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Rezaei S, Khanmohammadi R. Comparison of short- and long-term effects of neurofeedback and transcranial electrical stimulation on the motor learning in healthy adults. Behav Brain Res 2024; 476:115263. [PMID: 39307285 DOI: 10.1016/j.bbr.2024.115263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 08/30/2024] [Accepted: 09/18/2024] [Indexed: 09/26/2024]
Abstract
Researchers are exploring non-invasive neuromodulation techniques like transcranial direct current stimulation (tDCS) and neurofeedback (NFB) for enhancing motor learning. While tDCS modulates brain excitability using exogenous electric fields, NFB is an endogenous brain stimulation technique that enables individuals to regulate brain excitability in a closed-loop system. Despite their differing mechanisms, a direct comparison of their effects on motor learning is lacking. This study aimed to compare tDCS and NFB on online learning, short-term offline learning, and long-term offline learning in healthy participants, seeking to identify the most effective method for motor learning enhancement. In this parallel, randomized, single-blinded, controlled trial, 100 healthy participants were randomly assigned to one of five groups: real tDCS, sham tDCS, real NFB, sham NFB, and passive control. Primary outcomes included normalized reaction time (NRT), normalized response accuracy (NRA), and normalized skill index (NSI), measured through a serial reaction time task. Secondary outcomes involved physical and mental fatigue, assessed using a visual analog scale. The study involved 14 blocks of 80 trials each. Online learning was assessed by changes in NRT, NRA, and NSI between Block 3 and Block 9. Short-term and long-term offline learning were evaluated by changes in these measures between Block 9 and Block 11, and between Block 9 and Block 13, respectively. RESULTS: showed a significant decrease in NRA in the sham tDCS and passive control groups from block 3-9, with no changes in other groups. NRT significantly decreased in all intervention groups from block 9-11, with no change in the control group. The NSI significantly increased across all intervention groups between blocks 9 and 11, with large to very large effect sizes, while the passive control group saw a medium effect size increase. Furthermore, NRA significantly increased in the real NFB and real tDCS groups from block 9 to block 13. NRT also significantly decreased in all intervention groups when comparing block 13 to block 9, while the passive control group showed no significant changes. Notably, the reduction in NRT from block 9 to block 13 was significantly greater in the real tDCS group than in the control group, with a mean difference of 0.087 (95 % CI: 0.004-0.169, p = 0.031). Additionally, NSI significantly increased in all intervention groups except the control group from block 9 to block 13. In conclusion, neither NFB nor tDCS had a significant positive impact on online learning. However, both real and sham versions of tDCS and NFB resulted in notable improvements in short-term offline learning. The difference in improvement between NFB and tDCS, as well as between real and sham interventions, was not statistically significant, suggesting that the placebo effect may play a significant role in enhancing short-term offline learning. For long-term offline learning, both brain stimulation methods, particularly tDCS, showed positive effects, although the placebo effect also appeared to contribute.
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Affiliation(s)
- Sara Rezaei
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Khanmohammadi
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran.
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Rice DA, Ozolins C, Biswas R, Almesfer F, Zeng I, Parikh A, Vile WG, Rashid U, Graham J, Kluger MT. Home-based EEG Neurofeedback for the Treatment of Chronic Pain: A Randomized Controlled Clinical Trial. THE JOURNAL OF PAIN 2024:104651. [PMID: 39154809 DOI: 10.1016/j.jpain.2024.104651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 08/06/2024] [Accepted: 08/10/2024] [Indexed: 08/20/2024]
Abstract
This parallel, 2-arm, blinded, randomized controlled superiority trial examined whether, when added to usual care, active-electroencephalography neurofeedback (EEG NFB) was safe and more effective than sham control-EEG NFB for chronic pain. In total, 116 participants with chronic pain were randomly assigned (1:1) to usual care plus ≥32 sessions of active-EEG NFB upregulating relative alpha power over C4 or usual care plus ≥32 sessions of sham control-EEG NFB. Per-protocol analyses revealed no significant between-group differences in the primary outcome, Brief Pain Inventory average pain (mean difference [95% confidence interval]: -.04 [-.39 to .31], P = .90), or any secondary outcomes. However, 44% of participants in the active-EEG NFB group and 45% in the control-EEG NFB group reported at least a moderate (≥30%), clinically important improvement in Brief Pain Inventory average pain. The number of treatment-emergent adverse events were similar in both groups (P = .83), and none were serious. Post hoc analyses revealed similar upregulated relative alpha power in both groups during training, with concordant positive rewards delivered to the active-EEG group 100% of the time and the control-EEG group ∼25% of the time, suggesting a partially active sham intervention. When added to usual care, the active-EEG NFB intervention used in this study was not superior to the sham control-EEG NFB intervention. However, a large proportion of participants in both groups reported a clinically important reduction in pain intensity. A partially active sham intervention may have obscured between-group differences. The intervention was free of important side effects, with no safety concerns identified. PERSPECTIVES: This study is the first attempt at an appropriately blinded, randomized, sham-controlled trial of alpha EEG NFB for the treatment of chronic pain. The findings may interest people living with chronic pain, clinicians involved in chronic pain management, and may inform the design of future EEG NFB trials. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000667819.
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Affiliation(s)
- David A Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, Auckland, New Zealand; Waitemata Pain Services, Te Whatu Ora - Health New Zealand Waitematā, Auckland, Auckland, New Zealand.
| | | | - Riya Biswas
- Exsurgo Limited, Auckland, Auckland, New Zealand
| | | | - Irene Zeng
- Department of Biostatistics, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, Auckland, New Zealand
| | - Ankit Parikh
- Exsurgo Limited, Auckland, Auckland, New Zealand
| | | | - Usman Rashid
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, Auckland, New Zealand
| | - Jon Graham
- PhysioFunction Ltd., Northampton, Northamptonshire, United Kingdom
| | - Michal T Kluger
- Waitemata Pain Services, Te Whatu Ora - Health New Zealand Waitematā, Auckland, Auckland, New Zealand; Department of Anaesthesiology and Perioperative Medicine, Te Whatu Ora - Health New Zealand Waitematā, Auckland, Auckland, New Zealand; Department of Anaesthesiology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, Auckland, New Zealand
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3
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Schmidt C. The potential of infra-low frequency neurofeedback training in peak performance: The first double-blinded placebo-controlled longitudinal study in healthy adults. J Psychiatr Res 2024; 175:280-286. [PMID: 38759495 DOI: 10.1016/j.jpsychires.2024.04.035] [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: 02/02/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
Infra-low frequency neurofeedback training (ILF-NFT) has shown promise in addressing cognitive and affective distress symptoms across a range of psychiatric disorders. This study tested ILF-NFT's effects in a double-blinded, placebo-controlled longitudinal context in healthy psychology students. Across five weeks, forty-two healthy psychology students (aged 18-35) were randomly allocated into two groups, receiving ten sessions of 30 minutes of active and sham ILF-NFT. Dependent variables were measured before, following, and two months after the intervention and were comprised of: heartrate variability assessments as a measure of stress resilience; digit span, n-back, trail making and go-no-go task measures of executive functioning performance; and SCL-90-R, WHOQOL-Bref, and peak performance measures of subjective self-report. Statistical analysis was performed using an ANCOVA and compared across groups correcting for baseline differences and multiple comparisons. ANCOVA analyses revealed no significant differences across active and placebo groups in any dependent variables, when correcting for multiple comparisons. Thus, the remaining analyses focused on questionnaire correlations. Here, significant correlations were observed between the novel peak performance questionnaire with the SCL-90-R and WHOQOL-Bref, confirming its construct and retest validity. Despite several methodological limitations, including a potential type-2 error, this study highlights limited effects of ILF-NFT in healthy volunteers. Future research should thus focus on clinically driven experimental designs to explore ILF-NFT's potential in psychiatric contexts. Further research utilization of the novel peak performance questionnaire is recommended for measures of peak performance.
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Affiliation(s)
- Casper Schmidt
- Department of Communication and Psychology, Aalborg University, Rendsburggade 14, 9000, Aalborg, Denmark.
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Dousset C, Wyckmans F, Monseigne T, Fourdin L, Boulanger R, Sistiaga S, Ingels A, Kajosch H, Noël X, Kornreich C, Campanella S. Sensori-motor neurofeedback improves inhibitory control and induces neural changes: a placebo-controlled, double-blind, event-related potentials study. Int J Clin Health Psychol 2024; 24:100501. [PMID: 39328986 PMCID: PMC11426047 DOI: 10.1016/j.ijchp.2024.100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/23/2024] [Indexed: 09/28/2024] Open
Abstract
Background/Objective Inhibition is crucial for controlling behavior and is impaired in various psychopathologies. Neurofeedback holds promise in addressing cognitive deficits, and experimental research is essential for identifying its functional benefits. This study aimed to investigate whether boosting sensorimotor activity (SMR) improves inhibitory control in a final sample of healthy individuals (N = 53), while exploring the underlying neurophysiological mechanism. Method Participants were randomly divided into two groups: one receiving SMR neurofeedback training to enhance sensorimotor activity within the 12-15 Hz frequency range, and the other receiving sham feedback. Inhibition performance and neural correlates were evaluated with a Go-NoGo task before (T0) and after (T1) 10 neurofeedback sessions using event-related potentials. Data were analyzed via ANOVAs and regression analyses. Results Compared to placebo, the active group demonstrated higher absolute SMR power (p = 0.040) and improvements in inhibitory control, including faster response times and fewer inhibition errors (p < 0.001, d = 6.06), associated with a larger NoGoP3d amplitude (p < 0.001, d = 3.35). A positive correlation between the increase in SMR power and the rise in NoGoP3d amplitude (β=0.46, p = 0.015) explains 21 % of the observed variance. Conclusions Uptraining SMR power is linked to heightened utilization of neural resources for executing optimal inhibition responses. These results uphold its effectiveness in cognitive rehabilitation.
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Affiliation(s)
- Clémence Dousset
- Laboratory of Medical Psychology and Addictology, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten 1020, Brussels, Belgium
| | - Florent Wyckmans
- Laboratory of Medical Psychology and Addictology, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten 1020, Brussels, Belgium
| | | | - Lauréline Fourdin
- Center for Research in Cognition and Neurosciences (CRCN), ULB Neuroscience Institute (UNI), Université Libre de Bruxelles (ULB), 50 avenue Franklin Roosevelt, CP191 1050 Brussels, Belgium
| | - Romane Boulanger
- Center for Research in Cognition and Neurosciences (CRCN), ULB Neuroscience Institute (UNI), Université Libre de Bruxelles (ULB), 50 avenue Franklin Roosevelt, CP191 1050 Brussels, Belgium
| | - Sonia Sistiaga
- Laboratory of Medical Psychology and Addictology, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten 1020, Brussels, Belgium
| | - Anaïs Ingels
- Laboratory of Medical Psychology and Addictology, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten 1020, Brussels, Belgium
| | - Hendrik Kajosch
- Laboratory of Medical Psychology and Addictology, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten 1020, Brussels, Belgium
| | - Xavier Noël
- Laboratory of Medical Psychology and Addictology, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten 1020, Brussels, Belgium
| | - Charles Kornreich
- Laboratory of Medical Psychology and Addictology, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten 1020, Brussels, Belgium
| | - Salvatore Campanella
- Laboratory of Medical Psychology and Addictology, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten 1020, Brussels, Belgium
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Diotaiuti P, Valente G, Corrado S, Tosti B, Carissimo C, Di Libero T, Cerro G, Rodio A, Mancone S. Enhancing Working Memory and Reducing Anxiety in University Students: A Neurofeedback Approach. Brain Sci 2024; 14:578. [PMID: 38928578 PMCID: PMC11202122 DOI: 10.3390/brainsci14060578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: Neurofeedback training (NFT) has emerged as a promising approach for enhancing cognitive functions and reducing anxiety, yet its specific impact on university student populations requires further investigation. This study aims to examine the effects of NFT on working memory improvement and anxiety reduction within this demographic. (2) Methods: A total of forty healthy university student volunteers were randomized into two groups: an experimental group that received NFT and a control group. The NFT protocol was administered using a 14-channel Emotiv Epoc X headset (EMOTIV, Inc., San Francisco, CA 94102, USA) and BrainViz software version Brain Visualizer 1.1 (EMOTIV, Inc., San Francisco, CA 94102, USA), focusing on the alpha frequency band to target improvements in working memory and reductions in anxiety. Assessment tools, including the Corsi Block and Memory Span tests for working memory and the State-Trait Anxiety Inventory-2 (STAI-2) for anxiety, were applied pre- and post-intervention. (3) Results: The findings indicated an increase in alpha wave amplitude in the experimental group from the second day of NFT, with statistically significant differences observed on days 2 (p < 0.05) and 8 (p < 0.01). Contrary to expectations based on the previous literature, the study did not observe a concurrent positive impact on working memory. Nonetheless, a significant reduction in state anxiety levels was recorded in the experimental group (p < 0.001), corroborating NFT's potential for anxiety management. (4) Conclusions: While these results suggest some potential of the technique in enhancing neural efficiency, the variability across different days highlights the need for further investigation to fully ascertain its effectiveness. The study confirms the beneficial impact of NFT on reducing state anxiety among university students, underscoring its value in psychological and cognitive performance enhancement. Despite the lack of observed improvements in working memory, these results highlight the need for continued exploration of NFT applications across different populations and settings, emphasizing its potential utility in educational and therapeutic contexts.
