Magnetoencephalography discriminates modality-specific infraslow signals less than 0.1 Hz

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

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.

Concurrent EEG- and fMRI-derived functional connectomes exhibit linked dynamics

Long-range connectivity has become the most studied feature of human functional Magnetic Resonance Imaging (fMRI), yet the spatial and temporal relationship between its whole-brain dynamics and electrophysiological connectivity remains largely unknown. FMRI-derived functional connectivity exhibits spatial reconfigurations or time-varying dynamics at infraslow (<0.1Hz) speeds. Conversely, electrophysiological connectivity is based on cross-region coupling of fast oscillations (~1-100Hz). It is unclear whether such fast oscillation-based coupling varies at infraslow speeds, temporally coinciding with infraslow dynamics across the fMRI-based connectome. If so, does the association of fMRI-derived and electrophysiological dynamics spatially vary over the connectome across the functionally distinct electrophysiological oscillation bands? In two concurrent electroencephalography (EEG)-fMRI resting-state datasets, oscillation-based coherence in all canonical bands (delta through gamma) indeed reconfigured at infraslow speeds in tandem with fMRI-derived connectivity changes in corresponding region-pairs. Interestingly, irrespective of EEG frequency-band the cross-modal tie of connectivity dynamics comprised a large proportion of connections distributed across the entire connectome. However, there were frequency-specific differences in the relative strength of the cross-modal association. This association was strongest in visual to somatomotor connections for slower EEG-bands, and in connections involving the Default Mode Network for faster EEG-bands. Methodologically, the findings imply that neural connectivity dynamics can be reliably measured by fMRI despite heavy susceptibility to noise, and by EEG despite shortcomings of source reconstruction. Biologically, the findings provide evidence that contrast with known territories of oscillation power, oscillation coupling in all bands slowly reconfigures in a highly distributed manner across the whole-brain connectome.

DC Shifts-fMRI: A Supplement to Event-Related fMRI

Event-related fMRI have been widely used in locating brain regions which respond to specific tasks. However, activities of brain regions which modulate or indirectly participate in the response to a specific task are not event-related. Event-related fMRI can't locate these regulatory regions, detrimental to the integrity of the result that event-related fMRI revealed. Direct-current EEG shifts (DC shifts) have been found linked to the inner brain activity, a fusion DC shifts-fMRI method may have the ability to reveal a more complete response of the brain. In this study, we used DC shifts-fMRI to verify that even when responding to a very simple task, (1) The response of the brain is more complicated than event-related fMRI generally revealed and (2) DC shifts-fMRI have the ability of revealing brain regions whose responses are not in event-related way. We used a classical and simple paradigm which is often used in auditory cortex tonotopic mapping. Data were recorded from 50 subjects (25 male, 25 female) who were presented with randomly presented pure tone sequences with six different frequencies (200, 400, 800, 1,600, 3,200, 6,400 Hz). Our traditional fMRI results are consistent with previous findings that the activations are concentrated on the auditory cortex. Our DC shifts-fMRI results showed that the cingulate-caudate-thalamus network which underpins sustained attention is positively activated while the dorsal attention network and the right middle frontal gyrus which underpin attention orientation are negatively activated. The regional-specific correlations between DC shifts and brain networks indicate the complexity of the response of the brain even to a simple task and that the DC shifts can effectively reflect these non-event-related inner brain activities.

Infra-slow EEG fluctuations are correlated with resting-state network dynamics in fMRI

Ongoing neuronal activity in the CNS waxes and wanes continuously across widespread spatial and temporal scales. In the human brain, these spontaneous fluctuations are salient in blood oxygenation level-dependent (BOLD) signals and correlated within specific brain systems or "intrinsic-connectivity networks." In electrophysiological recordings, both the amplitude dynamics of fast (1-100 Hz) oscillations and the scalp potentials per se exhibit fluctuations in the same infra-slow (0.01-0.1 Hz) frequency range where the BOLD fluctuations are conspicuous. While several lines of evidence show that the BOLD fluctuations are correlated with fast-amplitude dynamics, it has remained unclear whether the infra-slow scalp potential fluctuations in full-band electroencephalography (fbEEG) are related to the resting-state BOLD signals. We used concurrent fbEEG and functional magnetic resonance imaging (fMRI) recordings to address the relationship of infra-slow fluctuations (ISFs) in scalp potentials and BOLD signals. We show here that independent components of fbEEG recordings are selectively correlated with subsets of cortical BOLD signals in specific task-positive and task-negative, fMRI-defined resting-state networks. This brain system-specific association indicates that infra-slow scalp potentials are directly associated with the endogenous fluctuations in neuronal activity levels. fbEEG thus yields a noninvasive, high-temporal resolution window into the dynamics of intrinsic connectivity networks. These results support the view that the slow potentials reflect changes in cortical excitability and shed light on neuronal substrates underlying both electrophysiological and behavioral ISFs.

Infra-slow fluctuations in electrophysiological recordings, blood-oxygenation-level-dependent signals, and psychophysical time series

Converging electrophysiological and neuroimaging data show that mammalian brain dynamics are governed by spontaneous modulations of neuronal activity levels in cortical and subcortical structures. The time scales of these fluctuations form a continuum from seconds to tens and hundreds of seconds corresponding to slow (0.1-1Hz), infra-slow (0.01-0.1Hz), and "ultradian" (<0.01Hz) frequency bands, respectively. We focus here on the spontaneous neuronal dynamics in the infra-slow frequency band, infra-slow fluctuations (ISFs), and explore their electrophysiological substrates and behavioral correlates. Although electrophysiological ISFs and the associated infra-slow modulations of fast (here, >1Hz) neuronal activities have been recognized on numerous occasions since late 50's, a resurgence in interest towards this frequency band has been driven by a discovery that ISFs in blood-oxygenation-level dependent (BOLD) signals are correlated among specific constellations of brain regions, which constitute intrinsic connectivity networks and define the dynamic architecture of spontaneous brain activity at large. Importantly, electrophysiological and BOLD signal ISFs are directly correlated both with ISFs in amplitudes of fast neuronal activities and with ISFs in behavioral performance. Moreover, both electrophysiological and neuroimaging data suggest that the apparently scale-free ISFs may arise from more local quasi-periodic infra-slow oscillations with a contribution of time-scale-specific cellular-level mechanisms. We conclude that ISFs in electrophysiological recordings, BOLD signals, neuronal activity levels, and behavioral time series are likely to reflect the same underlying phenomenon; a superstructure of interacting and transiently oscillatory ISFs that regulate both the integration within and decoupling between concurrently active neuronal communities.