{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:57:38Z","timestamp":1785430658080,"version":"3.56.0"},"posted":{"date-parts":[[2026,7,1]]},"group-title":"Neurology","reference-count":49,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000055","name":"National Institute on Deafness and Other Communication Disorders","doi-asserted-by":"crossref","award":["U01DC016686"],"award-info":[{"award-number":["U01DC016686"]}],"id":[{"id":"10.13039\/100000055","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"crossref","award":["UH3NS114439"],"award-info":[{"award-number":["UH3NS114439"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"crossref"}]},{"award":["UGT7685"],"award-info":[{"award-number":["UGT7685"]}],"id":[{"id":"https:\/\/ror.org\/04jsz6e67","id-type":"ROR","asserted-by":"publisher"}]},{"award":["SSM06011"],"award-info":[{"award-number":["SSM06011"]}],"id":[{"id":"https:\/\/ror.org\/04jsz6e67","id-type":"ROR","asserted-by":"publisher"}]},{"award":["12803"],"award-info":[{"award-number":["12803"]}],"id":[{"id":"https:\/\/ror.org\/04jsz6e67","id-type":"ROR","asserted-by":"publisher"}]},{"award":["17619"],"award-info":[{"award-number":["17619"]}],"id":[{"id":"https:\/\/ror.org\/04jsz6e67","id-type":"ROR","asserted-by":"publisher"}]},{"award":["19072"],"award-info":[{"award-number":["19072"]}],"id":[{"id":"https:\/\/ror.org\/04jsz6e67","id-type":"ROR","asserted-by":"publisher"}]},{"name":"European Research Council","award":["320708"],"award-info":[{"award-number":["320708"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The field of implantable Brain-Computer Interfaces (iBCIs) is rapidly advancing, with individuals with amyotrophic lateral sclerosis (ALS) as key beneficiaries. However, ALS-related cortical degeneration may impair iBCI effectiveness. This study investigated whether structural magnetic resonance imaging (MRI) and functional MRI (fMRI) metrics are associated with the quality of electrocorticography (ECoG) signals critical for iBCI use.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Six late-stage ALS participants and 76 controls underwent T1-weighted structural MRI and task-based fMRI during right-hand movement or attempts thereof. ECoG data of ALS participants was benchmarked using ECoG data acquired in epilepsy patients. Grey matter thickness in the sensorimotor cortex and fMRI activation in the motor-hand area were measured.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Four ALS participants showed &gt;0.4 mm thinning in the precentral gyrus, while the postcentral gyrus was spared. ECoG signal quality was significantly associated with precentral grey matter thickness, but not with fMRI activity.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These findings suggest that presurgical assessment of precentral grey matter thickness could potentially prove useful for iBCI candidate selection in advanced ALS.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Plain Language Summary<\/jats:title>\n                  <jats:p>People with amyotrophic lateral sclerosis (ALS) can lose the ability to move and speak, but their thinking often remains intact. Implantable brain-computer interfaces (iBCIs) can help by translating brain signals into commands for communication devices. However, ALS damages the motor cortex, which may reduce the quality of these signals. In this study, we examined brain scans and electrical recordings from six people with advanced ALS. We found that thinning of the motor cortex was linked to weaker brain signals needed for iBCI control, while functional MRI activity was less predictive. This suggests that measuring motor cortex thickness before surgery could help identify who will benefit most from an iBCI, improving treatment decisions and future clinical trials.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Two sentence summary<\/jats:title>\n                  <jats:p>We examine presurgical MRI\/fMRI and ECoG recordings from people with advanced ALS receiving implanted brain-computer interfaces. Motor cortex thinning is associated with poorer ECoG signal quality, suggesting cortical thickness may help identify candidates likely to benefit.