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Affiliation(s)
- Pierluigi Diotaiuti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Giuseppe Valente
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Stefano Corrado
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Beatrice Tosti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Chiara Carissimo
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (C.C.); (G.C.)
| | - Tommaso Di Libero
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Gianni Cerro
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (C.C.); (G.C.)
| | - Angelo Rodio
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Stefania Mancone
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
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Gacek M, Smoleń T, Krzywoszański Ł, Bartecka-Śmietana A, Kulasek-Filip B, Piotrowska M, Sepielak D, Supernak K. Effects of School-Based Neurofeedback Training on Attention in Students with Autism and Intellectual Disabilities. J Autism Dev Disord 2024:10.1007/s10803-024-06400-8. [PMID: 38806749 DOI: 10.1007/s10803-024-06400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 05/30/2024]
Abstract
In this study we aimed to assess the influence of school-based neurofeedback training on the attention of students with autism and intellectual disabilities. We assessed 24 students of a special education center who attended neurofeedback training sessions during the schoolyear; we also assessed 25 controls from the same center. We used two computer tasks to assess sustained attention in simple and cognitively demanding test situations, and we used a pen-and-paper task to assess selective attention. Each student who took part in the study was tested at the beginning and at the end of the schoolyear. Students from the experimental group significantly improved their performance in the task related to sustained attention to simple stimuli. No performance improvement related to neurofeedback treatment was observed in either sustained attention in cognitively demanding situations or selective attention. School-based neurofeedback training may improve sustained attention to simple stimuli in students with developmental disabilities.
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Affiliation(s)
- Michał Gacek
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060, Krakow, Poland.
| | - Tomasz Smoleń
- Department of Cognitive Science, Jagiellonian University, ul. Grodzka 52, 31-044, Krakow, Poland
| | - Łukasz Krzywoszański
- Institute of Psychology, The Pedagogical University of Krakow, ul. Podchorazych 2, 30-084, Krakow, Poland
| | | | - Beata Kulasek-Filip
- Special Education and Child Care Center No. 1 in Krakow, ul. Barska 45, 30-307, Krakow, Poland
| | - Maja Piotrowska
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060, Krakow, Poland
| | - Dominika Sepielak
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060, Krakow, Poland
| | - Katarzyna Supernak
- Special Education and Child Care Center No. 1 in Krakow, ul. Barska 45, 30-307, Krakow, Poland
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Fruchter E, Goldenthal N, Adler LA, Gross R, Harel EV, Deutsch L, Nacasch N, Grinapol S, Amital D, Voigt JD, Marmar CR. Amygdala-derived-EEG-fMRI-pattern neurofeedback for the treatment of chronic post-traumatic stress disorder. A prospective, multicenter, multinational study evaluating clinical efficacy. Psychiatry Res 2024; 333:115711. [PMID: 38325159 DOI: 10.1016/j.psychres.2023.115711] [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: 09/03/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024]
Abstract
We conducted a prospective, single arm, multisite, multinational, open label trial assessing the safety and efficacy of a novel amygdala derived neurofeedback treatment, designated Amygdala-Derived-EFP, for chronic PTSD. Participants, including veterans and civilians, underwent screening, training, 15 neurofeedback sessions over 8 weeks and; baseline, termination (8 weeks) and 3 month post treatment assessments with validated measures. The primary endpoint was more than 50 % of the participants demonstrating a Minimally Clinically Important Difference (MCID) defined as a 6-point reduction, on the Clinician Administered PTSD Scale (CAPS-5) total score at 3 months. Secondary measures included the PCL-5, ERQ, PHQ-9, and CGI. Statistical analyses were performed using SAS®V9.4. The primary endpoint was met, with a CAPS-5 MCID response rate of 66.7 %. The average reduction in CAPS-5 total scores at 3 month follow up was 13.5 points, more than twice the MCID. Changes from baseline in CAPS-5, PCL-5, PHQ-9 scores at 8 weeks and the 3 month follow-up demonstrated statistically significant improvements in response and; demonstrated effect sizes ranging from 0.46 to 1.07. Adverse events were mild and resolved after treatment. This study builds on prior research demonstrating similar outcomes using amygdala-derived neurofeedback. Positive attributes of this therapy include monitoring by non-physician personnel, affordability, accessibility, and tolerability.
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Affiliation(s)
- Eyal Fruchter
- Rambam Medical Center, Bruss Rapaport Faculty of Medicine - Technicon - Haifa, Haifa, Israel
| | - Nadav Goldenthal
- Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Lenard A Adler
- Department Psychiatry, New York University Grossman School of Medicine, NY, NY, United States
| | - Raz Gross
- Department of Epidemiology, School of Public Health and Department of Psychiatry, School of Medicine, Tel Aviv University, Sheba Medical Center, Tel Aviv, Isreal
| | - Eiran V Harel
- Be'er Ya'akov Mental Health Center, Tel Aviv, Israel
| | | | - Nitsa Nacasch
- Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shulamit Grinapol
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Daniela Amital
- Division of Psychology, Barzilai Medical Center, Ashkelon, Israel
| | | | - Charles R Marmar
- Department Psychiatry, New York University Grossman School of Medicine, NY, NY, United States
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Marcu GM, Dumbravă A, Băcilă IC, Szekely-Copîndean RD, Zăgrean AM. Increasing Value and Reducing Waste of Research on Neurofeedback Effects in Post-traumatic Stress Disorder: A State-of-the-Art-Review. Appl Psychophysiol Biofeedback 2024; 49:23-45. [PMID: 38151684 DOI: 10.1007/s10484-023-09610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Post-Traumatic Stress Disorder (PTSD) is often considered challenging to treat due to factors that contribute to its complexity. In the last decade, more attention has been paid to non-pharmacological or non-psychological therapies for PTSD, including neurofeedback (NFB). NFB is a promising non-invasive technique targeting specific brainwave patterns associated with psychiatric symptomatology. By learning to regulate brain activity in a closed-loop paradigm, individuals can improve their functionality while reducing symptom severity. However, owing to its lax regulation and heterogeneous legal status across different countries, the degree to which it has scientific support as a psychiatric treatment remains controversial. In this state-of-the-art review, we searched PubMed, Cochrane Central, Web of Science, Scopus, and MEDLINE and identified meta-analyses and systematic reviews exploring the efficacy of NFB for PTSD. We included seven systematic reviews, out of which three included meta-analyses (32 studies and 669 participants) that targeted NFB as an intervention while addressing a single condition-PTSD. We used the MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 and the criteria described by Cristea and Naudet (Behav Res Therapy 123:103479, 2019, https://doi.org/10.1016/j.brat.2019.103479 ) to identify sources of research waste and increasing value in biomedical research. The seven assessed reviews had an overall extremely poor quality score (5 critically low, one low, one moderate, and none high) and multiple sources of waste while opening opportunities for increasing value in the NFB literature. Our research shows that it remains unclear whether NFB training is significantly beneficial in treating PTSD. The quality of the investigated literature is low and maintains a persistent uncertainty over numerous points, which are highly important for deciding whether an intervention has clinical efficacy. Just as importantly, none of the reviews we appraised explored the statistical power, referred to open data of the included studies, or adjusted their pooled effect sizes for publication bias and risk of bias. Based on the obtained results, we identified some recurrent sources of waste (such as a lack of research decisions based on sound questions or using an appropriate methodology in a fully transparent, unbiased, and useable manner) and proposed some directions for increasing value (homogeneity and consensus) in designing and reporting research on NFB interventions in PTSD.
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Affiliation(s)
- Gabriela Mariana Marcu
- Division of Physiology and Neuroscience, Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
- Department of Psychology, "Lucian Blaga" University of Sibiu, Sibiu, Romania.
| | - Andrei Dumbravă
- George I.M. Georgescu Institute of Cardiovascular Diseases, Iaşi, Romania
- Alexandru Ioan Cuza University Iaşi, Iaşi, Romania
| | - Ionuţ-Ciprian Băcilă
- Scientific Research Group in Neuroscience "Dr. Gheorghe Preda" Clinical Psychiatry Hospital, Sibiu, Romania
- Faculty of Medicine, "Lucian Blaga" University of Sibiu Romania, Sibiu, Romania
| | - Raluca Diana Szekely-Copîndean
- Scientific Research Group in Neuroscience "Dr. Gheorghe Preda" Clinical Psychiatry Hospital, Sibiu, Romania
- Department of Social and Human Research, Romanian Academy - Cluj-Napoca Branch, Cluj-Napoca, Romania
| | - Ana-Maria Zăgrean
- Division of Physiology and Neuroscience, Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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9
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Fine NB, Helpman L, Armon DB, Gurevitch G, Sheppes G, Seligman Z, Hendler T, Bloch M. Amygdala-related electroencephalogram neurofeedback as add-on therapy for treatment-resistant childhood sexual abuse posttraumatic stress disorder: feasibility study. Psychiatry Clin Neurosci 2024; 78:19-28. [PMID: 37615935 DOI: 10.1111/pcn.13591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
AIM Childhood sexual abuse (CSA) among women is an alarmingly prevalent traumatic experience that often leads to debilitating and treatment-refractory posttraumatic stress disorder (PTSD), raising the need for novel adjunctive therapies. Neuroimaging investigations systematically report that amygdala hyperactivity is the most consistent and reliable neural abnormality in PTSD and following childhood abuse, raising the potential of implementing volitional neural modulation using neurofeedback (NF) aimed at down-regulating amygdala activity. This study aimed to reliably probe limbic activity but overcome the limited applicability of functional magnetic resonance imaging (fMRI) NF by using a scalable electroencephalogram NF probe of amygdala-related activity, termed amygdala electrical-finger-print (amyg-EFP) in a randomized controlled trial. METHOD Fifty-five women with CSA-PTSD who were in ongoing intensive trauma-focused psychotherapy for a minimum of 1 year but still met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD criteria were randomized to either 10 add-on sessions of amyg-EFP-NF training (test group) or continuing psychotherapy (control group). Participants were blindly assessed for PTSD symptoms before and after the NF training period, followed by self-reported clinical follow-up at 1, 3, and 6 months, as well as one session of amygdala real-time fMRI-NF before and after NF training period. RESULTS Participants in the test group compared with the control group demonstrated a marginally significant immediate reduction in PTSD symptoms, which progressively improved during the follow-up period. In addition, successful neuromodulation during NF training was demonstrated. CONCLUSION This feasibility study for patients with treatment-resistant CSA-PTSD indicates that amyg-EFP-NF is a viable and efficient intervention.
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Affiliation(s)
- Naomi B Fine
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Liat Helpman
- Womens' Reproductive Mental Health research Unit, Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Daphna Bardin Armon
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Guy Gurevitch
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gal Sheppes
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Zivya Seligman
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Talma Hendler
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Miki Bloch
- Womens' Reproductive Mental Health research Unit, Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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10
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Jackson LE, Han YJ, Evans LH. The efficacy of electroencephalography neurofeedback for enhancing episodic memory in healthy and clinical participants: A systematic qualitative review and meta-analysis. Neurosci Biobehav Rev 2023; 155:105455. [PMID: 37926240 DOI: 10.1016/j.neubiorev.2023.105455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Several studies have examined whether electroencephalography neurofeedback (EEG-NF), a self-regulatory technique where an individual receives real-time feedback on a pattern of brain activity that is theoretically linked to a target behaviour, can enhance episodic memory. The aim of this research was to i) provide a qualitative overview of the literature, and ii) conduct a meta-analysis of appropriately controlled studies to determine whether EEG-NF can enhance episodic memory. The literature search returned 46 studies, with 21 studies (44 effect sizes) meeting the inclusion criteria for the meta-analysis. The qualitative overview revealed that, across EEG-NF studies on both healthy and clinical populations, procedures and protocols vary considerably and many studies were insufficiently powered with inadequate design features. The meta-analysis, conducted on studies with an active control, revealed a small-size, significant positive effect of EEG-NF on episodic memory performance (g = 0.31, p = 0.003), moderated by memory modality and EEG-NF self-regulation success. These results are discussed with a view towards optimising EEG-NF training and subsequent benefits to episodic memory.
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Affiliation(s)
- Lucy E Jackson
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff CF24 4HQ, Wales, UK
| | - Yi-Jhong Han
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 9RJ, England, UK
| | - Lisa H Evans
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff CF24 4HQ, Wales, UK.
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11
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Ribeiro TF, Carriello MA, de Paula EP, Garcia AC, da Rocha GL, Teive HAG. Clinical applications of neurofeedback based on sensorimotor rhythm: a systematic review and meta-analysis. Front Neurosci 2023; 17:1195066. [PMID: 38053609 PMCID: PMC10694284 DOI: 10.3389/fnins.2023.1195066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/07/2023] [Indexed: 12/07/2023] Open
Abstract
Background Among the brain-machine interfaces, neurofeedback is a non-invasive technique that uses sensorimotor rhythm (SMR) as a clinical intervention protocol. This study aimed to investigate the clinical applications of SMR neurofeedback to understand its clinical effectiveness in different pathologies or symptoms. Methods A systematic review study with meta-analysis of the clinical applications of EEG-based SMR neurofeedback performed using pre-selected publication databases. A qualitative analysis of these studies was performed using the Consensus tool on the Reporting and Experimental Design of Neurofeedback studies (CRED-nf). The Meta-analysis of clinical efficacy was carried out using Review Manager software, version 5.4.1 (RevMan 5; Cochrane Collaboration, Oxford, UK). Results The qualitative analysis includes 44 studies, of which only 27 studies had some kind of control condition, five studies were double-blinded, and only three reported a blind follow-up throughout the intervention. The meta-analysis included a total sample of 203 individuals between stroke and fibromyalgia. Studies on multiple sclerosis, insomnia, quadriplegia, paraplegia, and mild cognitive impairment were excluded due to the absence of a control group or results based only on post-intervention scales. Statistical analysis indicated that stroke patients did not benefit from neurofeedback interventions when compared to other therapies (Std. mean. dif. 0.31, 95% CI 0.03-0.60, p = 0.03), and there was no significant heterogeneity among stroke studies, classified as moderate I2 = 46% p-value = 0.06. Patients diagnosed with fibromyalgia showed, by means of quantitative analysis, a better benefit for the group that used neurofeedback (Std. mean. dif. -0.73, 95% CI -1.22 to -0.24, p = 0.001). Thus, on performing the pooled analysis between conditions, no significant differences were observed between the neurofeedback intervention and standard therapy (0.05, CI 95%, -0.20 to -0.30, p = 0.69), with the presence of substantial heterogeneity I2 = 92.2%, p-value < 0.001. Conclusion We conclude that although neurofeedback based on electrophysiological patterns of SMR contemplates the interest of numerous researchers and the existence of research that presents promising results, it is currently not possible to point out the clinical benefits of the technique as a form of clinical intervention. Therefore, it is necessary to develop more robust studies with a greater sample of a more rigorous methodology to understand the benefits that the technique can provide to the population.
