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Yang X, Zeng Y, Jiao G, Gan X, Linden D, Hernaus D, Zhu C, Li K, Yao D, Yao S, Jiang Y, Becker B. A brief real-time fNIRS-informed neurofeedback training of the prefrontal cortex changes brain activity and connectivity during subsequent working memory challenge. Prog Neuropsychopharmacol Biol Psychiatry 2024; 132:110968. [PMID: 38354898 DOI: 10.1016/j.pnpbp.2024.110968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/06/2023] [Accepted: 02/11/2024] [Indexed: 02/16/2024]
Abstract
Working memory (WM) represents a building-block of higher cognitive functions and a wide range of mental disorders are associated with WM impairments. Initial studies have shown that several sessions of functional near-infrared spectroscopy (fNIRS) informed real-time neurofeedback (NF) allow healthy individuals to volitionally increase activity in the dorsolateral prefrontal cortex (DLPFC), a region critically involved in WM. For the translation to therapeutic or neuroenhancement applications, however, it is critical to assess whether fNIRS-NF success transfers into neural and behavioral WM enhancement in the absence of feedback. We therefore combined single-session fNIRS-NF of the left DLPFC with a randomized sham-controlled design (N = 62 participants) and a subsequent WM challenge with concomitant functional MRI. Over four runs of fNIRS-NF, the left DLPFC NF training group demonstrated enhanced neural activity in this region, reflecting successful acquisition of neural self-regulation. During the subsequent WM challenge, we observed no evidence for performance differences between the training and the sham group. Importantly, however, examination of the fMRI data revealed that - compared to the sham group - the training group exhibited significantly increased regional activity in the bilateral DLPFC and decreased left DLPFC - left anterior insula functional connectivity during the WM challenge. Exploratory analyses revealed a negative association between DLPFC activity and WM reaction times in the NF group. Together, these findings indicate that healthy individuals can learn to volitionally increase left DLPFC activity in a single training session and that the training success translates into WM-related neural activation and connectivity changes in the absence of feedback. This renders fNIRS-NF as a promising and scalable WM intervention approach that could be applied to various mental disorders.
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Affiliation(s)
- Xi Yang
- The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital; University of Electronic Science and Technology of China, Chengdu, China; MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Yixu Zeng
- The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital; University of Electronic Science and Technology of China, Chengdu, China; MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Guojuan Jiao
- The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital; University of Electronic Science and Technology of China, Chengdu, China; MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Xianyang Gan
- The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital; University of Electronic Science and Technology of China, Chengdu, China; MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - David Linden
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Dennis Hernaus
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Chaozhe Zhu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China
| | - Keshuang Li
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Dezhong Yao
- MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Shuxia Yao
- MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yihan Jiang
- Center for the Cognitive Science of Language, Beijing Language and Culture University, Beijing, China.
| | - Benjamin Becker
- The University of Hong Kong, State Key Laboratory of Brain and Cognitive Sciences, Hong Kong, China; The University of Hong Kong, Department of Psychology, Hong Kong, China.
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Trambaiolli LR, Cassani R, Mehler DMA, Falk TH. Neurofeedback and the Aging Brain: A Systematic Review of Training Protocols for Dementia and Mild Cognitive Impairment. Front Aging Neurosci 2021; 13:682683. [PMID: 34177558 PMCID: PMC8221422 DOI: 10.3389/fnagi.2021.682683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/03/2021] [Indexed: 11/24/2022] Open
Abstract
Dementia describes a set of symptoms that occur in neurodegenerative disorders and that is characterized by gradual loss of cognitive and behavioral functions. Recently, non-invasive neurofeedback training has been explored as a potential complementary treatment for patients suffering from dementia or mild cognitive impairment. Here we systematically reviewed studies that explored neurofeedback training protocols based on electroencephalography or functional magnetic resonance imaging for these groups of patients. From a total of 1,912 screened studies, 10 were included in our final sample (N = 208 independent participants in experimental and N = 81 in the control groups completing the primary endpoint). We compared the clinical efficacy across studies, and evaluated their experimental designs and reporting quality. In most studies, patients showed improved scores in different cognitive tests. However, data from randomized controlled trials remains scarce, and clinical evidence based on standardized metrics is still inconclusive. In light of recent meta-research developments in the neurofeedback field and beyond, quality and reporting practices of individual studies are reviewed. We conclude with recommendations on best practices for future studies that investigate the effects of neurofeedback training in dementia and cognitive impairment.
