91

ELECTROCORTICOGRAPHY-BASED COMPUTER INTERFACE FOR PEDIATRIC PATIENT: CHALLENGE ON THE HORIZON

Reza A Department of , Faculty of Medicine, Universitas Indonesia.

ABSTRACT Electrocorticography-based brain computer interface has accepted recognition as modality connecting to computer device for its signal recording excellence and stability. Implantation for medical purpose has welcomed this modality for bypassing existing nervous system and natural organ to create alternative solution towards previously-unsolved medical problems. Clinical trials have already initiated for Electrocorticography-based BCI implantation in adult. Therefore, bridging a direct brain to computer connectivity in pediatric patient should also become possible. However, several characteristics has made Electrocorticography-based BCI for pediatric patient more complex and should await for further technical solution rather than its adult counterparts.

Keywords: Electrocorticography, Brain-Computer Interface, Pediatric.

INTRODUCTION electronic communication (Hirata et al., Electrocorticography (ECoG)- 2015; Yanagisawa et al., 2012; Hirata et based brain computer interface (BCI) is a al., 2011; Vastenseel et al., 2016). method to connect brain signal with Clinical trial has been started for ECoG- output devices based on recording of based BCI implantation in adult with electrode surgically implanted at the brain Amyotrophic Lateral Sclerosis (ALS) surface (Hirata et al., 2015). An ECoG- resulting in satisfying result (Vastenseel based BCI offers benefit in comparison to et al., 2016). Although pediatric other signal acquisition system existed for population also look up for benefit from BCI. These includes: low noise and high BCI for communication and controlling frequency activities detection ability artificial limbs, BCI for child is still compared to scalp EEG, superior in long- mainly provided by the non – invasive term stability and less invasive than (EEG)-based BCI microneedle electrode. Implantation (Mikołajewska et al., 2013). through surgery makes the ECog-based BCI is not only portable and permanent DISCUSSION rather than the functional MRI (fMRI), There are several dilemma before a near-infrared spectroscopy (NIRS) and long-term implantation of an ECoG-based (MEG)-based BCI for child is available in the near signal acquisition system (Hirata et al., future. First, younger the chid, smaller 2015). Signal acquied from ECoG can be gyri and sulci that they had. Current modulated to control robotic arm for clinical-oriented ECoG provides assistance or move computer cursor for interelectrode spacing at about 1 cm.

Jurnal Kedokteran p-ISSN 2460-9749 Vol. 05 No.01 Desember 2019 e-ISSN 2620-5890

92

When the same interspacing covered described that ECoG implantation for 6- smaller anatomical size of cortical gyri, 22 months possibly resulted in mild the signal quality will be reduced. A inflammatory process, mild necrosis, customized electrode with denser macrophages and foreign-body giant cell arrangement has been proposed with main adherence without reduction of the goal to meet patient’s specific contour of quality of signal acquisition (Degenhart et gyri and sulci (Morris et al., 2015). al., 2016; Romanelli et al., 2018). In However, providing an ECoG which order to support a decision of surgically- sufficiently covered smaller pediatric gyri implanted external device to a child’s is much more difficult than adult. brain along his lifespan, a firm knowledge Growth and expansion of cranial about long term in-growth brain reaction content. Implantation of long-term ECoG toward subdural electrode implantation is in adult is unrestrained from cranial needed. expansion problem, while head Difference of signal characteristics circumference growth in a child is toward ages. Roland et al has evaluated expected as natural process. Experience the variations of ECoG signals from from ECoG implant for spikes recording patient with ages 11-59 years and its before pediatric surgery usually implication towards BCI (Roland et al., took 2-14 days prior to surgery (Asano et 2011). Although the result supports the al., 2009). This common practice is far high gamma rhythms utilization as shorter than duration of ECoG-based BCI separable signal which considered as implant in adults which has progressed to control features and can be used through more than one year (Vastenseel et al., the course of patient’s life, our 2016). An implant inside a progressed understanding on ECoG characteristics of cranial content may slipped away from young human brain is still lacking. desired recording area thus nullifying the Child’s learning and adapting optimum signal acquisition. When the process with implanted device. Mental head growth is faster on a certain stage of workload during BCI learning and development, the risk will also become adaptation is noticed within adult higher. (Elizabeth et al., 2012). Eventhough it Unknown child’s brain tissue was proven that child can be taught to use reaction to chronic implantation. The BCI platform with satisfying result, there long-term effect and histologcal reaction was possible variation of result among to ECoG implantation needs further childgroup with different ages (Zhang et evaluation. Some research in animal has al., 2019). General assumption that adult

