The 'Brussels 4': essential requirements for implantable brain-computer interface user autonomy.

Implantable brain-computer interfaces (iBCIs) hold great promise for individuals with severe paralysis and are advancing toward commercialization. The features required to achieve autonomous use of an iBCI may be under recognized in traditional academic measures of iBCI function and deserve further consideration to achieve successful clinical translation and patient adoption. Here, we present four key considerations to achieve autonomous use, reflecting the authors' perspectives based on discussions during various sessions and workshops across the 10th International BCI Society Meeting, Brussels, 2023: (1) immediate use, (2) easy to use, (3) continuous use, and (4) stable system use.

A 10-year journey towards clinical translation of an implantable endovascular BCI a keynote lecture given at the BCI society meeting in Brussels.

In the rapidly evolving field of brain-computer interfaces (BCIs), a novel modality for recording electrical brain signals has quietly emerged over the past decade. The technology is endovascular electrocorticography (ECoG), an innovation that stands alongside well-established methods such as electroencephalography, traditional ECoG, and single/multi-unit activity recording. This system was inspired by advancements in interventional cardiology, particularly the integration of electronics into various medical interventions.

Building consensus on clinical outcome assessments for BCI devices. A summary of the 10th BCI society meeting 2023 workshop.

: The 10th International brain computer interface (BCI) Society Meeting, 'Balancing Innovation and Translation', was held from the 6th to 9th of June 2023 in Brussels, Belgium. This report provides a summary of the workshop ''. This workshop was intended to give participants an overview of the current state of BCI, future opportunities, and how different countries and regions provide regulatory oversight to support the BCI community to develop safe and effective devices for patients.

Superior cortical venous anatomy for endovascular device implantation: a systematic review.

Endovascular electrode arrays provide a minimally invasive approach to access intracranial structures for neural recording and stimulation. These arrays are currently used as brain-computer interfaces (BCIs) and are deployed within the superior sagittal sinus (SSS), although cortical vein implantation could improve the quality and quantity of recorded signals. However, the anatomy of the superior cortical veins is heterogenous and poorly characterised.

The Promise of Endovascular Neurotechnology: A Brain-Computer Interface to Restore Autonomy to People With Motor Impairment.

This Joel A. DeLisa Lecture on endovascular brain-computer interfaces was presented by Dr Thomas Oxley on February 23, 2023, at the Association of Academic Physiatrists Annual Scientific Meeting. The lecture described how brain-computer interfaces replace lost physiological function to enable direct communication between the brain and external digital devices, such as computers, smartphones, and robotic limbs.

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.

Assessment of Safety of a Fully Implanted Endovascular Brain-Computer Interface for Severe Paralysis in 4 Patients: The Stentrode With Thought-Controlled Digital Switch (SWITCH) Study.

Importance: Brain-computer interface (BCI) implants have previously required craniotomy to deliver penetrating or surface electrodes to the brain. Whether a minimally invasive endovascular technique to deliver recording electrodes through the jugular vein to superior sagittal sinus is safe and feasible is unknown.

Objective: To assess the safety of an endovascular BCI and feasibility of using the system to control a computer by thought.

Reduced-form and complex ACTM modelling for air quality policy development: A model inter-comparison.

Simulation models can be valuable tools in supporting development of air pollution policy. However, exploration of future scenarios depends on reliable and robust modelling to provide confidence in outcomes which cannot be tested against measurements. Here we focus on the UK Integrated Assessment Model, a fast reduced-form model with a purpose to support policy development with modelling of multiple alternative future scenarios, and the EMEP4UK model which is a complex Eulerian Atmospheric Chemistry Transport Model requiring significant computing resources.

Vascular remodeling in sheep implanted with endovascular neural interface.

The aim of this work was to assess vascular remodeling after the placement of an endovascular neural interface (ENI) in the superior sagittal sinus (SSS) of sheep. We also assessed the efficacy of neural recording using an ENI.The study used histological analysis to assess the composition of the foreign body response.

Feasibility of using discrete Brain Computer Interface for people with Multiple Sclerosis.

Aim: Brain-Computer Interfaces (BCIs) hold promise to provide people with partial or complete paralysis, the ability to control assistive technology. This study reports offline classification of imagined and executed movements of the upper and lower limb in one participant with multiple sclerosis and people with no limb function deficits.

Methods: We collected neural signals using electroencephalography (EEG) while participants performed executed and imagined motor tasks as directed by prompts shown on a screen.

Stimulating the Facial Nerve to Treat Ischemic Stroke: A Systematic Review.

Acute ischemic stroke (AIS) is a common devastating disease that has increased yearly in absolute number of cases since 1990. While mechanical thrombectomy and tissue plasminogen activator (tPA) have proven to be effective treatments, their window-of-efficacy time is very short, leaving many patients with no viable treatment option. Over recent years there has been a growing interest in stimulating the facial nerves or ganglions to treat AIS.