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Affiliation(s)
- Lucas R Trambaiolli
- Basic Neuroscience Division, McLean Hospital - Harvard Medical School, Boston, MA, United States
| | - Raymundo Cassani
- Institut National de la Recherche Scientifique - Energy, Materials, and Telecommunications Centre (INRS-EMT), University of Québec, Montréal, QC, Canada
| | - David M A Mehler
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tiago H Falk
- Institut National de la Recherche Scientifique - Energy, Materials, and Telecommunications Centre (INRS-EMT), University of Québec, Montréal, QC, Canada
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Klink K, Jaun U, Federspiel A, Wunderlin M, Teunissen CE, Kiefer C, Wiest R, Scharnowski F, Sladky R, Haugg A, Hellrung L, Peter J. Targeting hippocampal hyperactivity with real-time fMRI neurofeedback: protocol of a single-blind randomized controlled trial in mild cognitive impairment. BMC Psychiatry 2021; 21:87. [PMID: 33563242 PMCID: PMC7871643 DOI: 10.1186/s12888-021-03091-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Several fMRI studies found hyperactivity in the hippocampus during pattern separation tasks in patients with Mild Cognitive Impairment (MCI; a prodromal stage of Alzheimer's disease). This was associated with memory deficits, subsequent cognitive decline, and faster clinical progression. A reduction of hippocampal hyperactivity with an antiepileptic drug improved memory performance. Pharmacological interventions, however, entail the risk of side effects. An alternative approach may be real-time fMRI neurofeedback, during which individuals learn to control region-specific brain activity. In the current project we aim to test the potential of neurofeedback to reduce hippocampal hyperactivity and thereby improve memory performance. METHODS In a single-blind parallel-group study, we will randomize n = 84 individuals (n = 42 patients with MCI, n = 42 healthy elderly volunteers) to one of two groups receiving feedback from either the hippocampus or a functionally independent region. Percent signal change of the hemodynamic response within the respective target region will be displayed to the participant with a thermometer icon. We hypothesize that only feedback from the hippocampus will decrease hippocampal hyperactivity during pattern separation and thereby improve memory performance. DISCUSSION Results of this study will reveal whether real-time fMRI neurofeedback is able to reduce hippocampal hyperactivity and thereby improve memory performance. In addition, the results of this study may identify predictors of successful neurofeedback as well as the most successful regulation strategies. TRIAL REGISTRATION The study has been registered with clinicaltrials.gov on the 16th of July 2019 (trial identifier: NCT04020744 ).
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Affiliation(s)
- Katharina Klink
- grid.5734.50000 0001 0726 5157University Hospital of Old Age Psychiatry and Psychotherapy, Bern University, Bern, Switzerland
| | - Urs Jaun
- grid.5734.50000 0001 0726 5157Department of Technology and Innovation, Inselgruppe AG, Bern University, Bern, Switzerland
| | - Andrea Federspiel
- grid.5734.50000 0001 0726 5157Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern University, Bern, Switzerland
| | - Marina Wunderlin
- grid.5734.50000 0001 0726 5157University Hospital of Old Age Psychiatry and Psychotherapy, Bern University, Bern, Switzerland
| | - Charlotte E. Teunissen
- grid.12380.380000 0004 1754 9227Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Vrije University, Amsterdam, The Netherlands
| | - Claus Kiefer
- Support Center for Advanced Neuroimaging, Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University, Bern, Switzerland
| | - Frank Scharnowski
- grid.10420.370000 0001 2286 1424Department of Basic Psychological Research and Research Methods, Vienna University, Vienna, Austria
| | - Ronald Sladky
- grid.10420.370000 0001 2286 1424Department of Basic Psychological Research and Research Methods, Vienna University, Vienna, Austria
| | - Amelie Haugg
- grid.7400.30000 0004 1937 0650Department of Psychiatry, Psychotherapy, and Psychosomatics, Zurich University, Zurich, Switzerland
| | - Lydia Hellrung
- grid.7400.30000 0004 1937 0650Department of Economics, Zurich University, Zurich, Switzerland
| | - Jessica Peter
- University Hospital of Old Age Psychiatry and Psychotherapy, Bern University, Bern, Switzerland.
