Emergence of Distinct Neural Subspaces in Motor Cortical Dynamics during Volitional Adjustments of Ongoing Locomotion.

The ability to modulate ongoing walking gait with precise, voluntary adjustments is what allows animals to navigate complex terrains. However, how the nervous system generates the signals to precisely control the limbs while simultaneously maintaining locomotion is poorly understood. One potential strategy is to distribute the neural activity related to these two functions into distinct cortical activity coactivation subspaces so that both may be conducted simultaneously without disruptive interference. To investigate this hypothesis, we recorded the activity of primary motor cortex in male nonhuman primates during obstacle avoidance on a treadmill. We found that the same neural population was active during both basic unobstructed locomotion and volitional obstacle avoidance movements. We identified the neural modes spanning the subspace of the low-dimensional dynamics in primary motor cortex and found a subspace that consistently maintains the same cyclic activity throughout obstacle stepping, despite large changes in the movement itself. All of the variance corresponding to this large change in movement during the obstacle avoidance was confined to its own distinct subspace. Furthermore, neural decoders built for ongoing locomotion did not generalize to decoding obstacle avoidance during locomotion. Our findings suggest that separate underlying subspaces emerge during complex locomotion that coordinates ongoing locomotor-related neural dynamics with volitional gait adjustments. These findings may have important implications for the development of brain-machine interfaces.SIGNIFICANCE STATEMENT Locomotion and precise, goal-directed movements are two distinct movement modalities with known differing requirements of motor cortical input. Previous studies have characterized the cortical activity during obstacle avoidance while walking in rodents and felines, but, to date, no such studies have been completed in primates. Additionally, in any animal model, it is unknown how these two movements are represented in primary motor cortex (M1) low-dimensional dynamics when both activities are performed at the same time, such as during obstacle avoidance. We developed a novel obstacle avoidance paradigm in freely moving nonhuman primates and discovered that the rhythmic locomotion-related dynamics and the voluntary, gait-adjustment movement separate into distinct subspaces in M1 cortical activity. Our analysis of decoding generalization may also have important implications for the development of brain-machine interfaces.

A brain-spine interface alleviating gait deficits after spinal cord injury in primates.

Spinal cord injury disrupts the communication between the brain and the spinal circuits that orchestrate movement. To bypass the lesion, brain-computer interfaces have directly linked cortical activity to electrical stimulation of muscles, and have thus restored grasping abilities after hand paralysis. Theoretically, this strategy could also restore control over leg muscle activity for walking. However, replicating the complex sequence of individual muscle activation patterns underlying natural and adaptive locomotor movements poses formidable conceptual and technological challenges. Recently, it was shown in rats that epidural electrical stimulation of the lumbar spinal cord can reproduce the natural activation of synergistic muscle groups producing locomotion. Here we interface leg motor cortex activity with epidural electrical stimulation protocols to establish a brain-spine interface that alleviated gait deficits after a spinal cord injury in non-human primates. Rhesus monkeys (Macaca mulatta) were implanted with an intracortical microelectrode array in the leg area of the motor cortex and with a spinal cord stimulation system composed of a spatially selective epidural implant and a pulse generator with real-time triggering capabilities. We designed and implemented wireless control systems that linked online neural decoding of extension and flexion motor states with stimulation protocols promoting these movements. These systems allowed the monkeys to behave freely without any restrictions or constraining tethered electronics. After validation of the brain-spine interface in intact (uninjured) monkeys, we performed a unilateral corticospinal tract lesion at the thoracic level. As early as six days post-injury and without prior training of the monkeys, the brain-spine interface restored weight-bearing locomotion of the paralysed leg on a treadmill and overground. The implantable components integrated in the brain-spine interface have all been approved for investigational applications in similar human research, suggesting a practical translational pathway for proof-of-concept studies in people with spinal cord injury.

Leveraging Large Language Models for Decision Support in Personalized Oncology.

