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Longevity of a Brain-Computer Interface for Amyotrophic Lateral Sclerosis.
Mariska J Vansteensel1, Sacha Leinders1, Mariana P Branco1
1From the Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (M.J.V., S.L., M.P.B., Z.V.F., S.H.G., P.H.G., M.R., A.S., M.V., E.J.A., N.F.R.); the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore (N.E.C.); and the Institute of Biomedical Engineering and the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (T.D.).
This study tracked a brain-computer interface (BCI) for communication in amyotrophic lateral sclerosis (ALS) over 7 years. Ultimately, neurodegeneration caused BCI signal decline and ineffectiveness, despite initial success.
Area of Science:
- Neuroscience
- Biomedical Engineering
- Neurology
Background:
- The long-term efficacy of brain-computer interfaces (BCIs) for communication in individuals with progressive neurodegenerative diseases remains under-explored.
- Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that severely impacts motor control and communication abilities.
Purpose of the Study:
- To evaluate the durability and long-term performance of an implanted BCI for communication in a patient with advanced ALS over a 7-year period.
- To investigate the factors contributing to the eventual decline in BCI effectiveness in the context of progressive neurodegeneration.
Main Methods:
- Longitudinal case study reporting on 7 years of independent at-home use of an implanted BCI for communication.
- Monitoring of BCI usage frequency, patient's functional status (eye-gaze tracking), and neural signal amplitude.
- Computed tomographic (CT) imaging to assess brain structure and neurodegeneration.
Main Results:
- Initial increase in BCI usage frequency over the first 6 years, compensating for loss of eye-gaze control.
- A subsequent progressive decrease in BCI use starting around year 6, leading to cessation due to unreliability.
- No technical malfunctions identified; observed decline attributed to reduced neural signal amplitude and progressive cerebral atrophy linked to ALS.
Conclusions:
- An implanted BCI can provide sustained communication for individuals with ALS for several years.
- Progressive neurodegeneration, specifically reduced neural signal amplitude and brain atrophy, can ultimately limit BCI effectiveness.
- Long-term BCI performance is influenced by the underlying disease progression, necessitating ongoing monitoring and potential adaptation strategies.