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The Current Evidence Levels for Biofeedback and Neurofeedback Interventions in Treating Depression: A Narrative Review. Neural Plast 2021; 2021:8878857. [PMID: 33613671 PMCID: PMC7878101 DOI: 10.1155/2021/8878857] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/28/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
This article is aimed at showing the current level of evidence for the usage of biofeedback and neurofeedback to treat depression along with a detailed review of the studies in the field and a discussion of rationale for utilizing each protocol. La Vaque et al. criteria endorsed by the Association for Applied Psychophysiology and Biofeedback and International Society for Neuroregulation & Research were accepted as a means of study evaluation. Heart rate variability (HRV) biofeedback was found to be moderately supportable as a treatment of MDD while outcome measure was a subjective questionnaire like Beck Depression Inventory (level 3/5, “probably efficacious”). Electroencephalographic (EEG) neurofeedback protocols, namely, alpha-theta, alpha, and sensorimotor rhythm upregulation, all qualify for level 2/5, “possibly efficacious.” Frontal alpha asymmetry protocol also received limited evidence of effect in depression (level 2/5, “possibly efficacious”). Finally, the two most influential real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback protocols targeting the amygdala and the frontal cortices both demonstrate some effectiveness, though lack replications (level 2/5, “possibly efficacious”). Thus, neurofeedback specifically targeting depression is moderately supported by existing studies (all fit level 2/5, “possibly efficacious”). The greatest complication preventing certain protocols from reaching higher evidence levels is a relatively high number of uncontrolled studies and an absence of accurate replications arising from the heterogeneity in protocol details, course lengths, measures of improvement, control conditions, and sample characteristics.
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Young KD, Friedman ES, Collier A, Berman SR, Feldmiller J, Haggerty AE, Thase ME, Siegle GJ. Response to SSRI intervention and amygdala activity during self-referential processing in major depressive disorder. NEUROIMAGE-CLINICAL 2020; 28:102388. [PMID: 32871385 PMCID: PMC7476063 DOI: 10.1016/j.nicl.2020.102388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 01/20/2023]
Abstract
Examined whether SSRIs normalize amygdala activity or dampen responsiveness. Responders and non-responders did not differ in amygdala activity prior to treatment. SSRI responders had increased amygdala activation to positive stimuli after treatment. SSRI responders also had decreased amygdala activation to negative stimuli after treatment.
There are conflicting reports on the impact of antidepressants on neural reactions for positive information. We thus hypothesized that there would be clinically important individual differences in neural reactivity to positive information during SSRI therapy. We further predicted that only those who responded to SSRIs would show increased amygdala reactivity to positive information following treatment to a level similar to that seen in healthy participants. Depressed individuals (n = 17) underwent fMRI during performance of a task involving rating the self-relevance of emotionally positive and negative cue words before and after receiving 12 weeks of SSRI therapy. At post-treatment, SSRI responders (n = 11) had increased amygdala activity in response to positive stimuli, and decreased activity in response to negative stimuli, compared to non-responders (n = 6). Results suggest that normalizing amygdala responses to salient information is a correlate of SSRI efficacy. Second line interventions that modulate amygdala activity, such as fMRI neurofeedback, may be beneficial in those who do not respond to SSRI medications.
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Affiliation(s)
- Kymberly D Young
- University of Pittsburgh School of Medicine, Pittsburgh, 15213 PA, USA.
| | - Edward S Friedman
- University of Pittsburgh School of Medicine, Pittsburgh, 15213 PA, USA
| | - Amanda Collier
- University of Pittsburgh Medical Center, Pittsburgh, 15213 PA, USA
| | | | | | - Agnes E Haggerty
- University of Miami Miller School of Medicine, Miami, 33136 FL, USA
| | - Michael E Thase
- University of Pennsylvania School of Medicine, Philadelphia, 19104 PA, USA
| | - Greg J Siegle
- University of Pittsburgh School of Medicine, Pittsburgh, 15213 PA, USA
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6
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Heunis S, Lamerichs R, Zinger S, Caballero‐Gaudes C, Jansen JFA, Aldenkamp B, Breeuwer M. Quality and denoising in real-time functional magnetic resonance imaging neurofeedback: A methods review. Hum Brain Mapp 2020; 41:3439-3467. [PMID: 32333624 PMCID: PMC7375116 DOI: 10.1002/hbm.25010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/13/2020] [Accepted: 04/03/2020] [Indexed: 01/31/2023] Open
Abstract
Neurofeedback training using real-time functional magnetic resonance imaging (rtfMRI-NF) allows subjects voluntary control of localised and distributed brain activity. It has sparked increased interest as a promising non-invasive treatment option in neuropsychiatric and neurocognitive disorders, although its efficacy and clinical significance are yet to be determined. In this work, we present the first extensive review of acquisition, processing and quality control methods available to improve the quality of the neurofeedback signal. Furthermore, we investigate the state of denoising and quality control practices in 128 recently published rtfMRI-NF studies. We found: (a) that less than a third of the studies reported implementing standard real-time fMRI denoising steps, (b) significant room for improvement with regards to methods reporting and (c) the need for methodological studies quantifying and comparing the contribution of denoising steps to the neurofeedback signal quality. Advances in rtfMRI-NF research depend on reproducibility of methods and results. Notably, a systematic effort is needed to build up evidence that disentangles the various mechanisms influencing neurofeedback effects. To this end, we recommend that future rtfMRI-NF studies: (a) report implementation of a set of standard real-time fMRI denoising steps according to a proposed COBIDAS-style checklist (https://osf.io/kjwhf/), (b) ensure the quality of the neurofeedback signal by calculating and reporting community-informed quality metrics and applying offline control checks and (c) strive to adopt transparent principles in the form of methods and data sharing and support of open-source rtfMRI-NF software. Code and data for reproducibility, as well as an interactive environment to explore the study data, can be accessed at https://github.com/jsheunis/quality-and-denoising-in-rtfmri-nf.
