If you have been diagnosed with Alzheimer’s disease you may in fact be eligible to participate in a study involving implantation with Medtronic’s new deep-brain DBS-f device. The device is used to selectively stimulate nerve bundles like the fornix, a paired fiber tract that sends much of output of the hippocampus to the brainstem region. A similar Medtronic stimulator has already been implanted in over 80,000 people with Parkinson’s disease. Nowadays there are so many brain implants out there in need of programming, that surgeons have made arrangements to procure special-purpose robots, like the http://www.sciencedaily.com/releases/2013/01/130116111632.htm RP-7, just to teach the nurses how to tweak them.

What do you think the chances are that these devices are open-source? Medtronic’s online DBS-f manuals contain little by way of hard details, but you can discover for example, that diving below a depth of 33 feet with the device is prohibited. Then again, if you can’t find your house from your driveway, deep sea diving probably isn’t all that you will be missing. While it may not be too hard to meet the stipulation in the study requiring that your doctor has given you at least a year left to live, it is clear that not everyone has been invited to the DBS party. On the other hand, perhaps the only thing worse than being left out is to be included, but fail to recognize it.

It is no secret that one of the next big problems to be addressed with brain stimulators is epilepsy. What exactly constitutes a seizure though? You can have a seizure without seeing it on an EEG, and conversely your EEG can show a seizure without you ever feeling it. While drugs can treat many kinds of seizure, and indeed cause them as well, they are often not the treatment of choice. At the end of the day, diagnosis and treatment of any undesirable brain activity must closely involve the patient at every level. Stimulation with an implant or series of implants to short-circuit activity which may lead to seizure can not be a one-fits-all fixed procedure. The main risks associated with brain stimulation are precisely those symptoms this kind of implant would seek to remedy—the seizure itself. Programming these devices cannot be left to nurses struggling at some droid like and nameless interface, or surgeons who want to be removed as far as possible from any liability or risk.

The grinder, biohacker or wirehead is not someone that covets the crude offerings of companies like Meditronic, it is somebody who these companies would beg to test run their new products or perhaps share a tidbit of experience or knowledge with them. Brute force stimulation of the fornix is arguably about as reckless as you can get as far as brain interventions and plunging right through virgin cerebral territory to get there is hardly the best way to do it. A recent publication, Rise of the Cyborgs offers a few considerations when looking to mod the brain for larger scale stimulation and recording of activity and speculates on the interaction of hardware at the level of perception.

A central tenet of the cyborg paper is that it would be unwise to significantly interact with machine components directly using existing neural wetware. The best way forward would be to bridge existing structure to new hardware by introducing and enabling new tissue that can be reversibly disconnected—new interfaces will not be drawn up in CAD and then installed in the brain but rather must be configured in vivo and tested continuously to desired effect. Simularly external approaches like transcranial magnetic stimulation are far to crude to control brain activity in any useful way in a healthy brain. It current use is best understood as an assault—its most promising incarnation will likely be for configuration and control of implanted hardware.

The interoperability of implanted devices is now coming to a head. Some time ago, a report from a French hospital described a 22 year old patient who was implanted with a Biotronik Nanos-01AE pacemaker because of atrioventricular block, a rather serious heart condition. The immediate concern of the surgeons was that the patient had previously been implanted with a Digisonic DX10AE multichannel cochlear implant to restore their hearing, and nobody had any idea what level of interference to expect. As a result, the pacemaker was operated only in limited locked mode and a close watch was kept on the electrocardiogram.

This story was reported in a journal closer to 2 decades ago, yet little has changed as far as plans for making implants open. Compatibility is just not going to happen without openness. People that need several implants by different manufactures will be finding themselves increasingly out of luck. The grinder, enabled by smart devices running real time and fail safe operating systems, will be the one to drive solutions to this problem. Waiting on companies to do it for us is not an option.