Abstract
Brain-computer interfaces (BCIs) hold promise as assistive communication technology for people with severe paralysis. Although such BCIs should be available 24/7, feasibility of nocturnal BCI use has not been investigated. Here, we addressed this question using data from an electrocorticography-BCI user with amyotrophic lateral sclerosis. We investigated nocturnal dynamics of neural signal features used for BCI control. Additionally, we assessed nocturnal performance of a decoder trained on daytime data, by quantifying the number of unintentional BCI activations at night. Finally, we developed a nightmode functionality and assessed its performance. Mean and variance of low and high frequency band power were significantly higher at night than during the day. When applied to night data, daytime decoders caused unintentional BCI activations in 100% of nights (245 unintended click-commands and 13 unintended caregiver-calls per hour). The specifically developed nightmode functionality, however, functioned error-free in 79% of nights over a period of ± 1.5 years, allowing the user to reliably call the caregiver. Reliable nighttime use of a BCI requires strategies to adjust to circadian and sleep-related signal changes. This demonstration of a reliable nightmode and its long-term use by an individual with amyotrophic lateral sclerosis underscores the importance of 24/7 BCI reliability.
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Acknowledgements
The authors thank the participant of this study, and her family and caregiver team, whose courage, dedication, insights, and hospitality made this research possible. Thanks to Dr. Joram van Rheede for useful discussions about 24/7 neural signals, and to Dr. Mathijs Raemaekers for statistical advice.
Funding
The study is supported by the European Research Council (ERC-Advanced project iConnect, ADV 320708), Dutch Technology Foundation STW (grant UGT7685), National Institute on Deafness and Other Communication Disorders (U01DC016686) and National Institute of Neurological Disorders and Stroke (UH3NS114439) of the US National Institutes of Health. Implanted components for the UNP study were an in-kind contribution by Medtronic for research use only.
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EJA, NEC, TD, NFR and MJV contributed to conception and design of the study, SL, EJA, MPB, ZVF, SGH, AS, MSWV, MvdB, BvdV, NEC, TD, NFR and MJV contributed to acquisition, analysis and/or interpretation of data, SL, EJA, MPB, NFR and MJV contributed to drafting a significant portion of the manuscript or figures.
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Timothy Denison is a shareholder in Amber Therapeutics, board member at ONWARD, advisory board member and consultant with Cortec Neuro, and consultant with Synchron. Nick F. Ramsey was consultant for the Wyss Center (Geneva). Mariska J. Vansteensel was consultant for GA Capital and former board member ofthe International BCI Society.
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Leinders, S., Aarnoutse, E.J., Branco, M.P. et al. Implanted brain-computer interface functionality during nighttime in late-stage amyotrophic lateral sclerosis. Sci Rep (2026). https://doi.org/10.1038/s41598-026-44228-7
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DOI: https://doi.org/10.1038/s41598-026-44228-7
