Karunesh Ganguly, MD, PhD reviewing Vansteensel MJ et al. N Engl J Med 2016 Nov 24.

A case report demonstrates that a fully implantable wireless brain-computer interface can allow an ALS patient in a “locked-in” state to type letters.

Disorders of communication can be particularly disabling and result in a very poor quality of life. Patients in a locked-in state are the most severely affected and have limited alternative means of communication. In such patients, augmentative and alternative communication (AAC) systems are required. Currently available options range from partner-assisted alphabet boards to eye-gaze tracking systems. Brain–computer interfaces (BCIs) have great potential to significantly improve communication rates by directly decoding neural signals from the brain. BCIs using implantable electrodes have shown promise in allowing significantly greater rates of communication (e.g., 15–30 characters per minute; Sci Transl Med 2015; 7:313ra179 and Nat Med 2015; 21:1142) compared with previous technologies. Until now, these BCI devices have required a percutaneous connection and were always tested in the presence of research staff.

This case study demonstrates that an implantable BCI system can allow communication in a locked-in ALS patient in the patient's home. The study was partially manufacturer-sponsored. The patient required mechanical ventilation and could only communicate using eye movements. She was implanted with multiple subdural cortical electrodes; the neural signals were then processed and sent wirelessly to an external AAC. Using this setup, the patient could select a letter every 33 seconds. She could use the interface with no supervision from research staff. The patient was noted to prefer the BCI system to the eye-gaze tracker at times.

CITATION(S):

Vansteensel MJ et al. Fully Implanted brain–computer interface in a locked-in patient with ALS. N Engl J Med 2016 Nov 24; 375:2060.

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