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Affiliation(s)
- Tatiana Ferri Ribeiro
- Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Marcelo Alves Carriello
- Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Eugenio Pereira de Paula
- Physical Education (UFPR)—Invited Colaborador, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Amanda Carvalho Garcia
- Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Guilherme Luiz da Rocha
- Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Helio Afonso Ghizoni Teive
- Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
- Department of Clinical Medicine, UFPR, and Coordinator of the Movement Disorders Sector, Neurology Service, Clinic Hospital, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
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12
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Tene O, Bleich Cohen M, Helpman L, Fine N, Halevy A, Goldway N, Perry D, Bary P, Aisenberg Romano G, Ben-Zion Z, Hendler T, Bloch M. Limbic self-neuromodulation as a novel treatment option for emotional dysregulation in premenstrual dysphoric disorder (PMDD); a proof-of-concept study. Psychiatry Clin Neurosci 2023; 77:550-558. [PMID: 37354437 DOI: 10.1111/pcn.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
AIM To assess the efficacy of a novel neurofeedback (NF) method, targeting limbic activity, to treat emotional dysregulation related to premenstrual dysphoric disorder (PMDD). METHODS We applied a NF probe targeting limbic activity using a functional magnetic resonance imaging-inspired electroencephalogram model (termed Amyg-EFP-NF) in a double-blind randomized controlled trial. A frontal alpha asymmetry probe (AAS-NF), served as active control. Twenty-seven participants diagnosed with PMDD (mean age = 33.57 years, SD = 5.67) were randomly assigned to Amyg-EFP-NF or AAS-NF interventions with a 2:1 ratio, respectively. The treatment protocol consisted of 11 NF sessions through three menstrual cycles, and a follow-up assessment 3 months thereafter. The primary outcome measure was improvement in the Revised Observer Version of the Premenstrual Tension Syndrome Rating Scale (PMTS-OR). RESULTS A significant group by time effect was observed for the core symptom subscale of the PMTS-OR, with significant improvement observed at follow-up for the Amyg-EFP group compared with the AAS group [F(1, 15)=4.968, P = 0.042]. This finding was specifically robust for reduction in anger [F(1, 15) = 22.254, P < 0.001]. A significant correlation was found between learning scores and overall improvement in core symptoms (r = 0.514, P = 0.042) suggesting an association between mechanism of change and clinical improvement. CONCLUSION Our preliminary findings suggest that Amyg-EFP-NF may serve as an affordable and accessible non-invasive treatment option for emotional dysregulation in women suffering from PMDD. Our main limitations were the relatively small number of participants and the lack of a sham-NF placebo arm.
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Affiliation(s)
- Oren Tene
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Maya Bleich Cohen
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Liat Helpman
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
| | - Naomi Fine
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Halevy
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Noam Goldway
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Department of Psychology, New York University, New York City, New York, USA
| | - Daniella Perry
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Plia Bary
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gabi Aisenberg Romano
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ziv Ben-Zion
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Departments of Comparative Medicine and Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division, US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Talma Hendler
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Miki Bloch
- Department of Psychiatry and Sagol Brain Institute, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Sagol School of Neuroscience and Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
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13
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Drager LF, Assis M, Bacelar AFR, Poyares DLR, Conway SG, Pires GN, de Azevedo AP, Carissimi A, Eckeli AL, Pentagna Á, Almeida CMO, Franco CMR, Sobreira EST, Stelzer FG, Mendes GM, Minhoto GR, Linares IMP, Sousa KMM, Gitaí LLG, Sukys-Claudino L, Sobreira-Neto MA, Zanini MA, Margis R, Martinez SCG. 2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association. Sleep Sci 2023; 16:507-549. [PMID: 38370879 PMCID: PMC10869237 DOI: 10.1055/s-0043-1776281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P - Patient, problem, or population; I - Intervention; C - Comparison, control, or comparator; O - Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.
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Affiliation(s)
- Luciano Ferreira Drager
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Unidades de HipertenSão, Instituto do Coração (InCor) e Disciplina de Nefrologia, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Márcia Assis
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Clínica do Sono de Curitiba, Hospital São Lucas, Curitiba, Brazil.
| | - Andrea Frota Rego Bacelar
- Associação Brasileira do Sono, São Paulo, SP, Brazil.
- Clínica Bacelar - Neuro e Sono, Rio de Janeiro, RJ, Brazil.
| | - Dalva Lucia Rollemberg Poyares
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- Instituto do Sono, São Paulo, SP, Brazil.
| | - Silvia Gonçalves Conway
- Instituto de Psiquiatria (IPq), Universidade de São Paulo, São Paulo, SP, Brazil.
- Departamento de Otoneurologia, Universidade de São Paulo, São Paulo, SP, Brazil.
- AkasA - Formação e Conhecimento, São Paulo, SP, Brazil.
| | - Gabriel Natan Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- Instituto do Sono, São Paulo, SP, Brazil.
| | | | - Alicia Carissimi
- Faculdade Dom Bosco, Porto Alegre, RS, Brazil.
- Cronosul Clínica de Psicologia do Sono, Psicoterapia e Neuropsicologia, Porto Alegre, RS, Brazil.
| | - Allan Luiz Eckeli
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Álvaro Pentagna
- Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Emmanuelle Silva Tavares Sobreira
- AkasA - Formação e Conhecimento, São Paulo, SP, Brazil.
- Universidade Federal do Ceará, Fortaleza, CE, Brazil.
- Clínica Sinapse Diagnóstico, Fortaleza, CE, Brazil.
| | - Fernando Gustavo Stelzer
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | | | | | - Ila Marques Porto Linares
- Instituto de Psiquiatria (IPq), Universidade de São Paulo, São Paulo, SP, Brazil.
- Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Ksdy Maiara Moura Sousa
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
- SleepUp Tecnologia e Saúde LTDA, São Paulo, SP, Brazil.
| | | | - Lucia Sukys-Claudino
- Disciplina de Neurologia, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
| | | | - Marcio Andrei Zanini
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMPSE), São Paulo, SP, Brazil.
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Jensen M, Alanis JCG, Hüttenrauch E, Winther-Jensen M, Chavanon ML, Andersson G, Weise C. Does it matter what is trained? A randomized controlled trial evaluating the specificity of alpha/delta ratio neurofeedback in reducing tinnitus symptoms. Brain Commun 2023; 5:fcad185. [PMID: 37680692 PMCID: PMC10481778 DOI: 10.1093/braincomms/fcad185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/18/2023] [Accepted: 06/22/2023] [Indexed: 09/09/2023] Open
Abstract
Previous studies showed that alpha/delta ratio neurofeedback was effective in reducing unpleasant psychological, emotional and perceptual consequences of tinnitus. The main goal of the present study was to investigate, whether the specific combination of enhancing alpha frequency band activity and reducing delta frequency band activity was necessary, or merely sufficient, to obtain a positive treatment outcome regarding tinnitus distress and intensity. A second research aim was to assess the relative contribution of neurofeedback-related non-specific and general non-specific effects in neurofeedback treatment. In a three-arm, randomized controlled trial, 94 chronic tinnitus patients were randomly assigned to one of three conditions: alpha/delta ratio neurofeedback (n = 31), beta/theta ratio neurofeedback (n = 28) and non-neurofeedback minimal treatment intervention (n = 35). Neurofeedback participants underwent 10 treatment sessions over a 4-week period. Outcome measures were collected pre-, mid- and post-interventions and at 3-months follow-up. The Tinnitus Handicap Inventory and the Tinnitus Magnitude Index were used as primary outcome measures for tinnitus distress and tinnitus intensity. EEG data recorded during training supplemented primary outcomes. Since data were repeated measures, the analyses used a two-level mixed effects model approach including by-subject random effects (random intercept). For the Tinnitus Handicap Inventory, the results showed no interaction effect. For the Tinnitus Magnitude Index, the analysis showed a significant time × group interaction, indicating that both alpha/delta ratio neurofeedback and beta/theta ratio neurofeedback reported reduced tinnitus intensity. Analysis of EEG data showed a consistent pattern for the alpha/delta ratio over the course of training. Compared to beta/theta ratio neurofeedback, alpha/delta ratio neurofeedback showed an elevated response. Conversely, for the beta ratio to theta ratio, the pattern was more inconsistent, with no clear indication of superiority for beta/theta ratio neurofeedback over alpha/delta ratio neurofeedback. The main question of this piece of research was whether alpha/delta ratio neurofeedback demonstrated frequency band specificity in the alleviation of tinnitus distress and perceived intensity. Results showed that alpha/delta ratio neurofeedback was sufficient but importantly 'not' necessary to achieve a positive outcome on both the Tinnitus Handicap Inventory and Tinnitus Magnitude Index, when compared to beta/theta ratio neurofeedback. Still, the data suggest a trend towards specificity for alpha/delta ratio neurofeedback. Because of this, it may be too premature to discard alpha/delta ratio neurofeedback in the treatment of tinnitus. Recommendations for future studies are outlined.
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Affiliation(s)
- Martin Jensen
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
- Eriksholm Research Centre, 3070 Snekkersten, Denmark
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology and Audiology, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jose Carlos Garcia Alanis
- Division of Clinical Child and Adolescent Psychology, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
| | - Eva Hüttenrauch
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
| | - Matilde Winther-Jensen
- Department of Data, Biostatistics and Pharmacoepidemiology, Centre for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg-Frederiksberg, 2000 Copenhagen, Denmark
| | - Mira-Lynn Chavanon
- Division of Clinical Child and Adolescent Psychology, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, 58183 Linkoping, Sweden
| | - Cornelia Weise
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
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15
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Kuznetsova E, Veilahti AVP, Akhundzadeh R, Radev S, Konicar L, Cowley BU. Evaluation of Neurofeedback Learning in Patients with ADHD: A Systematic Review. Appl Psychophysiol Biofeedback 2023; 48:11-25. [PMID: 36178643 PMCID: PMC9908642 DOI: 10.1007/s10484-022-09562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/02/2022]
Abstract
NFB has a clear potential as a recognised treatment option for ADHD, but suffers from a lack of clarity about its efficacy, still unresolved after multiple controlled trials. Comparing learners and non-learners based on the evolution of patient-level indicators during the trial serves as a 'natural' control, and can help elucidate the mechanisms of NFB. We present a systematic review motivated by the need to establish the state of the art of patient learning during NFB treatment in current clinical literature. One particularly striking question we would like to answer here is whether existing NFB papers study learning variability, since only individual performance differences can give us information about mechanisms of learning. The results show that very few clinical trial reports have dealt with the heterogeneity of NFB learning, nor analysed whether NFB efficacy is dependent on NFB learning, even though NFB is believed to be a treatment based on learning to perform. In this systematic review we examine not only what has been reported, but also provide a critical analysis of possible flaws or gaps in existing studies, and discuss why no generalized conclusions about NFB efficacy have yet been made. Future research should focus on finding reliable ways of identifying the performers and studying participants' individual learning trajectories as it might enhance prognosis and the allocation of clinical resources.
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Affiliation(s)
- Elizaveta Kuznetsova
- Faculty of Educational Sciences, University of Helsinki, PO Box 9, 00014, Helsinki, Finland.
| | | | - Ruhoollah Akhundzadeh
- Faculty of Educational Sciences, University of Helsinki, PO Box 9, 00014, Helsinki, Finland
| | - Stefan Radev
- Department of Child and Adolescence Psychiatry, Medical University of Vienna, Vienna, Austria
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Lilian Konicar
- Department of Child and Adolescence Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Benjamin Ultan Cowley
- Faculty of Educational Sciences, University of Helsinki, PO Box 9, 00014, Helsinki, Finland
- Cognitive Science, Department of Digital Humanities, Faulty of Arts, University of Helsinki, Helsinki, Finland
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16
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Klöbl M, Prillinger K, Diehm R, Doganay K, Lanzenberger R, Poustka L, Plener P, Konicar L. Individual brain regulation as learned via neurofeedback is related to affective changes in adolescents with autism spectrum disorder. Child Adolesc Psychiatry Ment Health 2023; 17:6. [PMID: 36635760 PMCID: PMC9837918 DOI: 10.1186/s13034-022-00549-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/18/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Emotions often play a role in neurofeedback (NF) regulation strategies. However, investigations of the relationship between the induced neuronal changes and improvements in affective domains are scarce in electroencephalography-based studies. Thus, we extended the findings of the first study on slow cortical potential (SCP) NF in autism spectrum disorder (ASD) by linking affective changes to whole-brain activity during rest and regulation. METHODS Forty-one male adolescents with ASD were scanned twice at rest using functional magnetic resonance imaging. Between scans, half underwent NF training, whereas the other half received treatment as usual. Furthermore, parents reported on their child's affective characteristics at each measurement. The NF group had to alternatingly produce negative and positive SCP shifts during training and was additionally scanned using functional magnetic resonance imaging while applying their developed regulation strategies. RESULTS No significant treatment group-by-time interactions in affective or resting-state measures were found. However, we found increases of resting activity in the anterior cingulate cortex and right inferior temporal gyrus as well as improvements in affective characteristics over both groups. Activation corresponding to SCP differentiation in these regions correlated with the affective improvements. A further correlation was found for Rolandic operculum activation corresponding to positive SCP shifts. There were no significant correlations with the respective achieved SCP regulation during NF training. CONCLUSION SCP NF in ASD did not lead to superior improvements in neuronal or affective functioning compared to treatment as usual. However, the affective changes might be related to the individual strategies and their corresponding activation patterns as indicated by significant correlations on the whole-brain level. Trial registration This clinical trial was registered at drks.de (DRKS00012339) on 20th April, 2017.
