Intracranial brain-computer interface spelling using localized visual motion response

•Intracranial visual motion responses over MT drive BCI for spelling.•fMRI localizer developed to pinpoint the MT region individually.•Smart stopping algorithms to improve BCI performance.•BCI typing speed up to 12 char/min with only 3 electrodes. Intracranial brain-computer interfaces (BCIs) can assist severely disabled persons in text communication and environmental control with high precision and speed. Nevertheless, sustainable BCI implants require minimal invasiveness. One of the implantation strategies is to adopt localized and robust cortical activities to drive BCI communication and to make a precise presurgical planning. The visual motion response is a good candidate for inclusion in this strategy because of its focal activity over the middle temporal visual area (MT). Here, we developed an intracranial BCI for spelling, utilizing only three electrodes over the MT area. The best recording electrodes were decided by preoperative functional magnetic resonance imaging (MRI) localization of the MT, and local neural activities were further enhanced by differential rereferencing of these electrodes. The BCI spelling system was validated both offline and online by five epilepsy patients, achieving the fastest speed of 62 bits/min, i.e., 12 characters/min. Moreover, the response patterns of dual-directional visual motion stimuli provided an additional dimension of BCI target encoding and paved the way for a higher information transfer rate of intracranial BCI spelling.