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Affiliation(s)
- Stephan Heunis
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Research and DevelopmentEpilepsy Centre KempenhaegheHeezeThe Netherlands
| | - Rolf Lamerichs
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Research and DevelopmentEpilepsy Centre KempenhaegheHeezeThe Netherlands
- Philips ResearchEindhovenThe Netherlands
| | - Svitlana Zinger
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Research and DevelopmentEpilepsy Centre KempenhaegheHeezeThe Netherlands
| | | | - Jacobus F. A. Jansen
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of RadiologyMaastricht University Medical CentreMaastrichtThe Netherlands
- School for Mental Health and NeuroscienceMaastrichtThe Netherlands
| | - Bert Aldenkamp
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Research and DevelopmentEpilepsy Centre KempenhaegheHeezeThe Netherlands
- School for Mental Health and NeuroscienceMaastrichtThe Netherlands
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and NeuropsychologyGhent University HospitalGhentBelgium
- Department of NeurologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Marcel Breeuwer
- Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Philips HealthcareBestThe Netherlands
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7
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Patel K, Sutherland H, Henshaw J, Taylor JR, Brown CA, Casson AJ, Trujillo‐Barreton NJ, Jones AKP, Sivan M. Effects of neurofeedback in the management of chronic pain: A systematic review and meta‐analysis of clinical trials. Eur J Pain 2020; 24:1440-1457. [DOI: 10.1002/ejp.1612] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/08/2020] [Accepted: 05/31/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Kajal Patel
- School of Medicine University of Manchester Manchester UK
| | - Heather Sutherland
- Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
| | - James Henshaw
- Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
| | - Jason R. Taylor
- Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
| | | | - Alexander J. Casson
- School of Electrical and Electronic Engineering University of Manchester Manchester UK
| | | | - Anthony K. P. Jones
- Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
| | - Manoj Sivan
- Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
- Academic Department of Rehabilitation Medicine University of Leeds Leeds UK
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8
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Scheinost D, Hsu TW, Avery EW, Hampson M, Constable RT, Chun MM, Rosenberg MD. Connectome-based neurofeedback: A pilot study to improve sustained attention. Neuroimage 2020; 212:116684. [PMID: 32114151 DOI: 10.1016/j.neuroimage.2020.116684] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 12/27/2022] Open
Abstract
Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback is a non-invasive, non-pharmacological therapeutic tool that may be useful for training behavior and alleviating clinical symptoms. Although previous work has used rt-fMRI to target brain activity in or functional connectivity between a small number of brain regions, there is growing evidence that symptoms and behavior emerge from interactions between a number of distinct brain areas. Here, we propose a new method for rt-fMRI, connectome-based neurofeedback, in which intermittent feedback is based on the strength of complex functional networks spanning hundreds of regions and thousands of functional connections. We first demonstrate the technical feasibility of calculating whole-brain functional connectivity in real-time and provide resources for implementing connectome-based neurofeedback. We next show that this approach can be used to provide accurate feedback about the strength of a previously defined connectome-based model of sustained attention, the saCPM, during task performance. Although, in our initial pilot sample, neurofeedback based on saCPM strength did not improve performance on out-of-scanner attention tasks, future work characterizing effects of network target, training duration, and amount of feedback on the efficacy of rt-fMRI can inform experimental or clinical trial designs.
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Affiliation(s)
- Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; Child Study Center, Yale School of Medicine, New Haven, CT, USA; Department of Statistics and Data Science, Yale University, New Haven, CT, USA; Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA.
| | - Tiffany W Hsu
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Emily W Avery
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Michelle Hampson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; Child Study Center, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA; Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Marvin M Chun
- Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA; Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
| | - Monica D Rosenberg
- Department of Psychology, Yale University, New Haven, CT, USA; Department of Psychology, University of Chicago, Chicago, IL, USA.
