Endovascular Brain-Computer Interfaces in Poststroke Paralysis.

Stroke is a leading cause of paralysis, most frequently affecting the upper limbs and vocal folds. Despite recent advances in care, stroke recovery invariably reaches a plateau, after which there are permanent neurological impairments. Implantable brain-computer interface devices offer the potential to bypass permanent neurological lesions. They function by (1) recording neural activity, (2) decoding the neural signal occurring in response to volitional motor intentions, and (3) generating digital control signals that may be used to control external devices. While brain-computer interface technology has the potential to revolutionize neurological care, clinical translation has been limited. Endovascular arrays present a novel form of minimally invasive brain-computer interface devices that have been deployed in human subjects during early feasibility studies. This article provides an overview of endovascular brain-computer interface devices and critically evaluates the patient with stroke as an implant candidate. Future opportunities are mapped, along with the challenges arising when decoding neural activity following infarction. Limitations arise when considering intracerebral hemorrhage and motor cortex lesions; however, future directions are outlined that aim to address these challenges.
Competing Interests: Disclosures Drs Fry, Opie, and Oxley are employees of Synchron. Drs Fry, Opie, and Oxley report stock options from Synchron. Dr Brannigan reports consulting fees from Synchron. Drs Opie and Oxley report issued and pending patents for sensing or stimulating activity of neural tissue. P. Mitchell reports compensation from Stryker Corporation for consultant services; compensation from Medtronic USA, Inc, and Stryker Corporation for other services. The other author reports no conflicts.