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Affiliation(s)
- Manfred Klöbl
- Department of Psychiatry & Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Robert Diehm
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Kamer Doganay
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry & Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry, Medical University of Göttingen, Göttingen, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Lilian Konicar
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.
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17
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Zhidik AG, Kozhokaru AB. [Alternative methods of therapy for comorbid sleep disorders as a method of choice in adult patients with epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:42-48. [PMID: 37655409 DOI: 10.17116/jnevro202312308142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Systematization and generalization of data from domestic and foreign literature on alternative methods of treatment of sleep disorders in epilepsy. MATERIAL AND METHODS The search for data from domestic and foreign literary sources was carried out in the electronic databases Medline (PubMed), Scopus, Web of Science, eLibrary, CyberLeninka, Google Scholar. RESULTS The data of modern randomized trials, meta-analyzes on the effectiveness of various non-traditional methods as a method of choice for epilepsy with comorbid sleep disorders have been analyzed. CONCLUSIONS Complementary (alternative) treatments have many advantages over the classical pharmacotherapy of sleep disorders in epilepsy, in the form of non-invasiveness, low incidence of side-effects, ease of use, and lack of a dose-dependent effect. Of course, the targets of most of the above methods are not focused and not very specific, and the sample size is too small to obtain impartial and meaningful clinical conclusions, but this once again emphasizes the urgent need for large-scale clinical trials, which is necessary to develop evidence-based treatments for comorbid sleep disorders in epilepsy.
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Affiliation(s)
- A G Zhidik
- State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - A B Kozhokaru
- State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
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18
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Pindi P, Houenou J, Piguet C, Favre P. Real-time fMRI neurofeedback as a new treatment for psychiatric disorders: A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110605. [PMID: 35843369 DOI: 10.1016/j.pnpbp.2022.110605] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/12/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
Neurofeedback using real-time functional MRI (RT-fMRI-NF) is an innovative technique that allows to voluntarily modulate a targeted brain response and its associated behavior. Despite promising results in the current literature, its effectiveness on symptoms management in psychiatric disorders is not yet clearly demonstrated. Here, we provide 1) a state-of-art qualitative review of RT-fMRI-NF studies aiming at alleviating clinical symptoms in a psychiatric population; 2) a quantitative evaluation (meta-analysis) of RT-fMRI-NF effectiveness on various psychiatric disorders and 3) methodological suggestions for future studies. Thirty-one clinical trials focusing on psychiatric disorders were included and categorized according to standard diagnostic categories. Among the 31 identified studies, 22 consisted of controlled trials, of which only eight showed significant clinical improvement in the experimental vs. control group after the training. Nine studies found an effect at follow-up on ADHD symptoms, emotion dysregulation, facial emotion processing, depressive symptoms, hallucinations, psychotic symptoms, and specific phobia. Within-group meta-analysis revealed large effects of the NF training on depressive symptoms right after the training (g = 0.81, p < 0.01) and at follow-up (g = 1.19, p < 0.01), as well as medium effects on anxiety (g = 0.44, p = 0.01) and emotion regulation (g = 0.48, p < 0.01). Between-group meta-analysis showed a medium effect on depressive symptoms (g = 0.49, p < 0.01) and a large effect on anxiety (g = 0.77, p = 0.01). However, the between-studies heterogeneity is very high. The use of RT-fMRI-NF as a treatment for psychiatric symptoms is promising, however, further double-blind, multicentric, randomized-controlled trials are warranted.
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Affiliation(s)
- Pamela Pindi
- Paris Est Créteil University (UPEC), INSERM U955, IMRB, Translational Neuro-psychiatry Team, AP-HP, DMU IMPACT, Mondor University Hospitals, FondaMental Foundation, F-94010 Créteil, France; Paris-Saclay University, Neurospin, CEA, UNIACT Lab, PsyBrain Team, F-91191 Gif-sur-Yvette, France
| | - Josselin Houenou
- Paris Est Créteil University (UPEC), INSERM U955, IMRB, Translational Neuro-psychiatry Team, AP-HP, DMU IMPACT, Mondor University Hospitals, FondaMental Foundation, F-94010 Créteil, France; Paris-Saclay University, Neurospin, CEA, UNIACT Lab, PsyBrain Team, F-91191 Gif-sur-Yvette, France.
| | - Camille Piguet
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Campus Biotech, Geneva, Switzerland
| | - Pauline Favre
- Paris Est Créteil University (UPEC), INSERM U955, IMRB, Translational Neuro-psychiatry Team, AP-HP, DMU IMPACT, Mondor University Hospitals, FondaMental Foundation, F-94010 Créteil, France; Paris-Saclay University, Neurospin, CEA, UNIACT Lab, PsyBrain Team, F-91191 Gif-sur-Yvette, France
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Kalokairinou L, Specker Sullivan L, Wexler A. Neurofeedback as placebo: a case of unintentional deception? JOURNAL OF MEDICAL ETHICS 2022; 48:1037-1042. [PMID: 34521768 PMCID: PMC9205641 DOI: 10.1136/medethics-2021-107435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/18/2021] [Indexed: 05/27/2023]
Abstract
The use of placebo in clinical practice has been the topic of extensive debate in the bioethics literature, with much scholarship focusing on concerns regarding deception. While considerations of placebo without deception have largely centred on open-label placebo, this paper considers a different kind of ethical quandary regarding placebo without an intent to deceive-one where the provider believes a treatment is effective due to a direct physiological mechanism, even though that belief may not be supported by rigorous scientific evidence. This is often the case with complementary and alternative medicine (CAM) techniques and also with some mainstream therapies that have not proven to be better than sham. Using one such CAM technique as a case study-electroencephalography (EEG) neurofeedback for attention-deficit/hyperactivity disorder (ADHD)-this paper explores the ethics of providing therapies that may have some beneficial effect, although one that is likely due to placebo effect. First, we provide background on EEG neurofeedback for ADHD and its evidence base, showing how it has proven to be equivalent to-but not better than-sham neurofeedback. Subsequently, we explore whether offering therapies that are claimed to work via specific physical pathways, but may actually work due to the placebo effect, constitute deception. We suggest that this practice may constitute unintentional deception regarding mechanism of action. Ultimately, we argue that providers have increased information provision obligations when offering treatments that diverge from standard of care and we make recommendations for mitigating unintentional deception.
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Affiliation(s)
- Louiza Kalokairinou
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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Perez TM, Glue P, Adhia DB, Navid MS, Zeng J, Dillingham P, Smith M, Niazi IK, Young CK, De Ridder D. Infraslow closed-loop brain training for anxiety and depression (ISAD): a protocol for a randomized, double-blind, sham-controlled pilot trial in adult females with internalizing disorders. Trials 2022; 23:949. [PMID: 36397122 PMCID: PMC9670077 DOI: 10.1186/s13063-022-06863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/22/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The core intrinsic connectivity networks (core-ICNs), encompassing the default-mode network (DMN), salience network (SN) and central executive network (CEN), have been shown to be dysfunctional in individuals with internalizing disorders (IDs, e.g. major depressive disorder, MDD; generalized anxiety disorder, GAD; social anxiety disorder, SOC). As such, source-localized, closed-loop brain training of electrophysiological signals, also known as standardized low-resolution electromagnetic tomography (sLORETA) neurofeedback (NFB), targeting key cortical nodes within these networks has the potential to reduce symptoms associated with IDs and restore normal core ICN function. We intend to conduct a randomized, double-blind (participant and assessor), sham-controlled, parallel-group (3-arm) trial of sLORETA infraslow (<0.1 Hz) fluctuation neurofeedback (sLORETA ISF-NFB) 3 times per week over 4 weeks in participants (n=60) with IDs. Our primary objectives will be to examine patient-reported outcomes (PROs) and neurophysiological measures to (1) compare the potential effects of sham ISF-NFB to either genuine 1-region ISF-NFB or genuine 2-region ISF-NFB, and (2) assess for potential associations between changes in PRO scores and modifications of electroencephalographic (EEG) activity/connectivity within/between the trained regions of interest (ROIs). As part of an exploratory analysis, we will investigate the effects of additional training sessions and the potential for the potentiation of the effects over time. METHODS We will randomly assign participants who meet the criteria for MDD, GAD, and/or SOC per the MINI (Mini International Neuropsychiatric Interview for DSM-5) to one of three groups: (1) 12 sessions of posterior cingulate cortex (PCC) ISF-NFB up-training (n=15), (2) 12 sessions of concurrent PCC ISF up-training and dorsal anterior cingulate cortex (dACC) ISF-NFB down-training (n=15), or (3) 6 sessions of yoked-sham training followed by 6 sessions genuine ISF-NFB (n=30). Transdiagnostic PROs (Hospital Anxiety and Depression Scale, HADS; Inventory of Depression and Anxiety Symptoms - Second Version, IDAS-II; Multidimensional Emotional Disorder Inventory, MEDI; Intolerance of Uncertainty Scale - Short Form, IUS-12; Repetitive Thinking Questionnaire, RTQ-10) as well as resting-state neurophysiological measures (full-band EEG and ECG) will be collected from all subjects during two baseline sessions (approximately 1 week apart) then at post 6 sessions, post 12 sessions, and follow-up (1 month later). We will employ Bayesian methods in R and advanced source-localisation software (i.e. exact low-resolution brain electromagnetic tomography; eLORETA) in our analysis. DISCUSSION This protocol will outline the rationale and research methodology for a clinical pilot trial of sLORETA ISF-NFB targeting key nodes within the core-ICNs in a female ID population with the primary aims being to assess its potential efficacy via transdiagnostic PROs and relevant neurophysiological measures. TRIAL REGISTRATION Our study was prospectively registered with the Australia New Zealand Clinical Trials Registry (ANZCTR; Trial ID: ACTRN12619001428156). Registered on October 15, 2019.
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Affiliation(s)
- Tyson M Perez
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand.
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
| | - Paul Glue
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Divya B Adhia
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Muhammad S Navid
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Donders Institute for Brain, Cognition and Behaviour, Radbout University Medical Center, Nijmegen, The Netherlands
| | - Jiaxu Zeng
- Department of Preventative & Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Peter Dillingham
- Coastal People Southern Skies Centre of Research Excellence, Department of Mathematics & Statistics, University of Otago, Dunedin, New Zealand
| | - Mark Smith
- Neurofeedback Therapy Services of New York, New York, USA
| | - Imran K Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Calvin K Young
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Dirk De Ridder
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
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21
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Białkowska J, Mroczkowska D, Boraczyński M. Subjective Improvement of Sleep in Insomnia Patients Treated at a Day Rehabilitation Centre After the Use of EEG Neurofeedback Therapy – a Pilot Study. REHABILITACJA MEDYCZNA 2022. [DOI: 10.5604/01.3001.0016.0627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Insomnia affects nearly 1/3 of the worldwide population. Electroencephalography neurofeedback (EEG-NFB) is one of the methods used in applied psychophysiology, which can improve nightly sleep scheme.
Research objective: The aim of this pilot study was to assess the relative effect of a 20-day neurorehabilitation intervention based on EEG-NFB therapy in insomnia patients treated at a day rehabilitation centre.
Materials and methods: Seventy-four patients with insomnia: 28 women (mean age ± SD: 67.9 ± 8.84 years, range: 42–83 years) and 46 men (mean age ± SD: 63.0 ± 9.24 years, range: 42-80 years) were subjected to the EEG-NFB training-neurorehabilitation using the C4 protocol: sensorimotor rhythm (SMR) (12-15 Hz)/theta (4-7 Hz). The individual everyday EEG-NFB training consisted of 20, 30-minute sessions. Before and after the training, the data was collected from 12-electrode quantitative EEG (QEEG) tests. In addition, several standardised psychological questionnaires were performed: Pittsburgh Sleep Quality Index (PSQI), State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI).
Results: The EEG-NFB therapy reduced anxiety (7.39 ± 1.0 vs. 6.12 ± 0.88 in STAI, p< 0.001) and improved patients' mood (17.6 ± 3.9 vs. 14.65 ± 3.39 in BDI, p< 0.001). During the PSQI test, the time of falling asleep and number of night awakenings were statistically reduced (both p<0.001). However, there was no significant difference in the -SMR amplitude between pre- to post-treatment (9.15 ± 3.11 and 8.62 ± 2.82, respectively, p=0.095).
Conclusions: Due to the subjective improvement of sleep quality, without statistically significant changes in the electrophysiological record (expressed by SMR amplitude), it is advisable to continue research with the use of EEG-NFB therapy.