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.23.26355654","type":"posted-content","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T20:05:17Z","timestamp":1782936317000},"source":"Crossref","is-referenced-by-count":0,"title":["Association between motor cortex grey matter loss and inability to control an ECoG-based implanted Brain-Computer Interface in ALS"],"prefix":"10.64898","author":[{"given":"Mathijs","family":"Raemaekers","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon H.","family":"Geukes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik J.","family":"Aarnoutse","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana P.","family":"Branco","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zac V.","family":"Freudenburg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anouck","family":"Schippers","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan E.","family":"Crone","sequence":"additional","affiliation":[{"name":"Department of Neurology, Johns Hopkins University School of Medicine, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha","family":"Leinders","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Berezutskaya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7136-259X","authenticated-orcid":false,"given":"Nick F.","family":"Ramsey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands"},{"name":"Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9252-5116","authenticated-orcid":false,"given":"Mariska J.","family":"Vansteensel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026070401200805000_2026.06.23.26355654v1.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1603471"},{"key":"2026070401200805000_2026.06.23.26355654v1.2","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1016\/S0140-6736(10)61156-7","article-title":"Amyotrophic lateral sclerosis","volume":"377","year":"2011","journal-title":"The Lancet"},{"key":"2026070401200805000_2026.06.23.26355654v1.3","doi-asserted-by":"publisher","DOI":"10.1007\/BF00313105"},{"key":"2026070401200805000_2026.06.23.26355654v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(95)80031-X"},{"key":"2026070401200805000_2026.06.23.26355654v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1388-2457(02)00057-3"},{"key":"2026070401200805000_2026.06.23.26355654v1.6","doi-asserted-by":"publisher","DOI":"10.1038\/s44222-024-00239-5"},{"key":"2026070401200805000_2026.06.23.26355654v1.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1608085"},{"key":"2026070401200805000_2026.06.23.26355654v1.8","doi-asserted-by":"publisher","DOI":"10.1038\/S41586-025-09127-3"},{"key":"2026070401200805000_2026.06.23.26355654v1.9","doi-asserted-by":"publisher","DOI":"10.1001\/archneurpsyc.1954.02330050133019"},{"key":"2026070401200805000_2026.06.23.26355654v1.10","doi-asserted-by":"publisher","DOI":"10.1038\/nature17435"},{"key":"2026070401200805000_2026.06.23.26355654v1.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2023.08.003"},{"key":"2026070401200805000_2026.06.23.26355654v1.12","doi-asserted-by":"crossref","unstructured":"Fahimi Hnazaee, M. , et al. Towards predicting ECoG-BCI performance: assessing the potential of scalp-EEG *. J Neural Eng 19, 046045 (2022).","DOI":"10.1088\/1741-2552\/ac8764"},{"key":"2026070401200805000_2026.06.23.26355654v1.13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2314598"},{"key":"2026070401200805000_2026.06.23.26355654v1.14","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.3886-06.2007"},{"key":"2026070401200805000_2026.06.23.26355654v1.15","doi-asserted-by":"publisher","DOI":"10.1016\/0028-3932(71)90067-4"},{"key":"2026070401200805000_2026.06.23.26355654v1.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1608085"},{"key":"2026070401200805000_2026.06.23.26355654v1.17","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1177\/15459683221125788","article-title":"Methodological Recommendations for Studies on the Daily Life Implementation of Implantable Communication-Brain\u2013Computer Interfaces for Individuals With Locked-in Syndrome","volume":"36","year":"2022","journal-title":"Neurorehabil Neural Repair"},{"key":"2026070401200805000_2026.06.23.26355654v1.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2012.01.021"},{"key":"2026070401200805000_2026.06.23.26355654v1.19","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.200033797"},{"key":"2026070401200805000_2026.06.23.26355654v1.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2006.01.021"},{"key":"2026070401200805000_2026.06.23.26355654v1.21","doi-asserted-by":"publisher","DOI":"10.1007\/s12021-019-09441-y"},{"key":"2026070401200805000_2026.06.23.26355654v1.22","doi-asserted-by":"crossref","unstructured":"Raemaekers, M. , Bruurmijn, M. & Ramsey, N . The brain in a box: A toolbox for creating Cartesian geometric representations with isometric dimensions (Cgrids). J Neurosci Methods 339, 108738 (2020).","DOI":"10.1016\/j.jneumeth.2020.108738"},{"key":"2026070401200805000_2026.06.23.26355654v1.23","doi-asserted-by":"crossref","unstructured":"Candrea, D. N. et al. A click-based electrocorticographic brain-computer interface enables long-term high-performance switch scan spelling. Communications medicine 4, 207 (2024).","DOI":"10.1038\/s43856-024-00635-3"},{"key":"2026070401200805000_2026.06.23.26355654v1.24","doi-asserted-by":"publisher","DOI":"10.1109\/TBME.2004.827072"},{"key":"2026070401200805000_2026.06.23.26355654v1.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneumeth.2017.10.022"},{"key":"2026070401200805000_2026.06.23.26355654v1.