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Curated Papers > Recent high-impact research on "brain-computer interfaces" (IF≥30, past 5 years)

Longevity of a Brain-Computer Interface for Amyotrophic Lateral Sclerosis. ​

Literature Information ​

DOI10.1056/NEJMoa2314598
PMID39141854
JournalThe New England journal of medicine
Impact Factor78.5
JCR QuartileQ1
Publication Year2024
Times Cited5
KeywordsBrain-Computer Interface, Amyotrophic Lateral Sclerosis, Neurodegenerative Disease, Signal Amplitude Decline
Literature TypeJournal Article, Case Reports, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't
ISSN0028-4793
Pages619-626
Issue391(7)
AuthorsMariska J Vansteensel, Sacha Leinders, Mariana P Branco, Nathan E Crone, Timothy Denison, Zachary V Freudenburg, Simon H Geukes, Peter H Gosselaar, Mathijs Raemaekers, Anouck Schippers, Malinda Verberne, Erik J Aarnoutse, Nick F Ramsey

TL;DR ​

This study investigates the long-term use of an implanted brain-computer interface (BCI) for communication in a patient with advanced amyotrophic lateral sclerosis (ALS) over seven years, revealing that while communication frequency initially increased, it declined after six years due to progressive neural signal amplitude reduction and brain atrophy. The findings highlight the challenges of sustained BCI effectiveness in the context of neurodegenerative diseases, emphasizing the need for ongoing research in this area.

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Brain-Computer Interface · Amyotrophic Lateral Sclerosis · Neurodegenerative Disease · Signal Amplitude Decline

Abstract ​

The durability of communication with the use of brain-computer interfaces in persons with progressive neurodegenerative disease has not been extensively examined. We report on 7 years of independent at-home use of an implanted brain-computer interface for communication by a person with advanced amyotrophic lateral sclerosis (ALS), the inception of which was reported in 2016. The frequency of at-home use increased over time to compensate for gradual loss of control of an eye-gaze-tracking device, followed by a progressive decrease in use starting 6 years after implantation. At-home use ended when control of the brain-computer interface became unreliable. No signs of technical malfunction were found. Instead, the amplitude of neural signals declined, and computed tomographic imaging revealed progressive atrophy, which suggested that ALS-related neurodegeneration ultimately rendered the brain-computer interface ineffective after years of successful use, although alternative explanations are plausible. (Funded by the National Institute on Deafness and Other Communication Disorders and others; ClinicalTrials.gov number, NCT02224469.).

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Primary Questions Addressed ​

  1. What factors contribute to the decline in effectiveness of brain-computer interfaces in patients with ALS over time?
  2. How does the progression of neurodegeneration in ALS affect the performance of brain-computer interfaces compared to other neurodegenerative diseases?
  3. What alternative communication methods could be considered for ALS patients as brain-computer interfaces become less effective?
  4. How can the design of brain-computer interfaces be improved to enhance their longevity in progressive neurodegenerative conditions?
  5. What role does patient engagement and usage frequency play in the effectiveness of brain-computer interfaces over the long term?

Key Findings ​

Research Background and Purpose ​

Amyotrophic Lateral Sclerosis (ALS) leads to severe motor and speech impairments, making communication increasingly difficult. Traditional assistive communication technologies often fail as the disease progresses. This study investigates the long-term use and effectiveness of an implanted Brain-Computer Interface (BCI) in a patient with advanced ALS over a period of nearly seven years.

Main Methods/Materials/Experimental Design ​

The study involved a single female participant diagnosed with ALS who underwent BCI implantation in October 2015. The BCI system included:

  • Electrode Strips: Four subdural electrocorticography strips placed over the dorsolateral prefrontal cortex and sensorimotor cortex.
  • Amplifier/Transmitter: A subcutaneous device for signal transmission.

Key Experimental Steps: ​

  1. Implantation: The BCI was implanted as part of the Utrecht NeuroProsthesis study.

  2. Signal Acquisition: Neural signals were recorded from electrode pairs to generate click-commands for communication.

  3. Data Logging: The participant's BCI usage was logged on a tablet, tracking hours of use and requests for interface changes.

  4. Longitudinal Monitoring: Various tasks were performed to assess neural signal features over time, including:

    • Baseline Task: Relaxation with fixation.
    • Attempt-Rest Task: Attempted hand movements to generate neural signals.
    • Brush-Rest Task: Somatosensory stimulation to assess response.

  5. Imaging: CT scans were conducted before and after the study to assess brain atrophy and electrode placement.

Mermaid diagram

Key Results and Findings ​

  • At-Home Use: The BCI was used independently by the participant for communication, initially replacing an eye-tracking device. Usage peaked at 20-24 hours per day after the introduction of a night mode.
  • Decline in Use: A gradual decline in BCI usage began approximately six years post-implantation, coinciding with decreased click-command accuracy and increasing difficulty in interpreting caregiver calls.
  • Neural Signal Changes: A significant decline in low-frequency band (LFB) and high-frequency band (HFB) power was observed, indicating progressive neural degradation. CT imaging confirmed substantial brain atrophy over the study period.

Main Conclusions/Significance/Innovation ​

The study demonstrates that an implanted BCI can provide a viable communication method for individuals with advanced ALS for an extended period. However, the effectiveness diminishes as the disease progresses due to neural signal decline and brain atrophy. This research highlights the potential and limitations of BCIs in addressing communication needs in neurodegenerative diseases.