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Affiliation(s)
- Joanna Białkowska
- Faculty of Health Sciences, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland / Municipal Polyclinical Hospital in Olsztyn, Poland
| | - Dorota Mroczkowska
- Faculty of Health Sciences, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
| | - Michał Boraczyński
- Faculty of Health Sciences, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
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22
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Attention neuroenhancement through tDCS or neurofeedback: a randomized, single-blind, controlled trial. Sci Rep 2022; 12:17613. [PMID: 36266396 PMCID: PMC9584934 DOI: 10.1038/s41598-022-22245-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/12/2022] [Indexed: 01/13/2023] Open
Abstract
Neurofeedback and transcranial Direct Current Stimulation (tDCS) are promising techniques for neuroenhancement of attentional performance. As far as we know no study compared both techniques on attentional performance in healthy participants. We compared tDCS and neurofeedback in a randomized, single-blind, controlled experiment assessing both behavioral (accuracy and time reaction) and electrophysiological (N1, P1, and P3 components) data of participants responding to the Attention Network Task (ANT). Eighty volunteers volunteered for this study. We adopted standard protocols for both techniques, i.e., a Sensorimotor Rhythm (SMR) protocol for neurofeedback and the right DLPFC anodal stimulation for tDCS, applied over nine sessions (two weeks). We did not find significant differences between treatment groups on ANT, neither at the behavioral nor at the electrophysiological levels. However, we found that participants from both neuromodulation groups, irrespective of if active or sham, reported attentional improvements in response to the treatment on a subjective scale. Our study adds another null result to the neuromodulation literature, showing that neurofeedback and tDCS effects are more complex than previously suggested and associated with placebo effect. More studies in neuroenhancement literature are necessary to fully comprehend neuromodulation mechanisms.
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23
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Moore PT. Infra-low frequency neurofeedback and insomnia as a model of CNS dysregulation. Front Hum Neurosci 2022; 16:959491. [PMID: 36211128 PMCID: PMC9534730 DOI: 10.3389/fnhum.2022.959491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
This paper will review what is conventionally known of sleep homeostasis and focus on insomnia as a primary manifestation of brain dysregulation, whether as a solitary symptom or as part of a larger syndrome such as post-traumatic stress disorder, PTSD. It will discuss in brief behavioral/mindfulness treatments that have been used to treat neurologic diseases, as this is germane to the phenomenology of neurofeedback (NF). It will explore how neurofeedback may work at the subconscious level and cover the current clinical experience of the effectiveness of this technique in the treatment of insomnia. It will conclude with a case presentation.
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24
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Patil AU, Madathil D, Fan YT, Tzeng OJL, Huang CM, Huang HW. Neurofeedback for the Education of Children with ADHD and Specific Learning Disorders: A Review. Brain Sci 2022; 12:brainsci12091238. [PMID: 36138974 PMCID: PMC9497239 DOI: 10.3390/brainsci12091238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 12/02/2022] Open
Abstract
Neurofeedback (NF) is a type of biofeedback in which an individual’s brain activity is measured and presented to them to support self-regulation of ongoing brain oscillations and achieve specific behavioral and neurophysiological outcomes. NF training induces changes in neurophysiological circuits that are associated with behavioral changes. Recent evidence suggests that the NF technique can be used to train electrical brain activity and facilitate learning among children with learning disorders. Toward this aim, this review first presents a generalized model for NF systems, and then studies involving NF training for children with disorders such as dyslexia, attention-deficit/hyperactivity disorder (ADHD), and other specific learning disorders such as dyscalculia and dysgraphia are reviewed. The discussion elaborates on the potential for translational applications of NF in educational and learning settings with details. This review also addresses some issues concerning the role of NF in education, and it concludes with some solutions and future directions. In order to provide the best learning environment for children with ADHD and other learning disorders, it is critical to better understand the role of NF in educational settings. The review provides the potential challenges of the current systems to aid in highlighting the issues undermining the efficacy of current systems and identifying solutions to address them. The review focuses on the use of NF technology in education for the development of adaptive teaching methods and the best learning environment for children with learning disabilities.
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Affiliation(s)
- Abhishek Uday Patil
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Deepa Madathil
- Jindal Institute of Behavioural Sciences, O.P. Jindal Global University, Haryana 131001, India
| | - Yang-Tang Fan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan 320315, Taiwan
| | - Ovid J. L. Tzeng
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- Centre for Intelligent Drug Systems and Smart Bio-Devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- College of Humanities and Social Sciences, Taipei Medical University, Taipei 106339, Taiwan
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei 106308, Taiwan
- Hong Kong Institute for Advanced Studies, City University of Hong Kong, Hong Kong
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- Centre for Intelligent Drug Systems and Smart Bio-Devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Hsu-Wen Huang
- Department of Linguistics and Translation, City University of Hong Kong, Hong Kong
- Correspondence: ; Tel.: +852-3442-2579
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25
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Reynard S, Dias J, Mitic M, Schrank B, Woodcock KA. Digital Interventions for Emotion Regulation in Children and Early Adolescents: Systematic Review and Meta-analysis. JMIR Serious Games 2022; 10:e31456. [PMID: 35984681 PMCID: PMC9440412 DOI: 10.2196/31456] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 05/02/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background Difficulties in emotion regulation are common in adolescence and are associated with poor social and mental health outcomes. However, psychological therapies that promote adaptive emotion regulation may be inaccessible and unattractive to youth. Digital interventions may help address this need. Objective The aim of this systematic review and meta-analysis was to synthesize evidence on the efficacy, feasibility, and acceptability of emotion regulation digital interventions in children and early adolescents aged 8 to 14 years. Methods Systematic searches of Web of Science, MEDLINE, PsycINFO, EMBASE, Education Resources Information Centre, ACM Digital Library, and IEEE Xplore up to July 2020 identified 39 studies, of which 11 (28%) were included in the meta-analyses (n=2476 participants). A bespoke tool was used to assess risk of bias. Results The studies evaluated digital games (27/39, 69%), biofeedback (4/39, 10%), virtual or augmented reality (4/39, 10%), and program or multimedia (4/39, 10%) digital interventions in samples classified as diagnosed, at risk, healthy, and universal. The most consistent evidence came from digital games, which reduced negative emotional experience with a small significant effect, largely in youth at risk of anxiety (Hedges g=–0.19, 95% CI –0.34 to –0.04). In general, digital interventions tended to improve emotion regulation, but this effect was not significant (Hedges g=0.19, 95% CI –0.16 to 0.54). Conclusions Most feasibility issues were identified in diagnosed youth, and acceptability was generally high across intervention types and samples. Although there is cause to be optimistic about digital interventions supporting the difficulties that youth experience in emotion regulation, the predominance of early-stage development studies highlights the need for more work in this area.
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Affiliation(s)
- Sally Reynard
- Centre for Applied Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Joao Dias
- Faculty of Science and Technology, University of Algarve, Faro, Portugal.,Algarve Centre of Marine Sciences, Faro, Portugal.,Institute of Systems and Computer Engineering: Research and Development, Lisbon, Portugal
| | - Marija Mitic
- Die Offene Tür Research Group for Mental Health of Children and Adolescents, Ludwig Boltzmann Society, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Beate Schrank
- Die Offene Tür Research Group for Mental Health of Children and Adolescents, Ludwig Boltzmann Society, Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Psychiatry and Psychotherapy, University Hospital Tulln, Tulln, Austria
| | - Kate Anne Woodcock
- Centre for Applied Psychology, University of Birmingham, Birmingham, United Kingdom.,Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom
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26
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Kvamme TL, Sarmanlu M, Overgaard M. Doubting the double-blind: Introducing a questionnaire for awareness of experimental purposes in neurofeedback studies. Conscious Cogn 2022; 104:103381. [PMID: 35947940 DOI: 10.1016/j.concog.2022.103381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
Double-blinding subjects to the experiment's purpose is an important standard in neurofeedback studies. However, it is difficult to provide evidence that humans are entirely unaware of certain information. This study used insights from consciousness studies and neurophenomenology to develop a contingency awareness questionnaire for neurofeedback. We assessed whether participants had an awareness of experimental purposes to manipulate their attention and multisensory perception. A subset of subjects (5 out of 20) gained a degree of awareness of experimental purposes as evidenced by their correct guess about the purposes of the experiment to affect their attention and multisensory perceptions specific to their double-blinded group assignment. The results warrant replication before they are applied to clinical neurofeedback studies, given the considerable time taken to perform the questionnaire (∼25 min). We discuss the strengths and limitations of our contingency awareness questionnaire and the growing appeal of the double-blinded standard in clinical neurofeedback studies.
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Affiliation(s)
- Timo L Kvamme
- Cognitive Neuroscience Research Unit, CFIN/MINDLab, Aarhus University, Aarhus, Denmark; Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark.
| | - Mesud Sarmanlu
- Cognitive Neuroscience Research Unit, CFIN/MINDLab, Aarhus University, Aarhus, Denmark
| | - Morten Overgaard
- Cognitive Neuroscience Research Unit, CFIN/MINDLab, Aarhus University, Aarhus, Denmark
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27
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Arina GA, Dobrushina OR, Shvetsova ET, Osina ED, Meshkov GA, Aziatskaya GA, Trofimova AK, Efremova IN, Martunov SE, Nikolaeva VV. Infra-Low Frequency Neurofeedback in Tension-Type Headache: A Cross-Over Sham-Controlled Study. Front Hum Neurosci 2022; 16:891323. [PMID: 35669204 PMCID: PMC9164298 DOI: 10.3389/fnhum.2022.891323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Primary headaches are highly prevalent and represent a major cause of disability in young adults. Neurofeedback is increasingly used in the treatment of chronic pain; however, there are few studies investigating its efficacy in patients with headaches. We report the results of a cross-over sham-controlled study on the efficacy of neurofeedback in the prophylactic treatment of tension-type headache (TTH). Participants received ten sessions of infra-low frequency electroencephalographic neurofeedback and ten sessions of sham-neurofeedback, with the order of treatments being randomized. The study also included a basic psychotherapeutic intervention — a psychoeducational session performed before the main study phases and emotional support provided throughout the study period. The headache probability was modeled as a function of the neurofeedback and sham-neurofeedback sessions performed to date. As a result, we revealed a strong beneficial effect of neurofeedback and no influence of the sham sessions. The study supports the prophylactic use of infra-low frequency neurofeedback in patients with TTH. From a methodological point of view, we advocate for the explicit inclusion of psychotherapeutic components in neurofeedback study protocols.
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Affiliation(s)
- Galina A. Arina
- Faculty of Psychology, M. V. Lomonosov Moscow State University, Moscow, Russia
| | - Olga R. Dobrushina
- International Institute of Psychosomatic Health, Moscow, Russia
- Research Center of Neurology, Moscow, Russia
- *Correspondence: Olga R. Dobrushina,
| | | | - Ekaterina D. Osina
- Faculty of Psychology, M. V. Lomonosov Moscow State University, Moscow, Russia
| | | | | | - Alexandra K. Trofimova
- Federal State Budgetary Institution “Federal Center of Brain Research and Neurotechnologies” of the Federal Medical Biological Agency, Moscow, Russia
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28
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Zafarmand M, Farahmand Z, Otared N. A Systematic Literature Review and Meta-analysis on Effectiveness of Neurofeedback for Obsessive-Compulsive Disorder. Neurocase 2022; 28:29-36. [PMID: 35253624 DOI: 10.1080/13554794.2021.2019790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To evaluate the evidences related to the effectiveness of neurofeedback treatment for people with OCD. A literature review and meta-analysis of current controlled trials for patients with OCD symptoms was conducted across different databases. So, the primary outcome measure was OCD symptoms in subjects based on DSM IV. Y-BOCS was considered as primary outcomes. Nine met inclusion criteria (including 1211 patients). Analysis showed there was an important benefit of neurofeedback treatment in comparison to other treatments (MD = -6.815; 95% CI = [-9.033, -4.598]; P < 0.001). The results provide preliminary evidence that NFB is efficacious method for OCD and suggest that more clinical trials are needed to compare common treatment such as medication, neurological, and behavioral interventions.
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Affiliation(s)
| | - Zahra Farahmand
- Department of Clinical Psychology, Tehran University of Medical Science, Tehran, Iran
| | - Nastaran Otared
- Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
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29
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30
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Farkhondeh Tale Navi F, Heysieattalab S, Ramanathan DS, Raoufy MR, Nazari MA. Closed-loop Modulation of the Self-regulating Brain: A Review on Approaches, Emerging Paradigms, and Experimental Designs. Neuroscience 2021; 483:104-126. [PMID: 34902494 DOI: 10.1016/j.neuroscience.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
Closed-loop approaches, setups, and experimental designs have been applied within the field of neuroscience to enhance the understanding of basic neurophysiology principles (closed-loop neuroscience; CLNS) and to develop improved procedures for modulating brain circuits and networks for clinical purposes (closed-loop neuromodulation; CLNM). The contents of this review are thus arranged into the following sections. First, we describe basic research findings that have been made using CLNS. Next, we provide an overview of the application, rationale, and therapeutic aspects of CLNM for clinical purposes. Finally, we summarize methodological concerns and critics in clinical practice of neurofeedback and novel applications of closed-loop perspective and techniques to improve and optimize its experiments. Moreover, we outline the theoretical explanations and experimental ideas to test animal models of neurofeedback and discuss technical issues and challenges associated with implementing closed-loop systems. We hope this review is helpful for both basic neuroscientists and clinical/ translationally-oriented scientists interested in applying closed-loop methods to improve mental health and well-being.
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Affiliation(s)
- Farhad Farkhondeh Tale Navi
- Department of Cognitive Neuroscience, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran
| | - Soomaayeh Heysieattalab
- Department of Cognitive Neuroscience, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran
| | | | - Mohammad Reza Raoufy
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Ali Nazari
- Department of Cognitive Neuroscience, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran; Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.
