Direct electrical brain stimulation of human memory: lessons learnt and future perspectives

Modulation of cognitive functions supporting human declarative memory is one of the grand challenges of neuroscience, and of vast importance for a variety of neuropsychiatric, neurodegenerative and neurodevelopmental diseases. Despite a recent surge of successful attempts at improving performance in a range of memory tasks, the optimal approaches and parameters for memory enhancement have yet to be determined. On a more fundamental level, it remains elusive as to how delivering electrical current in a given brain area leads to enhanced memory processing. Starting from the local and distal physiological effects on neural populations, the mechanisms of enhanced memory encoding, maintenance, consolidation or recall in response to direct electrical stimulation are only now being unravelled. With the advent of innovative neurotechnologies for concurrent recording and stimulation intracranially in the human brain, it becomes possible to study both acute and chronic effects of stimulation on memory performance and the underlying neural activities. In this review, we summarize the effects of various invasive stimulation approaches for modulating memory functions. We first outline the challenges that were faced in the initial studies of memory enhancement and the lessons learnt. Electrophysiological biomarkers are then reviewed as more objective measures of the stimulation effects than behavioural outcomes. Finally, we classify the various stimulation approaches into continuous and phasic modulation with an open or closed loop for responsive stimulation based on analysis of the recorded neural activities. Although the potential advantage of closed-loop responsive stimulation over the classic open-loop approaches is inconclusive, we foresee the emerging results from ongoing longitudinal studies and clinical trials will shed light on both the mechanisms and optimal strategies for improving declarative memory. Adaptive stimulation based on the biomarker analysis over extended periods of time is proposed as a future direction for obtaining lasting effects on memory functions. Chronic tracking and modulation of neural activities intracranially through adaptive stimulation opens tantalizing new avenues to continually monitor and treat memory and cognitive deficits in a range of brain disorders. Brain co-processors created with machine-learning tools and wireless bi-directional connectivity to seamlessly integrate implanted devices with smartphones and cloud computing are poised to enable real-time automated analysis of large data volumes and adaptively tune electrical stimulation based on electrophysiological biomarkers of behavioural states. Next-generation implantable devices for high-density recording and stimulation of electrophysiological activities, and technologies for distributed brain–computer interfaces are presented as selected future perspectives for modulating human memory and associated mental processes.