At-Home Movement State Classification Using Totally Implantable Bidirectional Cortical-Basal Ganglia Neural Interface

Movement decoding from invasive human recordings typically relies on a distributed system employing advanced machine learning algorithms programmed into an external computer for state classification. These brain-computer interfaces are limited to short-term studies in laboratory settings that may not reflect behavior and neural states in the real world. The development of implantable devices with sensing capabilities is revolutionizing the study and treatment of brain circuits. However, it is unknown whether these devices can decode natural movement state from recorded neural activity or accurately classify states in real-time using onboard algorithms. Here, using a totally implanted bidirectional neurostimulator to perform long-term, at-home recordings from the motor cortex and pallidum of four subjects with Parkinsons disease, we successfully identified highly sensitive and specific personalized signatures of gait state, as determined by wearable sensors. Additionally, we demonstrated the feasibility of using these neural biomarkers to drive adaptive stimulation with the classifier embedded onboard the neurostimulator. These findings offer a pipeline for ecologically valid movement biomarker identification that can advance therapy across a variety of diseases.