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Late last year, in the strange gloaming hours that wrest all rational thought from an otherwise rational mind on the tortuously long trans-Pacific flight between Hong Kong and New York, I found myself watching one of the most compelling films I have ever seen. It was called 20,000 Days on Earth — a pseudo-documentary of the life of singer Nick Cave. The story was mesmeric, but it was Cave's ruminations on human thought that so captured my attention.
“Memory is what we are,” he said. “Your very soul, your very reason to be alive is tied up in memory.”
This deceptively simple concept created a catalyst in my jet-lagged, travel-weary brain. First, I thought, can a memory ever be truly collective or is it simply an amalgam of everyone's own stories? And second, does it only become a story when you tell and retell it?
Over the course of that 17 hour flight, I had plenty of time to calculate that the JNNP was approaching its own milestone—35, 000 Days on Earth—and that it in fact could answer my existential algorithm. For the journal, which will celebrate its centenary at the end of this decade, constitutes a collection of memories, each one a story of creative and analytical advancement in the field of neuroscience (Figure 1).
The first volume of JNNP was launched in 1920 with an opening commentary by the foundation Editor Kinnear Wilson where, in colourful editorial style, he promoted discussion outlining why medical practitioners may aspire to a career in the clinical neurosciences. From this simple beginning, a range of influences and threads have emerged throughout each decade. A hereditary topography has been borne, with studies evolving but also linking back to the origins of the clinical neurosciences, making use of and incorporating the emerging technologies of the day, and the influences of the minds of great clinicians such as Charcot.
Here marked the beginning of a story that, through time, has driven discoveries across human neurobiology—from initial descriptions of disease states, to the unlocking of pathophysiological processes and, in turn, the development and validation of new therapies. The journal has borne witness to the launch of a therapeutic era and, frankly, the transformation has been remarkable. No better has that been illustrated than in the realm of multiple sclerosis (MS), where with a rapidly developing armamentarium of immunomodulatory medications, the outcomes for patients with MS diagnosed today is significantly better than it was 20 years ago. Similar transformations are now anticipated and evolving across the neuroscience landscape.1–9
Advances of this calibre of course beg the question: what does the future hold?
Thinking Neil Armstrong type moments, it now seems conceivable that paralysed patients will be able to walk, brain-implanted microchips will eradicate the need for computers as we know them and that damaged body parts will be replaced by neuroprostheses. Imagine the prospect of bypassing damaged brain cells or spinal cord to regain normal function.
One of the most intriguing developments involving the brain relates to the creation and evolution of brain-computer interfaces. Such interfaces will inevitably translate physiological measures of volitional thought processing into control signals capable of driving body parts and external computers. Recent developments for motor control interfaces that involve the implantation of electrodes directly into the brain of paralysed patients and the successful recording of neuronal activity, have laid the platform for critical discoveries over the coming decade. Through stimulating and recording human neurons, it is now achievable to effectively bypass regions of damage in the human nervous system to restore function.
Clinicians and researchers in the emerging field of neural interfaces have provided proof of concept in human experimentation, demonstrating that it is possible to intervene in the central and peripheral nervous system to produce simple movements in the motor system. Although the restored function by means of interfaces may remain inferior to natural motor function at this early phase of development, the recent successes of implants offer a glimpse of what future neuroprosthetics may hold for patients with profound motor dysfunction.
Further quantum leaps? A conceivable extension of these technologies may lie in the development of personalised therapy for individuals wishing to extend their capabilities—akin to a biological ‘memory upgrade’. Perhaps today that may be considered a step too far, but in practical terms, it really does seem feasible that clinicians will facilitate the development of neural networks capable of orchestrating movement in rehabilitation patients by making use of their kinaesthetic senses to provide information and further control loops to fine tune larger limb movements and even operational space path planning.
One hundred years ago, these concepts would have been laughable. Today, they seem limited only by time and ingenuity.
So, as my plane touched down at JFK, and these thoughts of histories and future possibilities came to a momentary pause, the words of Nick Cave stayed with me. Life is a “shimmering space where all imagination and reality intersect,” he said.
I look forward to continuing the expedition into that amazing and transforming space where we, as practitioners of the mind, have the potential to change history. What a journey!
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.