Breakthroughs in brain–computer interface (BCI) technology now enable speech synthesis with real-time voice modulation in patients with severe speech impairment. Implantation of microelectrode arrays in motor-related brain areas of users with ALS allows instantaneous decoding of intended speech sounds and paralinguistic cues such as intonation and melody. This real-time brain-to-voice neuroprosthesis marks a major advance over previous systems and opens new therapeutic possibilities for restoring naturalistic communication.