Jurnal Kedokteran p-ISSN 2460-9749 Vol. 05 No.01 Desember 2019 e-ISSN 2620-5890

93

will cope better with mental workload different centers around the world, it is during learning and also had better very natural that pediatric BCI experience with electronic implantation also comes to the horizon. communication may applied to the However, several characteristics made situation. invasive BCI implantation for pediatric is Considering the underlying more challenging. Several uniqueness problems above, prediction that the future needs novel soultion before a child can Ecog-based BCI will probably serve the also find benefit of ECoG-based BCI pediatric patient starting from equally as their adult predecessor. adolescence group. Adolescence will offer much similarity with adult while REFERENCE continuation of trials and research to Asano, E, Juhász, C, Shah, A, et al., (2009). Role of subdural younger group will provide deeper electrocorticography in prediction understanding and solution on how to put of long‐term outcome in . Brain 132, 1038– permanent cortical electrode to a child at 1047. URL: every stage of development. Meanwhile, https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC2668945/ non invasive BCI will stay as prima Degenhart A.D., Eles J., Dum R., et al., donna for brain to computer connectivity (2016) Histological evaluation of a in pediatric population. chronically-implanted electrocorticographic electrode grid Although the technical complexity in a non-human primate. J. Neural and scope of the problems are beyond the Eng., 13, 046019. URL: https://www.ncbi.nlm.nih.gov/pmc/ current literature, not to include the articles/PMC4993459/ ethical aspects of inserting a lifelong Elizabeth A, Felton , Justin C. et al., to a child, we believe (2012) Mental workload during brain–computer interface training, further research is worth the resources. Ergonomics, 55(5), 526-537. URL: Considering the assumption of a longer https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3344383/ life expectancy than adults, pediatric Hirata M, Yoshimine T. (2015). Chapter patients will gain benefit for a longer 5. Electrocorticographic Brain– duration when the technical solution is Machine Interfaces for Motor and Communication Control. In: available. Kansaku K, Cohen LG, Birbaumer N (eds). Clinical Systems (pp 83-100). Japan. CONCLUSION Springer. URL: Since the clinical implantation of https://www.springer.com/gp/book/ 9784431550365 ECoG-based brain computer interface for Hirata M, Matsushita K, Suzuki T, et al., adult has been initiated throughout (2011). A fully-implantable

Jurnal Kedokteran p-ISSN 2460-9749 Vol. 05 No.01 Desember 2019 e-ISSN 2620-5890

94

wireless system for human brain- Roland J, Miller K, Freudenburg Z, et al., machine interfaces using brain (2011). The effect of age on human surface electrodes: W-HERBS. motor electrocorticographic signals IEICE Trans Commun E94-B, and implications for brain- 2448–2453. URL: computer interface applications. J. https://search.ieice.org/bin/summar Neural Eng., 8, 046013. URL: y.php?id=e94-b_9_2448 https://iopscience.iop.org/article/10 .1088/1741-2560/8/4/046013 Mikołajewska E, Mikołajewski D. (2013) The prospects of brain—computer Vansteensel, M. J., Pels, E. G. M., interface applications in children. Bleichner, M. G., et al., (2016). Cent. Eur. J. Med. (9) 74–79. URL: Fully implanted brain–computer https://link.springer.com/article/10. interface in a locked-in patient with 2478/s11536-013-0249-3 ALS. N. Engl. J. Med, (375), 2060– 2066. URL: Morris S, Hirata M, Sugata H, et al., https://www.nejm.org/doi/10.1056/ (2015) Patient-Specific Cortical NEJMoa1608085?url_ver=Z39.88- Electrodes for Sulcal and Gyral 2003&rfr_id=ori:rid:crossref.org&r Implantation. IEEE Transactions fr_dat=cr_pub%3dwww.ncbi.nlm.n on Biomedical Engineering, 62(4) ih.gov 1034-1040. URL: https://tbme.embs.org/2015/03/28/p Yanagisawa T, Hirata M, Saitoh Y, et al., atient-specific-cortical-electrodes- (2012) Electrocorticographic sulcal-gyral-implantation/ control of a prosthetic arm in paralyzed patients. Ann. Neurol, Romanelli, Pantaleo, Piangerelli M, et al., 71(3), 353-361. URL: (2018). A novel neural prosthesis https://onlinelibrary.wiley.com/doi/ providing long-term full/10.1002/ana.22613 electrocorticography recording and cortical stimulation for epilepsy Zhang J, Jadavji Z., Zewdie E., et al., and brain-computer interface. (2019) Evaluating if children can Journal of Neurosurgery, May, 1– use simple brain computer 14. URL: interfaces. Frontiers Hum. https://thejns.org/view/journals/j- Neurosci., 13,Feb, 1–7. URL: neurosurg/130/4/article-p1166.xml https://www.frontiersin.org/articles /10.3389/fnhum.2019.00024/full

Jurnal Kedokteran p-ISSN 2460-9749 Vol. 05 No.01 Desember 2019 e-ISSN 2620-5890