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31
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Damanskyy Y, Olsen A, Hollup S. Prior Prognostic Expectations as a Potential Predictor in Neurofeedback Training. JOURNAL OF COGNITIVE ENHANCEMENT 2021. [DOI: 10.1007/s41465-021-00234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AbstractThe present study evaluated whether subjects’ expectations and neurofeedback training performance predict neurofeedback efficacy in cognitive training by controlling both factors as statistical variables. Twenty-two psychology students underwent neurofeedback training, employing beta/theta protocol to enhance beta1 power (13–21 Hz) and suppress theta (4–7 Hz) power. Neurofeedback efficacy was evaluated by behavioral components measured on pre-tests and post-tests employing a visual continuous performance task. The results revealed a significant interaction term between change in reaction time from pre-test to post-test and expectancy effect, indicating that participants with high prognostic expectations showed better improvement in reaction time scores. The data did not reveal that actual neurofeedback performance influenced the post-test measurements of the visual continuous performance task. No significant differences were found for reaction time variability, omission, or commission errors. Possible factors contributing to the results are discussed, and directions for future research are suggested.
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Neurofeedback for cognitive enhancement and intervention and brain plasticity. Rev Neurol (Paris) 2021; 177:1133-1144. [PMID: 34674879 DOI: 10.1016/j.neurol.2021.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/27/2021] [Indexed: 12/18/2022]
Abstract
In recent years, neurofeedback has been used as a cognitive training tool to improve brain functions for clinical or recreational purposes. It is based on providing participants with feedback about their brain activity and training them to control it, initiating directional changes. The overarching hypothesis behind this method is that this control results in an enhancement of the cognitive abilities associated with this brain activity, and triggers specific structural and functional changes in the brain, promoted by learning and neuronal plasticity effects. Here, we review the general methodological principles behind neurofeedback and we describe its behavioural benefits in clinical and experimental contexts. We review the non-specific effects of neurofeedback on the reinforcement learning striato-frontal networks as well as the more specific changes in the cortical networks on which the neurofeedback control is exerted. Last, we analyse the current challenges faces by neurofeedback studies, including the quantification of the temporal dynamics of neurofeedback effects, the generalisation of its behavioural outcomes to everyday life situations, the design of appropriate controls to disambiguate placebo from true neurofeedback effects and the development of more advanced cortical signal processing to achieve a finer-grained real-time modelling of cognitive functions.
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Lambert-Beaudet F, Journault WG, Rudziavic Provençal A, Bastien CH. Neurofeedback for insomnia: Current state of research. World J Psychiatry 2021; 11:897-914. [PMID: 34733650 PMCID: PMC8546766 DOI: 10.5498/wjp.v11.i10.897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/18/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic insomnia affects about 6%-13% of the Canadian population. Although treatments already exist, they each have their own issues. Neurofeedback is a neuromodulation technique that specifically targets abnormal brain activity and is gaining attention as a possible insomnia treatment.
AIM To review the latest studies pertaining to the use of neurofeedback in the treatment of insomnia.
METHODS In this non-systematic review, only experimental studies assessing the effects of neurofeedback on patients with insomnia were targeted across four bibliographic databases.
RESULTS A total of 12 studies were retained. All neurofeedback studies included in this study showed a clear improvement of subjective sleep. However, data concerning objective improvement are contradictory. Most studies regarding surface and z-score neurofeedback show that neurofeedback targeting the sensorimotor rhythm in the sensorimotor cortex may help improve subjective sleep. A placebo effect seems also to be present in some studies. Several limitations were present in each study.
CONCLUSION While studies concerning neurofeedback as a treatment for insomnia are encouraging, many methodological barriers remain to be resolved to prove its efficacy unequivocally. More studies using robust design parameters, as well as the replication of existing studies, are necessary to support neurofeedback as an effective treatment for insomnia.
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Affiliation(s)
| | | | | | - Célyne H Bastien
- Department of Psychology, School of Psychology Laval University, Québec G1V0A6, Canada
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Fruchtman-Steinbok T, Keynan JN, Cohen A, Jaljuli I, Mermelstein S, Drori G, Routledge E, Krasnoshtein M, Playle R, Linden DEJ, Hendler T. Amygdala electrical-finger-print (AmygEFP) NeuroFeedback guided by individually-tailored Trauma script for post-traumatic stress disorder: Proof-of-concept. NEUROIMAGE-CLINICAL 2021; 32:102859. [PMID: 34689055 PMCID: PMC8551212 DOI: 10.1016/j.nicl.2021.102859] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/21/2022]
Abstract
Randomized clinical trial with a novel self-neuromodulation training in PTSD. Demonstration of feasibility of an fMRI-informed EEG model of Amygdala modulation (AmygEFP). Individually-tailored trauma-related content as the training feedback interface. Results showed reduction of PTSD symptoms following AmygEFP trauma-related feedback training.
Background Amygdala activity dysregulation plays a central role in post-traumatic stress disorder (PTSD). Hence learning to self-regulate one's amygdala activity may facilitate recovery. PTSD is further characterized by abnormal contextual processing related to the traumatic memory. Therefore, provoking the personal traumatic narrative while training amygdala down-regulation could enhance clinical efficacy. We report the results of a randomized controlled trial (NCT02544971) of a novel self-neuromodulation procedure (i.e. NeuroFeedback) for PTSD, aimed at down-regulating limbic activity while receiving feedback from an auditory script of a personal traumatic narrative. To scale-up applicability, neural activity was probed by an fMRI-informed EEG model of amygdala activity, termed Amygdala Electrical Finger-Print (AmygEFP). Methods Fifty-nine adults meeting DSM-5 criteria for PTSD were randomized between three groups: Trauma-script feedback interface (Trauma-NF) or Neutral feedback interface (Neutral-NF), and a control group of No-NF (to control for spontaneous recovery). Before and immediately after 15 NF training sessions patients were blindly assessed for PTSD symptoms and underwent one session of amygdala fMRI-NF for transferability testing. Follow-up clinical assessment was performed at 3- and 6-months following NF treatment. Results Patients in both NF groups learned to volitionally down-regulate AmygEFP signal and demonstrated a greater reduction in PTSD symptoms and improved down-regulation of the amygdala during fMRI-NF, compared to the No-NF group. The Trauma-NF group presented the largest immediate clinical improvement. Conclusions This proof-of-concept study indicates the feasibility of the AmygEFP-NF process-driven as a scalable intervention for PTSD and illustrates its clinical potential. Further investigation is warranted to elucidate the contribution of AmygEFP-NF beyond exposure and placebo effects.
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Affiliation(s)
- Tom Fruchtman-Steinbok
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Jackob N Keynan
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; Department of Psychiatry & Behavioral Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Avihay Cohen
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Iman Jaljuli
- Department of Statistics and Operations Research, School of Mathematical Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Gadi Drori
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Efrat Routledge
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | | | - Rebecca Playle
- Center for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - David E J Linden
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Talma Hendler
- Sagol Brain Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel; School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Krepel N, Egtberts T, Touré-Cuq E, Bouny P, Arns M. Evaluation of the URGOnight Tele-neurofeedback Device: An Open-label Feasibility Study with Follow-up. Appl Psychophysiol Biofeedback 2021; 47:43-51. [PMID: 34585339 PMCID: PMC8831243 DOI: 10.1007/s10484-021-09525-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
SMR neurofeedback shows potential as a therapeutic tool for reducing sleep problems. It is hypothesized that SMR neurofeedback trains the reticulo-thalamocortical-cortical circuit involved in sleep-spindle generation. As such, strengthening this circuit is hypothesized to reduce sleep problems. The current study aims to investigate the effectiveness of a home-based device that uses SMR neurofeedback to help reduce sleep problems. Thirty-seven participants reporting sleep problems received the SMR neurofeedback-based program for 40 (n = 21) or 60 (n = 16) sessions. The Pittsburgh Sleep Quality Index (PSQI) and Holland Sleep Disorders Questionnaire (HSDQ) were assessed at baseline, session 20, outtake, and follow-up (FU). Actigraphy measurements were taken at baseline, session 20, and outtake. Significant improvements were observed in PSQI Total (d = 0.78), PSQI Sleep Duration (d = 0.52), HSDQ Total (d = 0.80), and HSDQ Insomnia (d = 0.79). Sleep duration (based on PSQI) increased from 5.3 h at baseline to 5.8 after treatment and 6.0 h. at FU. No effects of number of sessions were found. Participants qualified as successful SMR-learners demonstrated a significantly larger gain in sleep duration (d = 0.86 pre-post; average gain = 1.0 h.) compared to non-learners. The home-based SMR tele-neurofeedback device shows the potential to effectively reduce sleep problems, with SMR-learners demonstrating significantly better improvement. Although randomized controlled trials (RCTs) are needed to further elucidate the specific effect of this device on sleep problems, this is the first home-based SMR neurofeedback device using dry electrodes demonstrating effectiveness and feasibility.
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Affiliation(s)
- Noralie Krepel
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, The Netherlands
| | | | | | - Pierre Bouny
- UrgoTech, 15 avenue d'Iéna, 75116, Paris, France
| | - Martijn Arns
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, The Netherlands.
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Grosselin F, Breton A, Yahia-Cherif L, Wang X, Spinelli G, Hugueville L, Fossati P, Attal Y, Navarro-Sune X, Chavez M, George N. Alpha activity neuromodulation induced by individual alpha-based neurofeedback learning in ecological context: a double-blind randomized study. Sci Rep 2021; 11:18489. [PMID: 34531416 PMCID: PMC8445968 DOI: 10.1038/s41598-021-96893-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023] Open
Abstract
The neuromodulation induced by neurofeedback training (NFT) remains a matter of debate. Investigating the modulation of brain activity specifically associated with NF requires controlling for multiple factors, such as reward, performance, congruency between task and targeted brain activity. This can be achieved using sham feedback (FB) control condition, equating all aspects of the experiment but the link between brain activity and FB. We aimed at investigating the modulation of individual alpha EEG activity induced by NFT in a double-blind, randomized, sham-controlled study. Forty-eight healthy participants were assigned to either NF (n = 25) or control (n = 23) group and performed alpha upregulation training (over 12 weeks) with a wearable EEG device. Participants of the NF group received FB based on their individual alpha activity. The control group received the auditory FB of participants of the NF group. An increase of alpha activity across training sessions was observed in the NF group only (p < 0.001). This neuromodulation was selective in that there was no evidence for similar effects in the theta (4-8 Hz) and low beta (13-18 Hz) bands. While alpha upregulation was found in the NF group only, psychological outcome variables showed overall increased feeling of control, decreased anxiety level and increased relaxation feeling, without any significant difference between the NF and the control groups. This is interpreted in terms of learning context and placebo effects. Our results pave the way to self-learnt, NF-based neuromodulation with light-weighted, wearable EEG systems.
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Affiliation(s)
- Fanny Grosselin
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute (ICM), INSERM U 1127, CNRS UMR 7225, Equipe Aramis, 75013, Paris, France.
- myBrain Technologies, 75010, Paris, France.
- INRIA, Aramis Project-Team, 75013, Paris, France.
| | | | - Lydia Yahia-Cherif
- Institut du Cerveau-Paris Brain Institute-ICM, Centre MEG-EEG, Paris, France
- CNRS, UMR 7225, F-75013, Paris, France
- Inserm, U 1127, Paris, France
- Sorbonne Université, Paris, France
| | - Xi Wang
- myBrain Technologies, 75010, Paris, France
| | | | - Laurent Hugueville
- Institut du Cerveau-Paris Brain Institute-ICM, Centre MEG-EEG, Paris, France
- CNRS, UMR 7225, F-75013, Paris, France
- Inserm, U 1127, Paris, France
- Sorbonne Université, Paris, France
| | - Philippe Fossati
- CNRS, UMR 7225, F-75013, Paris, France
- Inserm, U 1127, Paris, France
- Sorbonne Université, Paris, France
- Institut du Cerveau-Paris Brain Institute-ICM, Equipe CIA-Cognitive Control, Interoception, Attention, 75013, Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Psychiatrie Adulte, 75013, Paris, France
| | | | | | | | - Nathalie George
- Institut du Cerveau-Paris Brain Institute-ICM, Centre MEG-EEG, Paris, France
- CNRS, UMR 7225, F-75013, Paris, France
- Inserm, U 1127, Paris, France
- Sorbonne Université, Paris, France
- Institut du Cerveau-Paris Brain Institute-ICM, Equipe Experimental Neurosurgery, 75013, Paris, France
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Taschereau-Dumouchel V, Cortese A, Lau H, Kawato M. Conducting decoded neurofeedback studies. Soc Cogn Affect Neurosci 2021; 16:838-848. [PMID: 32367138 PMCID: PMC8343564 DOI: 10.1093/scan/nsaa063] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/13/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022] Open
Abstract
Closed-loop neurofeedback has sparked great interest since its inception in the late 1960s. However, the field has historically faced various methodological challenges. Decoded fMRI neurofeedback may provide solutions to some of these problems. Notably, thanks to the recent advancements of machine learning approaches, it is now possible to target unconscious occurrences of specific multivoxel representations. In this tools of the trade paper, we discuss how to implement these interventions in rigorous double-blind placebo-controlled experiments. We aim to provide a step-by-step guide to address some of the most common methodological and analytical considerations. We also discuss tools that can be used to facilitate the implementation of new experiments. We hope that this will encourage more researchers to try out this powerful new intervention method.
