Development Timelines of Neurotechnologies and Related Technologies

Thanks to AJ Kourabi for research assistance.

Deep Brain Stimulators (source)

• Building on extant stereotactic neurosurgical tools and cardiac pacemaker technology, prototype DBS systems were first implanted in humans in the late 1960s.
• DBS performed in numerous patients until 1976, when the FDA was established. FDA stopped DBS sales until clinical trial data is submitted.
• No company was willing to run trials until the neurology field established clearer standards for patient improvement.
• Once they did, in 1997 Medtronic ran trials and got FDA approval for essential tremor and some Parkinson’s cases.
• FDA approved DBS for all Parkinson’s cases in 2002 after more trials.
• 40k individuals treated with DBS within 10 years of approval.
• Note: developing DBS for other indications like depression has been slow, due in large part to the slow pace of clinical research on such an invasive technology.

Summary: ~40 years from demonstration in humans to consistent human use, including ~20 year pause to convince FDA.

Cochlear Implants (source)

• First implantation of electrodes to explore restoration of hearing loss in 1957.
• By 1977 twenty-two patients had prototype implants.
• FDA granted approval for adults in 1984.
• Slow adoption because the adult deaf community was generally not interested in, and sometimes hostile to, the idea of becoming hearing people.
• Pediatric cochlear implants were approved in 1990, where there was stronger uptake. (90% of deaf children have hearing parents.)
• By 2009 there had been in the 100ks of implants total. This may be only 10% of the total addressable market (source).

Summary: on the order of 50 years from demonstration in humans to consistent human use, but ~15 years from FDA approval in a market with demand

Intracortical electrode array BCIs (iBCIs)

• Originally conceived of in 1980, the hardware necessary to enable multiple-electrode neuron recording in cortex was developed through the 1990s (source).
• In 1997, patient Johnny Ray controls computer cursor with a single implanted electrode (not array) (source).
• In 2002, two groups demonstrate cortical array BCI in monkeys (source, source).
• In 2004, patient Matt Nagle controls an artificial hand with a cortical array BCI called the BrainGate system (source).
• From 2004 to 2009 the Cyberkinetics company works on commercializing the BrainGate system, but fails to raise continued funding after 2009. The IP eventually goes to Blackrock Microsystems who continues developing cortical arrays for research use (source).
• From 2009 to the present a trial called BrainGate2 has continued in academia (source).
• Paradromics founded in 2015 and Neuralink founded in 2016 to commercialize higher-density cortical arrays (source).
• As of 2022, academic-led trials using Blackrock implants have accrued over 30,000 days of in-patient BCI research (source).

Summary: ~15 years from conception to first animal studies, ~10 more years until demonstration in humans, in the 18 years since no commercial BCI has yet been FDA-approved.

Stentrode

• Building on extant neurovascular stent technology, Synchron (originally named SmartStent) was founded in 2012 and developed their stent-based BCI prototype with funding from DARPA, and others. (source)
• First publication in 2016 demonstrating Stentrode in sheep. (source)
• Synchron got IDE approval for clinical trials from the FDA in 2021 and performed their first human implantation in 2022.

Summary: ~6 years from conception to (published) sheep and ~6 years from sheep to first human.

Transcranial Magnetic Stimulation (source)

• First demonstration of magnetic stimulation in 1896
• Single-pulse system demonstrated in humans in 1985
• Repeated-pulse system developed and effects on depression reported by 1994
• FDA approval for depression treatment in 2008. Arguably this would have gone faster had IP been handled better

Summary: ~9 years to development basic invention to demonstration in humans, ~12 years to get approved, widely used today but still a small fraction of neuropsychiatric treatments

Transcranial Electrical Stimulation (source)

• People have been running electricity through their heads since antiquity, including FDA approvals for electroconvulsive therapy and devices for treating migraine
• Two papers around 1998 reignited interest in low-output (<10 mA) transcranial electrical stimulation for modifying cortical excitability
• By 2006 a few articles about these systems make it into newspapers
• By 2012 DIY kits are being sold on the internet
• By 2014 startups like Halo and Thync have been started
• No FDA approvals have been made for low-output systems to date

Summary: ~6 years from popularization to DIY systems, with startups following immediately after

Prozac (fluoxetine) (source)

• First synthesized at Lilly in 1972
• FDA approved for depression in 1987, the first SSRI to be marketed
• Hailed as a breakthrough, eventually became 1/4 of Lilly’s revenue, >40M patients received it by 2002. (Many more had taken other SSRIs.)
• Consistently in the top 30 most-prescribed drugs in the U.S. by one estimate

Summary: 15 years from synthesis to approval, followed by widespread adoption almost immediately

LSD (source)

• First synthesized in 1938.
• First ingested in 1943. (source)
• Sandoz started marketing the drug in 1947 for a variety of uses.
• The CIA reportedly bought the world’s entire supply in the early 1950’s for use in the MK-ULTRA program. (source)
• Became popular recreationally from 1960s onward.
• Made illegal in U.S. in 1968. (source)
• Recently use has reportedly increased, and has been decriminalized in one state.
• An estimated ~10% people in the U.S. have used LSD in their lifetime. (source) Similar rates are reported for Australia. (source)

Summary: ~5 years from synthesis to demonstration of effects in humans, ~15 years until popular use began, despite tortuous history remains widely used

Mobile phones

• First mobile phone demonstrated in 1973. (source)
• First commercial offering 1983. (source)
• Usage in U.S. households rose from 10% in 1994 to 63% in 2004. (source)

Summary: ~10 years from working prototype to commercial product, ~20 more years to ubiquity, with a significant inflection

Personal computers (source)

• Xerox Alto demonstrated in 1973
• Apple Macintosh released in 1984
• Usage in U.S. households rose from 20% in 1992 to 63% in 2003

Summary: ~10 years from working prototype to mass commercial product, ~10 years to ubiquity

Breast augmentation (source)

• First breast implant surgery in 1962.
• FDA bans silicone implants in 1992, saline implants become dominant. (source)
• ~100k breast augmentation surgeries in 1997. (source)
• ~300k breast augmentation surgeries in 2018 and 2019
• An estimated 4% of women in the U.S. have had breast augmentation as of 2014.

Summary: ~30 years to becoming a standard procedure from demonstration in humans, with fairly linear growth

LASIK eye surgery (source)

• Building on knowledge from existing non-laser keratotomy surgeries, LASIK was conceived in 1988. (Similar procedures were being developed concurrently.)
• First LASIK surgery performed in U.S. in 1992.
• FDA approved devices for LASIK in 1998.
• Adoption rapidly increased to ~1.2M surgeries per year in the 2000s, then tapered to ~700k/yr in the 2010s (source)

Summary: ~4 years from conception to demonstration in humans, ~8 more years to become a standard procedure

Conclusions

The timelines above vary widely from 1 to 5 decades from conception to adoption and don’t have a consistent definition of “adoption” between them. But we can at least say that adoption seems to occur on the decade timescale, not single years.

We can also say that it would be unprecedented for a neurotechnology to have widespread adoption sooner than 10 years after its initial demonstration in humans.

The 20-year rule of thumb from conception to adoption of technologies in general seems short. An estimate of 30 years from initial demonstration in humans to adoption seems more reasonable, though it would not be surprising if any particular neurotechnology’s development timeline varied from this by 20 years in either direction.

Thanks to Sci-Hub for unspecified services.

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