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneumeth.2009.10.005"},{"key":"2026070401200805000_2026.06.23.26355654v1.27","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.neuroimage.2018.06.050","article-title":"GridLoc: An automatic and unsupervised localization method for high-density ECoG grids","volume":"179","year":"2018","journal-title":"Neuroimage"},{"key":"2026070401200805000_2026.06.23.26355654v1.28","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.25364"},{"key":"2026070401200805000_2026.06.23.26355654v1.29","doi-asserted-by":"crossref","unstructured":"Raemaekers, M. , Bruurmijn, M. & Ramsey, N . The brain in a box: A toolbox for creating Cartesian geometric representations with isometric dimensions (Cgrids). J Neurosci Methods 339, 108738 (2020).","DOI":"10.1016\/j.jneumeth.2020.108738"},{"key":"2026070401200805000_2026.06.23.26355654v1.30","doi-asserted-by":"publisher","DOI":"10.1007\/s12021-019-09441-y"},{"key":"2026070401200805000_2026.06.23.26355654v1.31","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-306839"},{"key":"2026070401200805000_2026.06.23.26355654v1.32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0080748"},{"key":"2026070401200805000_2026.06.23.26355654v1.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2013.07.020"},{"key":"2026070401200805000_2026.06.23.26355654v1.34","doi-asserted-by":"crossref","unstructured":"Dieckmann, N. et al. Cortical and subcortical grey matter atrophy in Amyotrophic Lateral Sclerosis correlates with measures of disease accumulation independent of disease aggressiveness. Neuroimage Clin 36, 103162 (2022).","DOI":"10.1016\/j.nicl.2022.103162"},{"key":"2026070401200805000_2026.06.23.26355654v1.35","first-page":"708","article-title":"Amyotrophic lateral sclerosis\u2014a model of corticofugal axonal spread","volume":"9","year":"2013","journal-title":"Nature Reviews Neurology 2013 9:12"},{"key":"2026070401200805000_2026.06.23.26355654v1.36","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.1787-21.2022"},{"key":"2026070401200805000_2026.06.23.26355654v1.37","doi-asserted-by":"crossref","unstructured":"Turner, M. R. & Swash, M . The expanding syndrome of amyotrophic lateral sclerosis: a clinical and molecular odyssey. J Neurol Neurosurg Psychiatry 86, 667 (2015).","DOI":"10.1136\/jnnp-2014-308946"},{"key":"2026070401200805000_2026.06.23.26355654v1.38","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-306839"},{"key":"2026070401200805000_2026.06.23.26355654v1.39","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0080748"},{"key":"2026070401200805000_2026.06.23.26355654v1.40","doi-asserted-by":"crossref","unstructured":"Dieckmann, N. et al. Cortical and subcortical grey matter atrophy in Amyotrophic Lateral Sclerosis correlates with measures of disease accumulation independent of disease aggressiveness. Neuroimage Clin 36, 103162 (2022).","DOI":"10.1016\/j.nicl.2022.103162"},{"key":"2026070401200805000_2026.06.23.26355654v1.41","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2314598"},{"key":"2026070401200805000_2026.06.23.26355654v1.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2007.03.061"},{"key":"2026070401200805000_2026.06.23.26355654v1.43","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2023.08.003"},{"key":"2026070401200805000_2026.06.23.26355654v1.44","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2011.11.061"},{"key":"2026070401200805000_2026.06.23.26355654v1.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2014.07.002"},{"key":"2026070401200805000_2026.06.23.26355654v1.46","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1001\/jamaneurol.2022.4847","article-title":"Assessment of Safety of a Fully Implanted Endovascular Brain-Computer Interface for Severe Paralysis in 4 Patients: The Stentrode With Thought-Controlled Digital Switch (SWITCH) Study","volume":"80","year":"2023","journal-title":"JAMA Neurol"},{"key":"2026070401200805000_2026.06.23.26355654v1.47","doi-asserted-by":"crossref","unstructured":"Guger, C. et al. Complete locked-in and locked-in patients: Command following assessment and communication with vibro-tactile P300 and motor imagery brain-computer interface tools. Front Neurosci 11, (2017).","DOI":"10.3389\/fnins.2017.00251"},{"key":"2026070401200805000_2026.06.23.26355654v1.48","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1000609"},{"key":"2026070401200805000_2026.06.23.26355654v1.49","doi-asserted-by":"publisher","DOI":"10.1038\/nn1233"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.06.23.26355654","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T08:20:31Z","timestamp":1783153231000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.06.23.26355654"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":49,"URL":"https:\/\/doi.org\/10.64898\/2026.06.23.26355654","relation":{},"subject":[],"published":{"date-parts":[[2026,7,1]]},"subtype":"preprint"}}