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Affiliation(s)
- Vincent Taschereau-Dumouchel
- Department of Decoded Neurofeedback, ATR Computational Neuroscience Laboratories, Kyoto 619-0288, Japan
- Department of Psychology, UCLA, Los Angeles, CA 90095, USA
| | - Aurelio Cortese
- Department of Decoded Neurofeedback, ATR Computational Neuroscience Laboratories, Kyoto 619-0288, Japan
| | - Hakwan Lau
- Department of Decoded Neurofeedback, ATR Computational Neuroscience Laboratories, Kyoto 619-0288, Japan
- Department of Psychology, UCLA, Los Angeles, CA 90095, USA
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
- Brain Research Institute, UCLA, Los Angeles, CA 90095, USA
- Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong
| | - Mitsuo Kawato
- Department of Decoded Neurofeedback, ATR Computational Neuroscience Laboratories, Kyoto 619-0288, Japan
- RIKEN Center for Advanced Intelligence Project, ATR Institute International, Kyoto, Japan
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Ide-Walters C, Thompson T. A Sham-Controlled Study of Neurofeedback for Pain Management. Front Neurosci 2021; 15:591006. [PMID: 34381326 PMCID: PMC8350778 DOI: 10.3389/fnins.2021.591006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 06/25/2021] [Indexed: 11/26/2022] Open
Abstract
Background Neurofeedback (NFB) attempts to alter the brain’s electrophysiological activity and has shown potential as a pain management technique. Existing studies, however, often lack appropriate control groups or fail to assess whether electrophysiological activity has been successfully regulated. The current study is a randomized controlled trial comparing changes in brain activity and pain during NFB with those of a sham-control group. Methods An experimental pain paradigm in healthy participants was used to provide optimal control of pain sensation. Twenty four healthy participants were blind randomized to receive either 10 × NFB (with real EEG feedback) or 10 × sham (with false EEG feedback) sessions during noxious cold stimulation. Prior to actual NFB training, training protocols were individually determined for each participant based on a comparison of an initial 32-channel qEEG assessment administered at both baseline and during an experimental pain task. Each individual protocol was based on the electrode site and frequency band that showed the greatest change in amplitude during pain, with alpha or theta up-regulation at various electrode sites (especially Pz) the most common protocols chosen. During the NFB sessions themselves, pain was assessed at multiple times during each session on a 0–10 rating scale, and ANOVA was used to examine changes in pain ratings and EEG amplitude both across and during sessions for both NFB and sham groups. Results For pain, ANOVA trend analysis found a significant general linear decrease in pain across the 10 sessions (p = 0.015). However, no significant main or interaction effects of group were observed suggesting decreases in pain occurred independently of NFB. For EEG, there was a significant During Session X Group interaction (p = 0.004), which indicated that EEG amplitude at the training site was significantly closer to the target amplitude for the NFB compared to the sham group during painful stimulation, but this was only the case at the beginning of the cold task. Conclusion While these results must be interpreted within the context of an experimental pain model, they underline the importance of including an appropriate comparison group to avoid attributing naturally occurring changes to therapeutic effects.
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Affiliation(s)
- Charlotte Ide-Walters
- Centre for Chronic Illness and Ageing, University of Greenwich, London, United Kingdom.,Cancer Research UK, London, United Kingdom
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, United Kingdom
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Inoue Y, Hirata K, Hoshino Y, Yamaguchi Y. Difference in background factors between responders to gabapentin enacarbil treatment and responders to placebo: pooled analyses of two randomized, double-blind, placebo-controlled studies in Japanese patients with restless legs syndrome. Sleep Med 2021; 85:138-146. [PMID: 34329897 DOI: 10.1016/j.sleep.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Restless legs syndrome (RLS) is a sensorimotor disorder that is characterized by uncomfortable and unpleasant sensations mainly in the legs. Two placebo-controlled studies (Phase II/III and post-marketing) in Japanese patients with RLS failed to demonstrate the efficacy of gabapentin enacarbil (GE) 600 mg in the change from baseline in International Restless Legs Syndrome Rating Scale (IRLS) score at the end of the treatment period. The high response to placebo is thought to be a possible reason why the post-marketing study failed. The objectives of these post hoc analyses were to determine potential predictive factors associated with improvement in IRLS score with GE treatment and to identify subgroups with higher placebo responses. METHODS We combined data from the two Japanese studies and analyzed change from baseline in IRLS score in the pooled population and subgroups defined by several patient characteristics. Moreover, we calculated the variable importance of each factor and performed predictive enrichment analysis to identify an enrichable subpopulation with greater improvement by GE treatment. RESULTS The post hoc analyses suggested that higher baseline IRLS score (≥21) and higher body mass index (≥25 kg/m2) were associated with higher placebo responses. On the other hand, positive family history of RLS, prior use of dopaminergic receptor agonists, and higher baseline ferritin level (≥50 ng/mL) were associated with higher responses to GE. CONCLUSIONS Our results suggest that patients with typical idiopathic RLS characteristics, including positive family history and no low ferritin level, would be expected to derive the greatest benefits from GE treatment.
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Affiliation(s)
- Yuichi Inoue
- Department of Somnology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, 5-10-10, Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan.
| | - Koichi Hirata
- Dokkyo Medical University, 880, Kitakobayashi, Mibu, Shimotsugagun, Tochigi, 321-0293, Japan.
| | - Yuya Hoshino
- Data Science, Astellas Pharma Inc., 2-5-1, Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411, Japan.
| | - Yusuke Yamaguchi
- Data Science, Astellas Pharma Inc., 2-5-1, Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411, Japan.
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Mihara M, Fujimoto H, Hattori N, Otomune H, Kajiyama Y, Konaka K, Watanabe Y, Hiramatsu Y, Sunada Y, Miyai I, Mochizuki H. Effect of Neurofeedback Facilitation on Poststroke Gait and Balance Recovery: A Randomized Controlled Trial. Neurology 2021; 96:e2587-e2598. [PMID: 33879597 PMCID: PMC8205450 DOI: 10.1212/wnl.0000000000011989] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/01/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that supplementary motor area (SMA) facilitation with functional near-infrared spectroscopy-mediated neurofeedback (fNIRS-NFB) augments poststroke gait and balance recovery, we conducted a 2-center, double-blind, randomized controlled trial involving 54 Japanese patients using the 3-meter Timed Up and Go (TUG) test. METHODS Patients with subcortical stroke-induced mild to moderate gait disturbance more than 12 weeks from onset underwent 6 sessions of SMA neurofeedback facilitation during gait- and balance-related motor imagery using fNIRS-NFB. Participants were randomly allocated to intervention (28 patients) or placebo (sham: 26 patients). In the intervention group, the fNIRS signal contained participants' cortical activation information. The primary outcome was TUG improvement 4 weeks postintervention. RESULTS The intervention group showed greater improvement in the TUG test (12.84 ± 15.07 seconds, 95% confidence interval 7.00-18.68) than the sham group (5.51 ± 7.64 seconds, 95% confidence interval 2.43-8.60; group difference 7.33 seconds, 95% CI 0.83-13.83; p = 0.028), even after adjusting for covariates (group × time interaction; F 1.23,61.69 = 4.50, p = 0.030, partial η2 = 0.083). Only the intervention group showed significantly increased imagery-related SMA activation and enhancement of resting-state connectivity between SMA and ventrolateral premotor area. Adverse effects associated with fNIRS-mediated neurofeedback intervention were absent. CONCLUSION SMA facilitation during motor imagery using fNIRS neurofeedback may augment poststroke gait and balance recovery by modulating the SMA and its related network. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for patients with gait disturbance from subcortical stroke, SMA neurofeedback facilitation improves TUG time (UMIN000010723 at UMIN-CTR; umin.ac.jp/english/).
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Affiliation(s)
- Masahito Mihara
- From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan.
| | - Hiroaki Fujimoto
- From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan
| | - Noriaki Hattori
- From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan
| | - Hironori Otomune
- From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan
| | - Yuta Kajiyama
- From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan
| | - Kuni Konaka
- From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan
| | - Yoshiyuki Watanabe
- From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan
| | - Yuichi Hiramatsu
- From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan
| | - Yoshihide Sunada
- From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan
| | - Ichiro Miyai
- From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan
| | - Hideki Mochizuki
- From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan
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Pérez-Elvira R, Oltra-Cucarella J, Carrobles JA, Moltó J, Flórez M, Parra S, Agudo M, Saez C, Guarino S, Costea RM, Neamtu B. Enhancing the Effects of Neurofeedback Training: The Motivational Value of the Reinforcers. Brain Sci 2021; 11:brainsci11040457. [PMID: 33916676 PMCID: PMC8067059 DOI: 10.3390/brainsci11040457] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
The brain activity that is measured by electroencephalography (EEG) can be modified through operant conditioning, specifically using neurofeedback (NF). NF has been applied to several disorders claiming that a change in the erratic brain activity would be accompanied by a reduction of the symptoms. However, the expected results are not always achieved. Some authors have suggested that the lack of an adequate response may be due to an incorrect application of the operant conditioning principles. A key factor in operant conditioning is the use of reinforcers and their value in modifying behavior, something that is not always sufficiently taken into account. This work aims to clarify the relevance of the motivational value versus the purely informational value of the reinforcer. In this study, 113 subjects were randomly assigned two different reinforcer conditions: a selected reinforcer—the subjects subjectively selected the reinforcers—or an imposed reinforcer—the reinforcers were assigned by the experimenter—and both groups undertook NF sessions to enhance the sensorimotor rhythm (SMR). In addition, the selected reinforcer group was divided into two subgroups: one receiving real NF and the other one sham NF. There were no significant differences between the groups at baseline in terms of SMR amplitude. After the intervention, only those subjects belonging to the selected reinforcer group and receiving real NF increased their SMR. Our results provide evidence for the importance of the motivational value of the reinforcer in Neurofeedback success.
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Affiliation(s)
- Rubén Pérez-Elvira
- Neuropsychophysiology Laboratory, NEPSA Rehabilitación Neurológica, 3003 Salamanca, Spain; (R.P.-E.); (M.A.); (C.S.)
| | - Javier Oltra-Cucarella
- Department of Health Psychology, Universidad Miguel Hernández de Elche, 03202 Elche, Spain
- Correspondence:
| | - José Antonio Carrobles
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Jorge Moltó
- PSYD-Neurofeedback, 46022 Valencia, Spain; (J.M.); (M.F.)
| | | | | | - María Agudo
- Neuropsychophysiology Laboratory, NEPSA Rehabilitación Neurológica, 3003 Salamanca, Spain; (R.P.-E.); (M.A.); (C.S.)
| | - Clara Saez
- Neuropsychophysiology Laboratory, NEPSA Rehabilitación Neurológica, 3003 Salamanca, Spain; (R.P.-E.); (M.A.); (C.S.)
| | - Sergio Guarino
- NEPSA Rehabilitación Neurológica, 47001 Valladolid, Spain;
| | - Raluca Maria Costea
- Research Department (Ceforaten), Sibiu Pediatric Hospital, 550178 Sibiu, Romania; (R.M.C.); (B.N.)
- Faculty of Medicine Lucian Blaga, University from Sibiu, 550169 Sibiu, Romania
| | - Bogdan Neamtu
- Research Department (Ceforaten), Sibiu Pediatric Hospital, 550178 Sibiu, Romania; (R.M.C.); (B.N.)
- Faculty of Medicine Lucian Blaga, University from Sibiu, 550169 Sibiu, Romania
- Faculty of Engineering, Lucian Blaga, University from Sibiu, 550025 Sibiu, Romania
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Nagappan A, Kalokairinou L, Wexler A. Ethical and Legal Considerations of Alternative Neurotherapies. AJOB Neurosci 2021; 12:257-269. [PMID: 33759705 DOI: 10.1080/21507740.2021.1896601] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neurotherapies for diagnostics and treatment-such as electroencephalography (EEG) neurofeedback, single-photon emission computerized tomography (SPECT) imaging for neuropsychiatric evaluation, and off-label/experimental uses of brain stimulation-are continuously being offered to the public outside mainstream healthcare settings. Because these neurotherapies share many key features of complementary and alternative medicine (CAM) techniques-and meet the definition of CAM as set out in Kaptchuk and Eisenberg-here we refer to them as "alternative neurotherapies." By explicitly linking these alternative neurotherapy practices under a common conceptual framework, this paper draws attention to, and critically considers, the cross-cutting ethical and legal issues related to the provision of these services. The first section of this paper provides an updated empirical overview of uses of SPECT neuropsychiatric evaluations, EEG neurofeedback, and experimental/off-label forms of brain stimulation. Next, drawing on CAM bioethics scholarship, we highlight the pertinent ethical issues in the alternative neurotherapy context, including the truthful representation of evidence base, marketing to vulnerable populations, potential harms, provider competency, and conflicts of interest. Finally, we consider the principal legal issues at stake for the provision of alternative neurotherapies in the U.S., namely those related to licensing and scope-of-practice considerations. We conclude with recommendations for future research in this domain.
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Schönenberg M, Weingärtner AL, Weimer K, Scheeff J. Believing is achieving - On the role of treatment expectation in neurofeedback applications. Prog Neuropsychopharmacol Biol Psychiatry 2021; 105:110129. [PMID: 33031860 DOI: 10.1016/j.pnpbp.2020.110129] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/16/2022]
Abstract
In neurofeedback applications, neural activity is recorded, processed in real-time and fed back to the user in order to facilitate self-regulation of the putative neural mechanisms that underlie cognition and behavior. Numerous studies suggest that neurofeedback interventions are an efficacious treatment particularly for patients with attention-deficit/hyperactivity disorder (ADHD). In recent years, however, findings of several well-controlled studies raised doubts concerning the proposed mechanism of action behind the behavioral effect of neurofeedback. This study investigated the impact of expectation on the efficacy of a sensorimotor rhythm (SMR) training. In a within-subjects design 30 blinded volunteers with ADHD symptoms received a standard SMR training session after inducing no (no-expectancy condition), positive (placebo condition), and negative (nocebo condition) expectations regarding the effectiveness of neurofeedback (by telling them that they would train a specific frequency band that was previously shown to be either unrelated to attention, should improve attention, or interfere with attentional processes). After each training, participants were presented with a cognitive test and subsequently requested to rate their performance on it. We could show that participants were able to successfully modify their EEG signal during training. Further, we found an effect over trainings on objective attentional performance. Most importantly, we found that the expectancy of positive or negative treatment effects considerably changed participants' perception of neurofeedback's efficacy even in the absence of any objective evidence. This study presents strong first evidence for a substantial effect of self-confirming response expectancies as one factor underlying the efficacy of neurofeedback. Future research has to carefully consider the impact of such psychosocial mechanisms when evaluating the (specific) efficacy of neuromodulatory treatments.
