Dorsolateral prefrontal cortex-based control with an implanted brain–computer interface

The objective of this study was to test the feasibility of using the dorsolateral prefrontal cortex as a signal source for brain–computer interface control in people with severe motor impairment. We implanted two individuals with locked-in syndrome with a chronic brain–computer interface designed to restore independent communication. The implanted system (Utrecht NeuroProsthesis) included electrode strips placed subdurally over the dorsolateral prefrontal cortex. In both participants, counting backwards activated the dorsolateral prefrontal cortex consistently over the course of 47 and 22 months, respectively. Moreover, both participants were able to use this signal to control a cursor in one dimension, with average accuracy scores of 78 ± 9% (standard deviation) and 71 ± 11% (chance level: 50%), respectively. Brain–computer interface control based on dorsolateral prefrontal cortex activity is feasible in people with locked-in syndrome and may become of relevance for those unable to use sensorimotor signals for control.