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 on-board algorithms. Here, using a totally implanted sensing-enabled neurostimulator to perform long-term, at-home recordings from the motor cortex and pallidum of four subjects with Parkinson's 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 at-home data to generate biomarkers compatible with the classifier embedded on-board the neurostimulator. These findings offer a pipeline for ecologically valid movement biomarker identification that can advance therapy across a variety of diseases.