Racial and Socioeconomic Disparities in the Use and Outcomes of Endovascular Thrombectomy for Acute Ischemic Stroke.

Background And Purpose: Racial and socioeconomic disparities in the incidence, treatment, and outcomes of acute ischemic stroke exist and have been described. We aimed to characterize disparities in the use of endovascular thrombectomy in a nationally representative analysis.

Materials And Methods: Discharge data from the Nationwide Inpatient Sample between 2006 and 2016 were queried using validated International Classification of Disease codes.

Mobile Interventional Stroke Teams Improve Outcomes in the Early Time Window for Large Vessel Occlusion Stroke.

Background And Purpose: Endovascular thrombectomy for large vessel occlusion stroke is a time-sensitive intervention. The use of a Mobile Interventional Stroke Team (MIST) traveling to Thrombectomy Capable Stroke Centers to perform endovascular thrombectomy has been shown to be significantly faster with improved discharge outcomes, as compared with the drip-and-ship (DS) model. The effect of the MIST model stratified by time of presentation has yet to be studied.

Palliative care for homeless and vulnerably housed people: scoping review and thematic synthesis.

Introduction: People who are homeless or vulnerably housed are subject to disproportionately high risks of physical and mental illness and are further disadvantaged by difficulties in access to services. Research has been conducted examining a wide range of issues in relation to end-of-life care for homeless and vulnerably housed people, however, a contemporary scoping review of this literature is lacking.

Objectives: To understand the provision of palliative care for people who are homeless or vulnerably housed from the perspective of, and for the benefit of, all those who should be involved in its provision.

The UK Integrated Assessment Model for source apportionment and air pollution policy applications to PM.

Source apportionment and the effect of reducing individual sources is important input for the development of strategies to address air pollution. The UK Integrated Assessment Model, UKIAM, has been developed for this purpose as a flexible framework, combining information from different atmospheric dispersion models to cover different pollutant contributions, and span the range from European to local scale. In this paper we describe the UKIAM as developed for SO, NOx, NH, PM and VOCs.

Neurological implications of COVID-19: a review of the science and clinical guidance.

COVID-19 is a significant global health burden. The pulmonary morbidity and mortality of COVID-19 is well described, however, there is mounting evidence of neurological manifestations of SARS-CoV-2, which may be of prognostic significance. This paper summarises the available evidence in order to provide clinicians with a concise summary of the peripheral and central neurological manifestations of COVID-19, discusses specific issues regarding the management of chronic neurological disease in the context of the pandemic, and provides a summary of the thrombotic implications of the disease for the neurologist.

Mobile Interventional Stroke Team Model Improves Early Outcomes in Large Vessel Occlusion Stroke: The NYC MIST Trial.

Background And Purpose: Triage of patients with emergent large vessel occlusion stroke to primary stroke centers followed by transfer to comprehensive stroke centers leads to increased time to endovascular therapy. A Mobile Interventional Stroke Team (MIST) provides an alternative model by transferring a MIST to a Thrombectomy Capable Stroke Center (TSC) to perform endovascular therapy. Our aim is to determine whether the MIST model is more time-efficient and leads to improved clinical outcomes compared with standard drip-and-ship (DS) and mothership models.

Motor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experience.

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.

Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE).

Background And Purpose: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic.

Emergent Large Vessel Occlusion Stroke During New York City's COVID-19 Outbreak: Clinical Characteristics and Paraclinical Findings.

Background And Purpose: The 2019 novel coronavirus outbreak and its associated disease (coronavirus disease 2019 [COVID-19]) have created a worldwide pandemic. Early data suggest higher rate of ischemic stroke in severe COVID-19 infection. We evaluated whether a relationship exists between emergent large vessel occlusion (ELVO) and the ongoing COVID-19 outbreak.

Distinct Neural Correlates Underlie Inhibitory Mechanisms of Motor Inhibition and Motor Imagery Restraint.

There is evidence to suggest that motor execution and motor imagery both involve planning and execution of the same motor plan, however, in the latter the output is inhibited. Currently, little is known about the underlying neural mechanisms of motor output inhibition during motor imagery. Uncovering the distinctive characteristics of motor imagery may help us better understand how we abstract complex thoughts and acquire new motor skills.

Endovascular Neuromodulation: Safety Profile and Future Directions.

Endovascular neuromodulation is an emerging technology that represents a synthesis between interventional neurology and neural engineering. The prototypical endovascular neural interface is the Stentrode, a stent-electrode array which can be implanted into the superior sagittal sinus via percutaneous catheter venography, and transmits signals through a transvenous lead to a receiver located subcutaneously in the chest. Whilst the Stentrode has been conceptually validated in ovine models, questions remain about the long term viability and safety of this device in human recipients.