FIRST-GENERATION BRAIN–COMPUTER INTERFACES: A NARRATIVE REVIEW OF CLINICAL TRANSLATION, COMPARATIVE SAFETY, AND NEURO-RIGHTS

Abstract

Objectives. This narrative review examines first-generation brain-computer interfaces (BCIs) across three domains: clinical translation in amyotrophic lateral sclerosis (ALS), locked-in syn-drome (LIS), tetraplegia, spinal cord injury (SCI), pharmacoresistant epilepsy and movement dis-orders; comparative safety covering neurological, infectious, technical and cybersecurity risks; and the emerging neuro-rights regulatory debate. Methods. Literature was retrieved from PubMed/MEDLINE, Scopus, Web of Science, IEEE Xplore and legal-academic databases, covering peer-reviewed clinical trials, systematic reviews, safety datasets, technical analyses and bioethics scholarship through 2026. Key Findings. The BrainGate dataset (14 adults, 12,203 implant-days) reported 68 device-related adverse events and six serious adverse events, with no intracranial infections, explantations or at-tributable deaths. The endovascular SWITCH trial found zero serious adverse events at 12 months. Safety risk follows access route and implant chronicity rather than a simple invasive/non-invasive binary. Closed-loop neurostimulation reduces seizure frequency by 60-65% in pharmacoresistant epilepsy; adaptive deep brain stimulation is the most mature movement-disorder application. The neuro-rights literature converges on mental privacy, integrity, autonomy and cognitive liberty as core protected interests. Conclusions. Responsible BCI deployment requires matching the least invasive platform to the indication, consent specific to device capabilities, cybersecurity treated as patient safety, and pro-spective neural-data governance built into device design.