on microstimulation in the somatosensory cortex to restore touch. The approaches are fundamentally similar, using the same devices, but each group has its own unique perspective. There’s also growing interest in stimulating the visual cortex to restore sight, which is promising but still in early stages.
JK: We’ve talked about reading neural signals from the brain. Imagine someone who is deaf and blind—could you go in reverse and “print” thoughts into the brain?
Robert Gaunt: In my presentation, I discussed restoring the sense of touch using electrical stimulation. Neurons are electric, and when active, they produce electric fields. We can use electricity to activate neurons, which is the basis for restoring touch. By placing electrodes in specific regions, we can evoke sensations—touch in the fingers, visual experiences in the visual cortex, and sounds in the auditory cortex. The ability to write information directly into the brain is limited by both technology and scientific understanding. It works well in primary sensory regions, but manipulating brain activity causally with electrical stimulation depends on our knowledge of what each brain region does. For language, could you clarify your question?
JK: Can language be written directly into the brain?
Robert Gaunt: We can write audio information into the brain, though it’s not a highly active research area right now. Cochlear implants, which interface with the auditory nerve, have been used for decades to restore hearing. I’m not aware of human work in primary auditory cortex to write information. Writing semantic language information directly into the brain is not something I’m aware of in current research.
Gregoire Courtine: It’s worth noting that stimulating the brain’s language circuits is routine in neurosurgery, especially during craniotomies for tumors or epilepsy. Surgeons interrupt language circuits to determine safe areas for operation. There’s a wealth of global experience in stimulating language circuits for clinical purposes, but research specifically on writing semantic language information into the brain is lacking.