Importance: Clinical interpretation of complex biomarkers for precision oncology currently requires manual investigations of previous studies and databases. Conversational large language models (LLMs) might be beneficial as automated tools for assisting clinical decision-making. Objective: To assess performance and define their role using 4 recent LLMs as support tools for precision oncology. Design, Setting, and Participants: This diagnostic study examined 10 fictional cases of patients with advanced cancer with genetic alterations. Each case was submitted to 4 different LLMs (ChatGPT, Galactica, Perplexity, and BioMedLM) and 1 expert physician to identify personalized treatment options in 2023. Treatment options were masked and presented to a molecular tumor board (MTB), whose members rated the likelihood of a treatment option coming from an LLM on a scale from 0 to 10 (0, extremely unlikely; 10, extremely likely) and decided whether the treatment option was clinically useful. Main Outcomes and Measures: Number of treatment options, precision, recall, F1 score of LLMs compared with human experts, recognizability, and usefulness of recommendations. Results: For 10 fictional cancer patients (4 with lung cancer, 6 with other; median [IQR] 3.5 [3.0-4.8] molecular alterations per patient), a median (IQR) number of 4.0 (4.0-4.0) compared with 3.0 (3.0-5.0), 7.5 (4.3-9.8), 11.5 (7.8-13.0), and 13.0 (11.3-21.5) treatment options each was identified by the human expert and 4 LLMs, respectively. When considering the expert as a criterion standard, LLM-proposed treatment options reached F1 scores of 0.04, 0.17, 0.14, and 0.19 across all patients combined. Combining treatment options from different LLMs allowed a precision of 0.29 and a recall of 0.29 for an F1 score of 0.29. LLM-generated treatment options were recognized as AI-generated with a median (IQR) 7.5 (5.3-9.0) points in contrast to 2.0 (1.0-3.0) points for manually annotated cases. A crucial reason for identifying AI-generated treatment options was insufficient accompanying evidence. For each patient, at least 1 LLM generated a treatment option that was considered helpful by MTB members. Two unique useful treatment options (including 1 unique treatment strategy) were identified only by LLM. Conclusions and Relevance: In this diagnostic study, treatment options of LLMs in precision oncology did not reach the quality and credibility of human experts; however, they generated helpful ideas that might have complemented established procedures. Considering technological progress, LLMs could play an increasingly important role in assisting with screening and selecting relevant biomedical literature to support evidence-based, personalized treatment decisions.

Long-term ecological assessment of intracranial electrophysiology synchronized to behavioral markers in obsessive-compulsive disorder.

Detection of neural signatures related to pathological behavioral states could enable adaptive deep brain stimulation (DBS), a potential strategy for improving efficacy of DBS for neurological and psychiatric disorders. This approach requires identifying neural biomarkers of relevant behavioral states, a task best performed in ecologically valid environments. Here, in human participants with obsessive-compulsive disorder (OCD) implanted with recording-capable DBS devices, we synchronized chronic ventral striatum local field potentials with relevant, disease-specific behaviors. We captured over 1,000 h of local field potentials in the clinic and at home during unstructured activity, as well as during DBS and exposure therapy. The wide range of symptom severity over which the data were captured allowed us to identify candidate neural biomarkers of OCD symptom intensity. This work demonstrates the feasibility and utility of capturing chronic intracranial electrophysiology during daily symptom fluctuations to enable neural biomarker identification, a prerequisite for future development of adaptive DBS for OCD and other psychiatric disorders.

Corrigendum: Low-Dimensional Motor Cortex Dynamics Preserve Kinematics Information During Unconstrained Locomotion in Nonhuman Primates.

[This corrects the article DOI: 10.3389/fnins.2019.01046.].

Low-Dimensional Motor Cortex Dynamics Preserve Kinematics Information During Unconstrained Locomotion in Nonhuman Primates.

The dynamical systems view of movement generation in motor cortical areas has emerged as an effective way to explain the firing properties of populations of neurons recorded from these regions. Recently, many studies have focused on finding low-dimensional representations of these dynamical systems during voluntary reaching and grasping behaviors carried out by the forelimbs. One such model, the Poisson linear-dynamical-system (PLDS) model, has been shown to extract dynamics which can be used to decode reaching kinematics. However, few have investigated these dynamics, especially in non-human primates, during behaviors such as locomotion, which may involve motor cortex to a lesser degree. Here, we focused on unconstrained quadrupedal locomotion, and investigated whether unsupervised latent state-space models can extract low-dimensional dynamics while preserving information about hind-limb kinematics. Spiking activity from the leg area of primary motor cortex of rhesus macaques was recorded simultaneously with hind-limb joint positions during ambulation across a corridor, ladder, and on a treadmill at various speeds. We found that PLDS models can extract stereotyped low-dimensional neural trajectories from these neurons phase-locked to the gait cycle, and that distinct trajectories emerge depending on the speed and class of behavior. Additionally, it was possible to decode both the hind-limb kinematics and the gait phase from these inferred trajectories just as well or better than from the full neural population (18-80 neurons) with only 12 dimensions. Our results demonstrate that kinematics and gait phase during various locomotion tasks are well represented in low-dimensional latent dynamics inferred from motor cortex population activity.