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9
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Fede SJ, Dean SF, Manuweera T, Momenan R. A Guide to Literature Informed Decisions in the Design of Real Time fMRI Neurofeedback Studies: A Systematic Review. Front Hum Neurosci 2020; 14:60. [PMID: 32161529 PMCID: PMC7052377 DOI: 10.3389/fnhum.2020.00060] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/07/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Although biofeedback using electrophysiology has been explored extensively, the approach of using neurofeedback corresponding to hemodynamic response is a relatively young field. Real time functional magnetic resonance imaging-based neurofeedback (rt-fMRI-NF) uses sensory feedback to operantly reinforce patterns of neural response. It can be used, for example, to alter visual perception, increase brain connectivity, and reduce depression symptoms. Within recent years, interest in rt-fMRI-NF in both research and clinical contexts has expanded considerably. As such, building a consensus regarding best practices is of great value. Objective: This systematic review is designed to describe and evaluate the variations in methodology used in previous rt-fMRI-NF studies to provide recommendations for rt-fMRI-NF study designs that are mostly likely to elicit reproducible and consistent effects of neurofeedback. Methods: We conducted a database search for fMRI neurofeedback papers published prior to September 26th, 2019. Of 558 studies identified, 146 met criteria for inclusion. The following information was collected from each study: sample size and type, task used, neurofeedback calculation, regulation procedure, feedback, whether feedback was explicitly related to changing brain activity, feedback timing, control group for active neurofeedback, how many runs and sessions of neurofeedback, if a follow-up was conducted, and the results of neurofeedback training. Results: rt-fMRI-NF is typically upregulation practice based on hemodynamic response from a specific region of the brain presented using a continually updating thermometer display. Most rt-fMRI-NF studies are conducted in healthy samples and half evaluate its effect on immediate changes in behavior or affect. The most popular control group method is to provide sham signal from another region; however, many studies do not compare use a comparison group. Conclusions: We make several suggestions for designs of future rt-fMRI-NF studies. Researchers should use feedback calculation methods that consider neural response across regions (i.e., SVM or connectivity), which should be conveyed as intermittent, auditory feedback. Participants should be given explicit instructions and should be assessed on individual differences. Future rt-fMRI-NF studies should use clinical samples; effectiveness of rt-fMRI-NF should be evaluated on clinical/behavioral outcomes at follow-up time points in comparison to both a sham and no feedback control group.
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Affiliation(s)
| | | | | | - Reza Momenan
- Clinical NeuroImaging Research Core, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
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10
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Delfino JG, Krainak DM, Flesher SA, Miller DL. MRI-related FDA adverse event reports: A 10-yr review. Med Phys 2019; 46:5562-5571. [PMID: 31419320 DOI: 10.1002/mp.13768] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/11/2019] [Accepted: 08/06/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To provide an overview of the types of adverse events reported to the US Food and Drug Administration (US FDA) for magnetic resonance (MR) systems over a 10-yr period. METHODS Two reviewers independently reviewed adverse events reported to FDA for MR systems from 1 January 2008 to 31 December 2017 and manually categorized events into eight event types. Thermal events were further subcategorized by probable cause. Objects that became projectiles were also categorized. RESULTS FDA received 1568 adverse event reports for MR systems between 1 January 2008 and 31 December 2017. This analysis included 1548 reports. Thermal events were the most commonly reported serious injury (59% of analyzed reports). Mechanical events - defined as slips, falls, crush injuries, broken bones, and cuts; musculoskeletal injuries from lifting or movement of the device - (11%), projectile events (9%), and acoustic events (6%) were also observed. CONCLUSIONS Adverse events related to MR systems consistent with the known hazards of the MR environment continue to be reported to FDA. Increased awareness of the types of adverse events occurring for MR imaging systems is important for prevention.
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Affiliation(s)
- Jana G Delfino
- Division of Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
| | - Daniel M Krainak
- Division of Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
| | - Stephanie A Flesher
- Division of Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
| | - Donald L Miller
- Office of In Vitro Devices and Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
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11
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Sorger B, Scharnowski F, Linden DEJ, Hampson M, Young KD. Control freaks: Towards optimal selection of control conditions for fMRI neurofeedback studies. Neuroimage 2019; 186:256-265. [PMID: 30423429 PMCID: PMC6338498 DOI: 10.1016/j.neuroimage.2018.11.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 12/31/2022] Open
Abstract
fMRI Neurofeedback research employs many different control conditions. Currently, there is no consensus as to which control condition is best, and the answer depends on what aspects of the neurofeedback-training design one is trying to control for. These aspects can range from determining whether participants can learn to control brain activity via neurofeedback to determining whether there are clinically significant effects of the neurofeedback intervention. Lack of consensus over criteria for control conditions has hampered the design and interpretation of studies employing neurofeedback protocols. This paper presents an overview of the most commonly employed control conditions currently used in neurofeedback studies and discusses their advantages and disadvantages. Control conditions covered include no control, treatment-as-usual, bidirectional-regulation control, feedback of an alternative brain signal, sham feedback, and mental-rehearsal control. We conclude that the selection of the control condition(s) should be determined by the specific research goal of the study and best procedures that effectively control for relevant confounding factors.
