title: Fully Implanted Brain-Computer Interface in a Locked-In Patient with ALS.
abstract: 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 .).
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Mariska J
authors.initials: MJ
authors.lastname: Vansteensel
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Elmar G M
authors.initials: EGM
authors.lastname: Pels
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Martin G
authors.initials: MG
authors.lastname: Bleichner
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Mariana P
authors.initials: MP
authors.lastname: Branco
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Timothy
authors.initials: T
authors.lastname: Denison
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Zachary V
authors.initials: ZV
authors.lastname: Freudenburg
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Peter
authors.initials: P
authors.lastname: Gosselaar
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Sacha
authors.initials: S
authors.lastname: Leinders
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Ottens
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Max A
authors.initials: MA
authors.lastname: Van Den Boom
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Peter C
authors.initials: PC
authors.lastname: Van Rijen
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Aarnoutse
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.J.V., E.G.M.P., M.P.B., Z.V.F., P.G., S.L., M.A.V.D.B., P.C.V.R., E.J.A., N.F.R.), and the Department of Anesthesiology (T.H.O.), University Medical Center Utrecht, Utrecht, the Netherlands; the Neuropsychology Laboratory, Department of Psychology, European Medical School, Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany (M.G.B.); and Neuromodulation Core Technology, Medtronic, Minneapolis (T.D.).
authors.forename: Nick F
authors.initials: NF
authors.lastname: Ramsey
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000534:rehabilitation*; D001044:Aphonia / Q000209:etiology / Q000534:rehabilitation*; D062207:Brain-Computer Interfaces; D003143:Communication Devices for People with Disabilities; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008875:Middle Aged; D009044:Motor Cortex; D000066530:Neurological Rehabilitation / Q000295:instrumentation; D011782:Quadriplegia / Q000209:etiology / Q000534:rehabilitation*