Options for people with severe paralysis who have lost the ability to communicate orally are limited. We describe a method for communication in a patient with late-stage amyotrophic lateral sclerosis (ALS), involving a fully implanted brain-computer interface that consists of subdural electrodes placed over the motor cortex and a transmitter placed subcutaneously in the left side of the thorax. By attempting to move the hand on the side opposite the implanted electrodes, the patient accurately and independently controlled a computer typing program 28 weeks after electrode placement, at the equivalent of two letters per minute. The brain-computer interface offered autonomous communication that supplemented and at times supplanted the patient's eye-tracking device. (Funded by the Government of the Netherlands and the European Union; ClinicalTrials.gov number, NCT02224469 .).

HighlightsStability of recorded neural signals is crucial for the clinical viability of implantable brain-computer interfaces (BCIs).A fully implantable BCI offers a long-term robust and durable control signal in a person with amyotrophic lateral sclerosis.Increasing home use of the electrocorticography (ECoG)-BCI demonstrates user adoption of the BCI for communication.

The sensorimotor cortex is a frequently targeted brain area for the development of Brain-Computer Interfaces (BCIs) for communication in people with severe paralysis and communication problems (locked-in syndrome; LIS). It is widely acknowledged that this area displays an increase in high-frequency band (HFB) power and a decrease in the power of the low frequency band (LFB) during movement of, for example, the hand. Upon termination of hand movement, activity in the LFB band typically shows a short increase (rebound). The ability to modulate the neural signal in the sensorimotor cortex by imagining or attempting to move is crucial for the implementation of sensorimotor BCI in people who are unable to execute movements. This may not always be self-evident, since the most common causes of LIS, amyotrophic lateral sclerosis (ALS) and brain stem stroke, are associated with significant damage to the brain, potentially affecting the generation of baseline neural activity in the sensorimotor cortex and the modulation thereof by imagined or attempted hand movement. In the Utrecht NeuroProsthesis (UNP) study, a participant with LIS caused by ALS and a participant with LIS due to brain stem stroke were implanted with a fully implantable BCI, including subdural electrocorticography (ECoG) electrodes over the sensorimotor area, with the purpose of achieving ECoG-BCI-based communication. We noted differences between these participants in the spectral power changes generated by attempted movement of the hand. To better understand the nature and origin of these differences, we compared the baseline spectral features and task-induced modulation of the neural signal of the LIS participants, with those of a group of able-bodied people with epilepsy who received a subchronic implant with ECoG electrodes for diagnostic purposes. Our data show that baseline LFB oscillatory components and changes generated in the LFB power of the sensorimotor cortex by (attempted) hand movement differ between participants, despite consistent HFB responses in this area. We conclude that the etiology of LIS may have significant effects on the LFB spectral components in the sensorimotor cortex, which is relevant for the development of communication-BCIs for this population.

The objective of this study was to test the feasibility of using the dorsolateral prefrontal cortex as a signal source for brain–computer interface control in people with severe motor impairment. We implanted two individuals with locked-in syndrome with a chronic brain–computer interface designed to restore independent communication. The implanted system (Utrecht NeuroProsthesis) included electrode strips placed subdurally over the dorsolateral prefrontal cortex. In both participants, counting backwards activated the dorsolateral prefrontal cortex consistently over the course of 47 and 22 months, respectively. Moreover, both participants were able to use this signal to control a cursor in one dimension, with average accuracy scores of 78 ± 9% (standard deviation) and 71 ± 11% (chance level: 50%), respectively. Brain–computer interface control based on dorsolateral prefrontal cortex activity is feasible in people with locked-in syndrome and may become of relevance for those unable to use sensorimotor signals for control.

