Towards clinical application of implantable brain-computer interfaces for people with late-stage ALS: medical and ethical considerations.

Content Provider	Europe PMC
Author	Vansteensel, Mariska J. Klein, Eran van Thiel, Ghislaine Gaytant, Michael Simmons, Zachary Wolpaw, Jonathan R. Vaughan, Theresa M.
Abstract	Individuals with amyotrophic lateral sclerosis (ALS) frequently develop speech and communication problems in the course of their disease. Currently available augmentative and alternative communication technologies do not present a solution for many people with advanced ALS, because these devices depend on residual and reliable motor activity. Brain–computer interfaces (BCIs) use neural signals for computer control and may allow people with late-stage ALS to communicate even when conventional technology falls short. Recent years have witnessed fast progression in the development and validation of implanted BCIs, which place neural signal recording electrodes in or on the cortex. Eventual widespread clinical application of implanted BCIs as an assistive communication technology for people with ALS will have significant consequences for their daily life, as well as for the clinical management of the disease, among others because of the potential interaction between the BCI and other procedures people with ALS undergo, such as tracheostomy. This article aims to facilitate responsible real-world implementation of implanted BCIs. We review the state of the art of research on implanted BCIs for communication, as well as the medical and ethical implications of the clinical application of this technology. We conclude that the contribution of all BCI stakeholders, including clinicians of the various ALS-related disciplines, will be needed to develop procedures for, and shape the process of, the responsible clinical application of implanted BCIs.
ISSN	03405354
Journal	Journal of Neurology
Volume Number	270
PubMed Central reference number	PMC9971103
Issue Number	3
PubMed reference number	36450968
e-ISSN	14321459
DOI	10.1007/s00415-022-11464-6
Language	English
Publisher	Springer Berlin Heidelberg
Publisher Date	2022-11-30
Publisher Place	Berlin/Heidelberg
Access Restriction	Open
Rights License	Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. © The Author(s) 2022
Subject Keyword	Brain–computer interface Implant Amyotrophic lateral sclerosis Ethics Clinical application Tracheostomy invasive ventilation
Content Type	Text
Resource Type	Article
Subject	Neurology Neurology (clinical)