Research Limitations and Future Directions ​

  • Limitations: The study is based on a single case, which may limit generalizability. The exact mechanisms behind the decline in BCI performance remain uncertain.
  • Future Directions: Further research is needed to explore ways to enhance BCI durability and performance in patients with progressive neurodegenerative diseases. Investigating alternative communication methods or adaptations to existing technologies could also be beneficial.
AspectFindings
BCI Longevity7 years of use before decline
Communication MethodsTransitioned from eye-tracking to BCI as ALS progressed
Neural Signal DeclineSignificant decrease in LFB and HFB power over time
Imaging ResultsConfirmed brain atrophy correlated with BCI performance

References ​

  1. The eye-tracking computer device for communication in amyotrophic lateral sclerosis. - R Spataro;M Ciriacono;C Manno;V La Bella - Acta neurologica Scandinavica (2014)
  2. Neuropsychological impairment in amyotrophic lateral sclerosis-frontotemporal spectrum disorder. - Sharon Abrahams - Nature reviews. Neurology (2023)
  3. Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. - N Tzourio-Mazoyer;B Landeau;D Papathanassiou;F Crivello;O Etard;N Delcroix;B Mazoyer;M Joliot - NeuroImage (2002)
  4. A high-performance speech neuroprosthesis. - Francis R Willett;Erin M Kunz;Chaofei Fan;Donald T Avansino;Guy H Wilson;Eun Young Choi;Foram Kamdar;Matthew F Glasser;Leigh R Hochberg;Shaul Druckmann;Krishna V Shenoy;Jaimie M Henderson - Nature (2023)
  5. Motor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experience. - Thomas J Oxley;Peter E Yoo;Gil S Rind;Stephen M Ronayne;C M Sarah Lee;Christin Bird;Victoria Hampshire;Rahul P Sharma;Andrew Morokoff;Daryl L Williams;Christopher MacIsaac;Mark E Howard;Lou Irving;Ivan Vrljic;Cameron Williams;Sam E John;Frank Weissenborn;Madeleine Dazenko;Anna H Balabanski;David Friedenberg;Anthony N Burkitt;Yan T Wong;Katharine J Drummond;Patricia Desmond;Douglas Weber;Timothy Denison;Leigh R Hochberg;Susan Mathers;Terence J O'Brien;Clive N May;J Mocco;David B Grayden;Bruce C V Campbell;Peter Mitchell;Nicholas L Opie - Journal of neurointerventional surgery (2021)
  6. Acute to long-term characteristics of impedance recordings during neurostimulation in humans. - Jie Cui;Filip Mivalt;Vladimir Sladky;Jiwon Kim;Thomas J Richner;Brian N Lundstrom;Jamie J Van Gompel;Hai-Long Wang;Kai J Miller;Nicholas Gregg;Long Jun Wu;Timothy Denison;Bailey Winter;Benjamin H Brinkmann;Vaclav Kremen;Gregory A Worrell - Journal of neural engineering (2024)
  7. Brain Parenchymal Fraction in Healthy Adults-A Systematic Review of the Literature. - Mattias Vågberg;Gabriel Granåsen;Anders Svenningsson - PloS one (2017)
  8. Stability of a chronic implanted brain-computer interface in late-stage amyotrophic lateral sclerosis. - Elmar G M Pels;Erik J Aarnoutse;Sacha Leinders;Zac V Freudenburg;Mariana P Branco;Benny H van der Vijgh;Tom J Snijders;Timothy Denison;Mariska J Vansteensel;Nick F Ramsey - Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology (2019)
  9. A high-performance neuroprosthesis for speech decoding and avatar control. - Sean L Metzger;Kaylo T Littlejohn;Alexander B Silva;David A Moses;Margaret P Seaton;Ran Wang;Maximilian E Dougherty;Jessie R Liu;Peter Wu;Michael A Berger;Inga Zhuravleva;Adelyn Tu-Chan;Karunesh Ganguly;Gopala K Anumanchipalli;Edward F Chang - Nature (2023)
  10. Cerebral atrophy in amyotrophic lateral sclerosis parallels the pathological distribution of TDP43. - Mahsa Dadar;Ana Laura Manera;Lorne Zinman;Lawrence Korngut;Angela Genge;Simon J Graham;Richard Frayne;D Louis Collins;Sanjay Kalra - Brain communications (2020)

Literatures Citing This Work ​

  1. The expanding repertoire of brain-computer interfaces. - Nick F Ramsey;Mariska J Vansteensel - Nature medicine (2025)
  2. Classifying mental motor tasks from chronic ECoG-BCI recordings using phase-amplitude coupling features. - Morgane Marzulli;Alexandre Bleuzé;Joe Saad;Felix Martel;Philippe Ciuciu;Tetiana Aksenova;Lucas Struber - Frontiers in human neuroscience (2025)
  3. Invasive Brain-Computer Interface for Communication: A Scoping Review. - Shujhat Khan;Leonie Kallis;Harry Mee;Salim El Hadwe;Damiano Barone;Peter Hutchinson;Angelos Kolias - Brain sciences (2025)
  4. Long-term performance of intracortical microelectrode arrays in 14 BrainGate clinical trial participants. - Nick V Hahn;Elias Stein; ;John P Donoghue;John D Simeral;Leigh R Hochberg;Francis R Willett - medRxiv : the preprint server for health sciences (2025)
  5. Toward the Clinical Translation of Implantable Brain-Computer Interfaces for Motor Impairment: Research Trends and Outcome Measures. - Esmee Dohle;Eleanor Swanson;Luka Jovanovic;Suraya Yusuf;Lucy Thompson;Hugo Layard Horsfall;William Muirhead;Luke Bashford;Jamie Brannigan - Advanced science (Weinheim, Baden-Wurttemberg, Germany) (2025)

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