RT Journal Article SR Electronic T1 Motor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experience JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP neurintsurg-2020-016862 DO 10.1136/neurintsurg-2020-016862 A1 Thomas J Oxley A1 Peter E Yoo A1 Gil S Rind A1 Stephen M Ronayne A1 C M Sarah Lee A1 Christin Bird A1 Victoria Hampshire A1 Rahul P Sharma A1 Andrew Morokoff A1 Daryl L Williams A1 Christopher MacIsaac A1 Mark E Howard A1 Lou Irving A1 Ivan Vrljic A1 Cameron Williams A1 Sam E John A1 Frank Weissenborn A1 Madeleine Dazenko A1 Anna H Balabanski A1 David Friedenberg A1 Anthony N Burkitt A1 Yan T Wong A1 Katharine J Drummond A1 Patricia Desmond A1 Douglas Weber A1 Timothy Denison A1 Leigh R Hochberg A1 Susan Mathers A1 Terence J O'Brien A1 Clive N May A1 J Mocco A1 David B Grayden A1 Bruce C V Campbell A1 Peter Mitchell A1 Nicholas L Opie YR 2020 UL http://jnis.bmj.com/content/early/2020/10/30/neurintsurg-2020-016862.abstract AB 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.