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Oxley TJ, Yoo PE, Rind GS, Ronayne SM, Lee CMS, Bird C, Hampshire V, Sharma RP, Morokoff A, Williams DL, MacIsaac C, Howard ME, Irving L, Vrljic I, Williams C, John SE, Weissenborn F, Dazenko M, Balabanski AH, Friedenberg D, Burkitt AN, Wong YT, Drummond KJ, Desmond P, Weber D, Denison T, Hochberg LR, Mathers S, O'Brien TJ, May CN, Mocco J, Grayden DB, Campbell BCV, Mitchell P, Opie NL. Motor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experience. J Neurointerv Surg 2021; 13:102-108. [PMID: 33115813 PMCID: PMC7848062 DOI: 10.1136/neurintsurg-2020-016862] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Implantable brain-computer interfaces (BCIs), functioning as motor neuroprostheses, have the potential to restore voluntary motor impulses to control digital devices and improve functional independence in patients with severe paralysis due to brain, spinal cord, peripheral nerve or muscle dysfunction. However, reports to date have had limited clinical translation. METHODS Two participants with amyotrophic lateral sclerosis (ALS) underwent implant in a single-arm, open-label, prospective, early feasibility study. Using a minimally invasive neurointervention procedure, a novel endovascular Stentrode BCI was implanted in the superior sagittal sinus adjacent to primary motor cortex. The participants undertook machine-learning-assisted training to use wirelessly transmitted electrocorticography signal associated with attempted movements to control multiple mouse-click actions, including zoom and left-click. Used in combination with an eye-tracker for cursor navigation, participants achieved Windows 10 operating system control to conduct instrumental activities of daily living (IADL) tasks. RESULTS Unsupervised home use commenced from day 86 onwards for participant 1, and day 71 for participant 2. Participant 1 achieved a typing task average click selection accuracy of 92.63% (100.00%, 87.50%-100.00%) (trial mean (median, Q1-Q3)) at a rate of 13.81 (13.44, 10.96-16.09) correct characters per minute (CCPM) with predictive text disabled. Participant 2 achieved an average click selection accuracy of 93.18% (100.00%, 88.19%-100.00%) at 20.10 (17.73, 12.27-26.50) CCPM. Completion of IADL tasks including text messaging, online shopping and managing finances independently was demonstrated in both participants. CONCLUSION We describe the first-in-human experience of a minimally invasive, fully implanted, wireless, ambulatory motor neuroprosthesis using an endovascular stent-electrode array to transmit electrocorticography signals from the motor cortex for multiple command control of digital devices in two participants with flaccid upper limb paralysis.
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Affiliation(s)
- Thomas J Oxley
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Synchron, Inc, Campbell, California, USA
| | - Peter E Yoo
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Synchron, Inc, Campbell, California, USA
| | - Gil S Rind
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Synchron, Inc, Campbell, California, USA
| | - Stephen M Ronayne
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Synchron, Inc, Campbell, California, USA
| | - C M Sarah Lee
- Neurology, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Christin Bird
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Rahul P Sharma
- Interventional Cardiology, Cardiovascular Medicine Faculty, Stanford University, Stanford, California, USA
| | - Andrew Morokoff
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Neurosurgery, Melbourne Health, Parkville, Victoria, Australia
| | | | | | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Lou Irving
- Respiratory Medicine, Melbourne Health, Parkville, Victoria, Australia
| | - Ivan Vrljic
- Radiology, Melbourne Health, Parkville, Victoria, Australia
| | | | - Sam E John
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Frank Weissenborn
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Madeleine Dazenko
- Neurology, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | | | | | - Anthony N Burkitt
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Yan T Wong
- Department of Electrical and Computer Systems Engineering, Monash University, Clayton, Victoria, Australia
| | - Katharine J Drummond
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Neurosurgery, Melbourne Health, Parkville, Victoria, Australia
| | - Patricia Desmond
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Radiology, Melbourne Health, Parkville, Victoria, Australia
| | - Douglas Weber
- Department of Mechanical Engineering and Neuroscience Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Timothy Denison
- Synchron, Inc, Campbell, California, USA
- Institute of Biomedical Engineering, Oxford University, Oxford, Oxfordshire, UK
| | - Leigh R Hochberg
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
| | - Susan Mathers
- Neurology, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Terence J O'Brien
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Neurology, Melbourne Health, Parkville, Victoria, Australia
| | - Clive N May
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - J Mocco
- Neurosurgery, The Mount Sinai Health System, New York, New York, USA
| | - David B Grayden
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce C V Campbell
- Medicine, University of Melbourne, Parkville, Victoria, Australia
- Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter Mitchell
- Radiology, Melbourne Health, Parkville, Victoria, Australia
| | - Nicholas L Opie
- Vascular Bionics Laboratory, Departments of Medicine, Neurology and Surgery, Melbourne Brain Centre at the Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Synchron, Inc, Campbell, California, USA
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