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Affiliation(s)
- Bettina Sorger
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Frank Scharnowski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland; Neuroscience Center Zürich, University of Zürich and Swiss Federal Institute of Technology, Zürich, Switzerland; Zürich Center for Integrative Human Physiology (ZIHP), University of Zürich, Zürich, Switzerland
| | - David E J Linden
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom; School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Michelle Hampson
- Department of Radiology and Biomedical Imaging, Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Kymberly D Young
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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12
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Kirschner M, Sladky R, Haugg A, Stämpfli P, Jehli E, Hodel M, Engeli E, Hösli S, Baumgartner MR, Sulzer J, Huys QJM, Seifritz E, Quednow BB, Scharnowski F, Herdener M. Self-regulation of the dopaminergic reward circuit in cocaine users with mental imagery and neurofeedback. EBioMedicine 2018; 37:489-498. [PMID: 30377073 PMCID: PMC6286189 DOI: 10.1016/j.ebiom.2018.10.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Enhanced drug-related reward sensitivity accompanied by impaired sensitivity to non-drug related rewards in the mesolimbic dopamine system are thought to underlie the broad motivational deficits and dysfunctional decision-making frequently observed in cocaine use disorder (CUD). Effective approaches to modify this imbalance and reinstate non-drug reward responsiveness are urgently needed. Here, we examined whether cocaine users (CU) can use mental imagery of non-drug rewards to self-regulate the ventral tegmental area and substantia nigra (VTA/SN). We expected that obsessive and compulsive thoughts about cocaine consumption would hamper the ability to self-regulate the VTA/SN activity and tested if real-time fMRI (rtfMRI) neurofeedback (NFB) can improve self-regulation of the VTA/SN. METHODS Twenty-two CU and 28 healthy controls (HC) were asked to voluntarily up-regulate VTA/SN activity with non-drug reward imagery alone, or combined with rtfMRI NFB. RESULTS On a group level, HC and CU were able to activate the dopaminergic midbrain and other reward regions with reward imagery. In CU, the individual ability to self-regulate the VTA/SN was reduced in those with more severe obsessive-compulsive drug use. NFB enhanced the effect of reward imagery but did not result in transfer effects at the end of the session. CONCLUSION CU can voluntary activate their reward system with non-drug reward imagery and improve this ability with rtfMRI NFB. Combining mental imagery and rtFMRI NFB has great potential for modifying the maladapted reward sensitivity and reinstating non-drug reward responsiveness. This motivates further work to examine the use of rtfMRI NFB in the treatment of CUD.
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Affiliation(s)
- Matthias Kirschner
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
| | - Ronald Sladky
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Amelie Haugg
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology, Switzerland
| | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Elisabeth Jehli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Martina Hodel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Etna Engeli
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Sarah Hösli
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Markus R Baumgartner
- Center for Forensic Hair Analysis, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - James Sulzer
- Department of Mechanical Engineering, University of Texas at Austin, TX, USA
| | - Quentin J M Huys
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Translational Neuromodeling Unit, Institute of Biomedical Engineering, University of Zurich and ETH, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Frank Scharnowski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland; Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Marcus Herdener
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
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13
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Thibault RT, MacPherson A, Lifshitz M, Roth RR, Raz A. Neurofeedback with fMRI: A critical systematic review. Neuroimage 2018; 172:786-807. [DOI: 10.1016/j.neuroimage.2017.12.071] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022] Open
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14
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Yao S, Becker B, Geng Y, Zhao Z, Xu X, Zhao W, Ren P, Kendrick KM. Voluntary control of anterior insula and its functional connections is feedback-independent and increases pain empathy. Neuroimage 2016; 130:230-240. [PMID: 26899786 DOI: 10.1016/j.neuroimage.2016.02.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 12/30/2022] Open
Abstract
Real-time functional magnetic resonance imaging (rtfMRI)-assisted neurofeedback (NF) training allows subjects to acquire volitional control over regional brain activity. Emerging evidence suggests its potential clinical utility as an effective non-invasive treatment approach in mental disorders. The therapeutic potential of rtfMRI-NF training depends critically upon whether: (1) acquired self-regulation produces functionally relevant changes at behavioral and brain network levels and (2) training effects can be maintained in the absence of feedback. To address these key questions, the present study combined rtfMRI-NF training for acquiring volitional anterior insula (AI) regulation with a sham-controlled between-subject design. The functional relevance of acquired AI control was assessed using both behavioral (pain empathy) and neural (activity, functional connectivity) indices. Maintenance of training effects in the absence of feedback was assessed two days later. During successful acquisition of volitional AI up-regulation subjects exhibited stronger empathic responses, increased AI-prefrontal coupling in circuits involved in learning and emotion regulation and increased resting state connectivity within AI-centered empathy networks. At follow-up both self-regulation and increased connectivity in empathy networks were fully maintained, although without further increases in empathy ratings. Overall these findings support the potential clinical application of rtfMRI-NF for inducing functionally relevant and lasting changes in emotional brain circuitry.