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Affiliation(s)
| | | | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Germany
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Yeh WH, Hsueh JJ, Shaw FZ. Neurofeedback of Alpha Activity on Memory in Healthy Participants: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2021; 14:562360. [PMID: 33469422 PMCID: PMC7813983 DOI: 10.3389/fnhum.2020.562360] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Neurofeedback training (NFT) has recently been proposed as a valuable technique for cognitive enhancement and psychiatric amelioration. However, effect of NFT of alpha activity on memory is controversial. The current study analyzed previous works in terms of randomized and blinded analyses, training paradigms, and participant characteristics to validate the efficacy of alpha NFT on memory in a healthy population. Objectives: A systematic meta-analysis of studies with randomized controlled trials was performed to explore the effect of alpha NFT on working memory (WM) and episodic memory (EM) in a healthy population. Methods: We searched PubMed, Embase, and Cochrane Library from January 1, 1999, to November 30, 2019. Previous studies were evaluated with the Cochrane risk of bias (RoB). A meta-analysis calculating absolute weighted standardized mean difference (SMD) using random-effects models was employed. Heterogeneity was estimated using I 2 statistics. Funnel plots and Egger's test were performed to evaluate the quality of evidence. Results: Sixteen studies with 217 healthy participants in the control group and 210 participants in the alpha group met the eligibility criteria. Alpha NFT studies with WM measures presented little publication bias (P = 0.116), and 5 of 7 domains in the Cochrane RoB exhibited a low risk of bias. The overall effect size from 14 WM studies was 0.56 (95% CI 0.31-0.81, P < 0.0001; I 2 = 28%). Six EM studies exhibited an effect size of 0.77 (95% CI 0.06-1.49, P = 0.03; I 2 = 77%). Conclusion: Meta-analysis results suggest that alpha NFT seems to have a positive effect on the WM and EM of healthy participants. Future efforts should focus on the neurophysiological mechanisms of alpha NFT in memory.
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Affiliation(s)
- Wen-Hsiu Yeh
- Institute of Basic Medical Science, National Cheng Kung University, Tainan, Taiwan
| | - Jen-Jui Hsueh
- Mind Research and Imaging Center, National Cheng Kung University, Tainan, Taiwan
| | - Fu-Zen Shaw
- Institute of Basic Medical Science, National Cheng Kung University, Tainan, Taiwan
- Mind Research and Imaging Center, National Cheng Kung University, Tainan, Taiwan
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
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45
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Peng W, Ding J, Wang X. The Management and Alternative Therapies for Comorbid Sleep Disorders in Epilepsy. Curr Neuropharmacol 2021; 19:1264-1272. [PMID: 33380304 PMCID: PMC8719297 DOI: 10.2174/1570159x19666201230142716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/29/2020] [Accepted: 12/06/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a complex and interactive relationship between sleep and epilepsy. Sleep disorders are common in patients with epilepsy, and methods for managing sleep disorders in patients with epilepsy are limited. OBJECTIVE This review addresses the relationship among sleep, sleep disorders, and epilepsy, focusing on the management of sleep disorders in epilepsy, including some complementary and alternative therapies. METHODS The terms related to "sleep" and "epilepsy" were searched in "Pubmed" and "Cochrane Library". RESULTS Sleep stages differently affect both seizures and interictal epileptiform discharges. Seizures disrupt sleep architecture greatly, especially when occurring during sleep in the night. Insomnia and obstructive sleep apnea (OSA) are the most frequent types of comorbid sleep disorders in patients with epilepsy. Pharmacological agents with both anti-convulsant and sedative effects are the priorities for comorbid sleep disorders in epilepsy. Continuous positive airway pressure (CPAP) therapy is the most effective non-pharmacological method to improve OSA and reduce seizures. Complementary and alternative therapies such as Chinese traditional medicine, cognitive behavioral therapy, meditation, yoga, neurofeedback, and acupuncture may have benefits in reducing seizures and improving sleep quality simultaneously by alleviating stress and seizure triggers; however, evidence- based therapies are still deficient. CONCLUSION Management of sleep disorders in patients with epilepsy is challenging. Large-scale randomized controlled clinical trials are in demand to guide the treatments in the future.
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Affiliation(s)
| | - Jing Ding
- Address correspondence to this author at the Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai, China; Tel: 86-21-64041990-2926; Fax: 86-21-34160748; E-mail:
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46
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Kober SE, Neuper C, Wood G. Differential Effects of Up- and Down-Regulation of SMR Coherence on EEG Activity and Memory Performance: A Neurofeedback Training Study. Front Hum Neurosci 2020; 14:606684. [PMID: 33424569 PMCID: PMC7793696 DOI: 10.3389/fnhum.2020.606684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/27/2020] [Indexed: 11/15/2022] Open
Abstract
Modulating connectivity measures in EEG-based neurofeedback studies is assumed to be a promising therapeutic and training tool. However, little is known so far about its effects and trainability. In the present study, we investigated the effects of up- and down-regulating SMR (12-15 Hz) coherence by means of neurofeedback training on EEG activity and memory functions. Twenty adults performed 10 neurofeedback training sessions in which half of them tried to increase EEG coherence between Cz and CPz in the SMR frequency range, while the other half tried to down-regulate coherence. Up-regulation of SMR coherence led to between- and within-session changes in EEG coherence. SMR power increased across neurofeedback training sessions but not within training sessions. Cross-over training effects on baseline EEG measures were also observed in this group. Up-regulation of SMR coherence was also associated with improvements in memory functions when comparing pre- and post-test results. Participants were not able to down-regulate SMR coherence. This group did not show any changes in baseline EEG measures or memory functions comparing pre- and post-test. Our results provide insights in the trainability and effects of connectivity-based neurofeedback training and indications for its practical application.
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Affiliation(s)
- Silvia Erika Kober
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Christa Neuper
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Guilherme Wood
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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47
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He S, Mostofi A, Syed E, Torrecillos F, Tinkhauser G, Fischer P, Pogosyan A, Hasegawa H, Li Y, Ashkan K, Pereira E, Brown P, Tan H. Subthalamic beta-targeted neurofeedback speeds up movement initiation but increases tremor in Parkinsonian patients. eLife 2020; 9:e60979. [PMID: 33205752 PMCID: PMC7695453 DOI: 10.7554/elife.60979] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
Previous studies have explored neurofeedback training for Parkinsonian patients to suppress beta oscillations in the subthalamic nucleus (STN). However, its impacts on movements and Parkinsonian tremor are unclear. We developed a neurofeedback paradigm targeting STN beta bursts and investigated whether neurofeedback training could improve motor initiation in Parkinson's disease compared to passive observation. Our task additionally allowed us to test which endogenous changes in oscillatory STN activities are associated with trial-to-trial motor performance. Neurofeedback training reduced beta synchrony and increased gamma activity within the STN, and reduced beta band coupling between the STN and motor cortex. These changes were accompanied by reduced reaction times in subsequently cued movements. However, in Parkinsonian patients with pre-existing symptoms of tremor, successful volitional beta suppression was associated with an amplification of tremor which correlated with theta band activity in STN local field potentials, suggesting an additional cross-frequency interaction between STN beta and theta activities.
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Affiliation(s)
- Shenghong He
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Abteen Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of LondonLondonUnited Kingdom
| | - Emilie Syed
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
| | - Flavie Torrecillos
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Gerd Tinkhauser
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Department of Neurology, Bern University Hospital and University of BernBernSwitzerland
| | - Petra Fischer
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Alek Pogosyan
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Harutomo Hasegawa
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, King's Health PartnersLondonUnited Kingdom
| | - Yuanqing Li
- School of Automation Science and Engineering, South China University of TechnologyGuangzhouChina
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, King's Health PartnersLondonUnited Kingdom
| | - Erlick Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of LondonLondonUnited Kingdom
| | - Peter Brown
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Huiling Tan
- MRC Brain Network Dynamics Unit at the University of OxfordOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
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48
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Selected Abstracts From the 2019 International Neuroethics Society Annual Meeting. AJOB Neurosci 2020; 11:W1-W15. [PMID: 33196352 DOI: 10.1080/21507740.2020.1830869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Kohl SH, Mehler DMA, Lührs M, Thibault RT, Konrad K, Sorger B. The Potential of Functional Near-Infrared Spectroscopy-Based Neurofeedback-A Systematic Review and Recommendations for Best Practice. Front Neurosci 2020; 14:594. [PMID: 32848528 PMCID: PMC7396619 DOI: 10.3389/fnins.2020.00594] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/14/2020] [Indexed: 01/04/2023] Open
Abstract
Background: The effects of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI)-neurofeedback on brain activation and behaviors have been studied extensively in the past. More recently, researchers have begun to investigate the effects of functional near-infrared spectroscopy-based neurofeedback (fNIRS-neurofeedback). FNIRS is a functional neuroimaging technique based on brain hemodynamics, which is easy to use, portable, inexpensive, and has reduced sensitivity to movement artifacts. Method: We provide the first systematic review and database of fNIRS-neurofeedback studies, synthesizing findings from 22 peer-reviewed studies (including a total of N = 441 participants; 337 healthy, 104 patients). We (1) give a comprehensive overview of how fNIRS-neurofeedback training protocols were implemented, (2) review the online signal-processing methods used, (3) evaluate the quality of studies using pre-set methodological and reporting quality criteria and also present statistical sensitivity/power analyses, (4) investigate the effectiveness of fNIRS-neurofeedback in modulating brain activation, and (5) review its effectiveness in changing behavior in healthy and pathological populations. Results and discussion: (1–2) Published studies are heterogeneous (e.g., neurofeedback targets, investigated populations, applied training protocols, and methods). (3) Large randomized controlled trials are still lacking. In view of the novelty of the field, the quality of the published studies is moderate. We identified room for improvement in reporting important information and statistical power to detect realistic effects. (4) Several studies show that people can regulate hemodynamic signals from cortical brain regions with fNIRS-neurofeedback and (5) these studies indicate the feasibility of modulating motor control and prefrontal brain functioning in healthy participants and ameliorating symptoms in clinical populations (stroke, ADHD, autism, and social anxiety). However, valid conclusions about specificity or potential clinical utility are premature. Conclusion: Due to the advantages of practicability and relatively low cost, fNIRS-neurofeedback might provide a suitable and powerful alternative to EEG and fMRI neurofeedback and has great potential for clinical translation of neurofeedback. Together with more rigorous research and reporting practices, further methodological improvements may lead to a more solid understanding of fNIRS-neurofeedback. Future research will benefit from exploiting the advantages of fNIRS, which offers unique opportunities for neurofeedback research.
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Affiliation(s)
- Simon H Kohl
- JARA-Institute Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany.,Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - David M A Mehler
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Michael Lührs
- Brain Innovation B.V., Research Department, Maastricht, Netherlands.,Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Robert T Thibault
- School of Psychological Science, University of Bristol, Bristol, United Kingdom.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Kerstin Konrad
- JARA-Institute Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany.,Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Bettina Sorger
- Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands
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50
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Melo DLM, Carvalho LBC, Prado LBF, Prado GF. Biofeedback Therapies for Chronic Insomnia: A Systematic Review. Appl Psychophysiol Biofeedback 2020; 44:259-269. [PMID: 31123938 DOI: 10.1007/s10484-019-09442-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The treatment of insomnia is still a challenge in clinical practice. This systematic review of randomized and quasi-randomized clinical trials aims to summarize the evidence for the use of biofeedback techniques in the treatment of chronic insomnia. Studies that compared biofeedback with other techniques of cognitive behavioral therapy, placebo, or absence of treatment were selected. The outcomes evaluated included sleep onset latency, total sleep time, sleep fragmentation, sleep efficiency and subjective sleep quality. Comparing to placebo and absence of treatment, some studies suggest possible benefits from the use of biofeedback for chronic insomnia in decreasing sleep onset latency and number of awakenings; however, there was marked divergence among included studies. There was no evidence of improvement in total sleep time, sleep efficiency and subjective sleep quality. Moreover, the maintenance of long-term benefits lacks evidence for any outcome. In the majority of outcomes evaluated, no significant differences in the effectiveness of biofeedback compared with other cognitive behavioral therapy techniques were observed. This systematic review found conflicting evidence for the effectiveness of biofeedback techniques in the treatment of chronic insomnia. Inter- and intra-group clinical heterogeneity among studies could be a reasonable explanation for the divergent results. These findings emphasize the need of performing further randomized clinical trials of higher methodological quality in order to better delineate the effectiveness of biofeedback on chronic insomnia treatment.
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Affiliation(s)
- Denise Lima Medeiros Melo
- Department of Neurology, Neuro-Sono Sleep Center, Federal University of Sao Paulo-UNIFESP, R. Cláudio Rossi, 394, São Paulo, SP, CEP 01547-000, Brazil.
| | - Luciane Bizari Coin Carvalho
- Department of Neurology, Neuro-Sono Sleep Center, Federal University of Sao Paulo-UNIFESP, R. Cláudio Rossi, 394, São Paulo, SP, CEP 01547-000, Brazil
| | - Lucila Bizari Fernandes Prado
- Department of Neurology, Neuro-Sono Sleep Center, Federal University of Sao Paulo-UNIFESP, R. Cláudio Rossi, 394, São Paulo, SP, CEP 01547-000, Brazil
| | - Gilmar Fernandes Prado
- Department of Neurology, Neuro-Sono Sleep Center, Federal University of Sao Paulo-UNIFESP, R. Cláudio Rossi, 394, São Paulo, SP, CEP 01547-000, Brazil
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