Implantable brain–computer interfaces (BCIs) promise to be a viable means to restore communication in individuals with locked-in syndrome (LIS). In 2016, we presented the world-first fully implantable BCI system that uses subdural electrocorticography electrodes to record brain signals and a subcutaneous amplifier to transmit the signals to the outside world, and that enabled an individual with LIS to communicate via a tablet computer by selecting icons in spelling software. For future clinical implementation of implantable communication-BCIs, however, much work is still needed, for example, to validate these systems in daily life settings with more participants, and to improve the speed of communication. We believe the design and execution of future studies on these and other topics may benefit from the experience we have gained. Therefore, based on relevant literature and our own experiences, we here provide an overview of procedures, as well as recommendations, for recruitment, screening, inclusion, imaging, hospital admission, implantation, training, and support of participants with LIS, for studies on daily life implementation of implantable communication-BCIs. With this article, we not only aim to inform the BCI community about important topics of concern, but also hope to contribute to improved methodological standardization of implantable BCI research.

Brain serotonin (5-hydroxytryptamine, 5-HT) dysfunction is considered to promote food intake and eating-related disturbances, especially under stress or negative mood. Vulnerability for 5-HT disturbances is considered to be genetically determined, including a short (S) allele polymorphism in the serotonin transporter gene (5-HTTLPR) that is associated with lower serotonin function. Since 5-HT function may be slightly increased by carbohydrate consumption, S-allele 5-HTTLPR carriers in particular may benefit from a sugar-preload due to their enhanced 5-HT vulnerability. The aim of the current study was to investigate whether a sugar-containing preload may reduce appetite and energy intake after exposure to stress to induce negative mood, depending on genetic 5-HT vulnerability. From a population of 771 healthy young male and female genotyped college students 31 S/S carriers (8 males, 23 females) and 26 long allele (L/L) carriers (9 males, 17 females) (mean ± S.D. 22 ± 1.6 years; body mass index, BMI, 18-33 kg/m(2)) were monitored for changes in appetite and snacking behavior after stress exposure. Results revealed an increased energy intake after mild mental stress (negative mood) mainly for high-fat sweet foods, which was significantly greater in S/S carriers, and only in these genotypes this intake was significantly reduced by a sucrose-containing preload. Although alternative explanations are possible, it is suggested that S/S participants may have enhanced brain (hypothalamic) 5-HT responsiveness to food that makes them more susceptible to the beneficial satiation effects of a sucrose-preload as well as to the negative effects of mild mental stress on weight gain.

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Objective: Implanted Brain-Computer Interfaces (BCIs) employ neural signals to control a computer and may offer an alternative communication channel for people with locked-in syndrome (LIS). Promising results have been obtained using signals from the sensorimotor (SM) area. However, in earlier work on home-use of an electrocorticography (ECoG)-based BCI by people with LIS, we detected differences in ECoG-BCI performance, which were related to differences in the modulation of low frequency band (LFB) power in the SM area. For future clinical implementation of ECoG-BCIs, it will be crucial to determine whether reliable performance can be predicted before electrode implantation. To assess if non-invasive scalp-electroencephalography (EEG) could serve such prediction, we here investigated if EEG can detect the characteristics observed in the LFB modulation of ECoG signals. Approach: We included 3 participants with LIS of the earlier study, and a control group of 20 healthy participants. All participants performed a Rest task, and a Movement task involving actual (healthy) or attempted (LIS) hand movements, while their EEG signals were recorded. Results: Data of the Rest task was used to determine signal-to-noise ratio, which showed a similar range for LIS and healthy participants. Using data of the Movement task, we selected 7 EEG electrodes that showed a consistent movement-related decrease in beta power (13-30Hz) across healthy participants. Within the EEG recordings of this subset of electrodes of two LIS participants, we recognized the phenomena reported earlier for the LFB in their ECoG recordings. Specifically, strong movement-related beta band suppression was observed in one, but not the other, LIS participant, and movement-related alpha band (8-12Hz) suppression was practically absent in both. Results of the third LIS participant were inconclusive due to technical issues with the EEG recordings. Significance: Together, these findings support a potential role for scalp EEG in the presurgical assessment of ECoG-BCI candidates.