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Affiliation(s)
- Shuxia Yao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Benjamin Becker
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China; Department of Psychiatry, Division of Medical Psychology, University of Bonn, 53105 Bonn, Germany
| | - Yayuan Geng
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Zhiying Zhao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Xiaolei Xu
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Weihua Zhao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Peng Ren
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Keith M Kendrick
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China.
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15
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Thibault RT, Lifshitz M, Raz A. The self-regulating brain and neurofeedback: Experimental science and clinical promise. Cortex 2016; 74:247-61. [PMID: 26706052 DOI: 10.1016/j.cortex.2015.10.024] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/22/2015] [Accepted: 10/29/2015] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Amir Raz
- McGill University, Montreal, QC, Canada; The Lady Davis Institute for Medical Research, Montreal, QC, Canada.
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16
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17
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Brühl AB. Making sense of real-time functional magnetic resonance imaging (rtfMRI) and rtfMRI neurofeedback. Int J Neuropsychopharmacol 2015; 18:pyv020. [PMID: 25716778 PMCID: PMC4438554 DOI: 10.1093/ijnp/pyv020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/19/2015] [Indexed: 11/29/2022] Open
Abstract
This review explains the mechanism of functional magnetic resonance imaging in general and specifically introduces real-time functional magnetic resonance imaging as a method for training self-regulation of brain activity. Using real-time functional magnetic resonance imaging neurofeedback, participants can acquire control over their own brain activity. In patients with neuropsychiatric disorders, this control can potentially have therapeutic implications. In this review, the technical requirements are presented and potential applications and limitations are discussed.
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Affiliation(s)
- Annette B Brühl
- University of Cambridge, Behavioural and Clinical Neuroscience Institute and Department of Psychiatry, Downing site, Cambridge, United Kingdom; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.
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18
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Abstract
Recent advances in imaging technology and in the understanding of neural circuits relevant to emotion, motivation, and depression have boosted interest and experimental work in neuromodulation for affective disorders. Real-time functional magnetic resonance imaging (fMRI) can be used to train patients in the self regulation of these circuits, and thus complement existing neurofeedback technologies based on electroencephalography (EEG). EEG neurofeedback for depression has mainly been based on models of altered hemispheric asymmetry. fMRI-based neurofeedback (fMRI-NF) can utilize functional localizer scans that allow the dynamic adjustment of the target areas or networks for self-regulation training to individual patterns of emotion processing. An initial application of fMRI-NF in depression has produced promising clinical results, and further clinical trials are under way. Challenges lie in the design of appropriate control conditions for rigorous clinical trials, and in the transfer of neurofeedback protocols from the laboratory to mobile devices to enhance the sustainability of any clinical benefits.
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Affiliation(s)
- David E J Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, National Centre for Mental Health, Cardiff University, Cardiff, UK
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19
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Linden DEJ. Neurofeedback and networks of depression. DIALOGUES IN CLINICAL NEUROSCIENCE 2014; 16:103-12. [PMID: 24733975 PMCID: PMC3984886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Recent advances in imaging technology and in the understanding of neural circuits relevant to emotion, motivation, and depression have boosted interest and experimental work in neuromodulation for affective disorders. Real-time functional magnetic resonance imaging (fMRI) can be used to train patients in the self regulation of these circuits, and thus complement existing neurofeedback technologies based on electroencephalography (EEG). EEG neurofeedback for depression has mainly been based on models of altered hemispheric asymmetry. fMRI-based neurofeedback (fMRI-NF) can utilize functional localizer scans that allow the dynamic adjustment of the target areas or networks for self-regulation training to individual patterns of emotion processing. An initial application of fMRI-NF in depression has produced promising clinical results, and further clinical trials are under way. Challenges lie in the design of appropriate control conditions for rigorous clinical trials, and in the transfer of neurofeedback protocols from the laboratory to mobile devices to enhance the sustainability of any clinical benefits.
