Editorial. Advancement in brain-machine interfaces for patients with tetraplegia: neurosurgical perspective.
TeTraplegia results in the loss of motor function of all limbs and torso. It can affect basic motor function, sensation, respiration, digestion, bladder control, and other core autonomic functions.48 The most common cause of tetraplegia is spinal cord injury (SCI). It can also be caused by neuromuscular disorders such as amyotrophic lateral sclerosis (ALS).28,37 Although extensive efforts have been devoted to restoring damaged neural pathways following SCI, including physical rehabilitation,16,30 neuromodulation therapies,3 surgical procedures,4 and regenerative medicine,9,29,35 there currently remain few effective options for the restoration of motor or sensory function in individuals with tetraplegia. Intracranial brain–machine interfaces (iBMIs), also known as intracranial brain–computer interfaces, are based on multidisciplinary approaches that combine neurophysiology, computer science, and bioengineering. Their principal aim is to restore motor and/or sensory capacities. Brain–machine interfaces use neural activity recorded from the brain to decode the motor intent of an individual in real time and, based on this, artificially produce the desired limb movement.33,42 Therefore, to obtain neuronal recordings, either through microelectrodes or electrocorticographic (ECoG) grids, iBMI intrinsically requires neurosurgical access to functionally defined brain areas.5 Although most of these approaches have been tested in animal models, more recent studies have demonstrated the prospective use of iBMI technology in human patients with SCI.19 The rapid development and significant research efforts in this field suggest a more prominent role of iBMI in restorative neurosurgery.