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Affiliation(s)
- David E. J. Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, National Centre for Mental Health, Cardiff University, Cardiff, UK
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20
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Sulzer J, Haller S, Scharnowski F, Weiskopf N, Birbaumer N, Blefari M, Bruehl A, Cohen L, deCharms R, Gassert R, Goebel R, Herwig U, LaConte S, Linden D, Luft A, Seifritz E, Sitaram R. Real-time fMRI neurofeedback: progress and challenges. Neuroimage 2013; 76:386-99. [PMID: 23541800 PMCID: PMC4878436 DOI: 10.1016/j.neuroimage.2013.03.033] [Citation(s) in RCA: 292] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 03/14/2013] [Accepted: 03/19/2013] [Indexed: 01/30/2023] Open
Abstract
In February of 2012, the first international conference on real time functional magnetic resonance imaging (rtfMRI) neurofeedback was held at the Swiss Federal Institute of Technology Zurich (ETHZ), Switzerland. This review summarizes progress in the field, introduces current debates, elucidates open questions, and offers viewpoints derived from the conference. The review offers perspectives on study design, scientific and clinical applications, rtfMRI learning mechanisms and future outlook.
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Affiliation(s)
- J. Sulzer
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, (ETH), Zurich CH-8092, Switzerland
| | - S. Haller
- University of Geneva, Geneva University Hospital CH-1211, Switzerland
| | - F. Scharnowski
- Department of Radiology and Medical Informatics - CIBM, University of Geneva, Switzerland
- Institute of Bioengineering, Swiss Institute of Technology Lausanne (EPFL) CH-1015, Switzerland
| | - N. Weiskopf
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, University College London WC1E 6BT, UK
| | - N. Birbaumer
- The Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen 72074, Germany
- Ospedale San Camillo, IRCCS, Venice 30126, Italy
| | - M.L. Blefari
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, (ETH), Zurich CH-8092, Switzerland
| | - A.B. Bruehl
- Department of Psychiatry, Psychotherapy and Psychosomatica, Zürich University Hospital for Psychiatry, Zurich CH-8032, Switzerland
| | - L.G. Cohen
- National Institutes of Health, Bethesda 20892, USA
| | | | - R. Gassert
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, (ETH), Zurich CH-8092, Switzerland
| | - R. Goebel
- Department of Neurocognition, University of Maastricht 6200, The Netherlands
| | - U. Herwig
- Department of Psychiatry, Psychotherapy and Psychosomatica, Zürich University Hospital for Psychiatry, Zurich CH-8032, Switzerland
- Department of Psychiatry and Psychotherapy III, University of Ulm, Germany
| | - S. LaConte
- Virginia Tech Carilion Research Institute 24016, USA
| | | | - A. Luft
- Department of Neurology, University Hospital Zurich, Switzerland
- University of Zurich CH-8008, Switzerland
| | - E. Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatica, Zürich University Hospital for Psychiatry, Zurich CH-8032, Switzerland
| | - R. Sitaram
- The Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen 72074, Germany
- Department of Biomedical Engineering, University of Florida, Gainesville 32611, USA
- Sri Chitra Tirunal Institute of Medical Science and Technology, Trivandrum, India
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21
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Real-time fMRI and its application to neurofeedback. Neuroimage 2012; 62:682-92. [DOI: 10.1016/j.neuroimage.2011.10.009] [Citation(s) in RCA: 227] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 10/06/2011] [Indexed: 11/20/2022] Open
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22
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Real-time functional magnetic resonance imaging neurofeedback for treatment of Parkinson's disease. J Neurosci 2012; 31:16309-17. [PMID: 22072682 DOI: 10.1523/jneurosci.3498-11.2011] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Self-regulation of brain activity in humans based on real-time feedback of functional magnetic resonance imaging (fMRI) signal is emerging as a potentially powerful, new technique. Here, we assessed whether patients with Parkinson's disease (PD) are able to alter local brain activity to improve motor function. Five patients learned to increase activity in the supplementary motor complex over two fMRI sessions using motor imagery. They attained as much activation in this target brain region as during a localizer procedure with overt movements. Concomitantly, they showed an improvement in motor speed (finger tapping) and clinical ratings of motor symptoms (37% improvement of the motor scale of the Unified Parkinson's Disease Rating Scale). Activation during neurofeedback was also observed in other cortical motor areas and the basal ganglia, including the subthalamic nucleus and globus pallidus, which are connected to the supplementary motor area (SMA) and crucial nodes in the pathophysiology of PD. A PD control group of five patients, matched for clinical severity and medication, underwent the same procedure but did not receive feedback about their SMA activity. This group attained no control of SMA activation and showed no motor improvement. These findings demonstrate that self-modulation of cortico-subcortical motor circuits can be achieved by PD patients through neurofeedback and may result in clinical benefits that are not attainable by motor imagery alone.
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