EEG and behavioral changes following neurofeedback treatment in learning disabled children

QEEG Characterizations During Hyperventilation, Writing and Reading Conditions: A Pre-Post Cognitive-Behavioral Intervention Study on Students with Learning Difficulty

Background: Electroencephalography (EEG) has been used to measure neural correlates of cognitive and social development in children for decades. It is essential to evaluate the relationship between EEG parameters and cognitive measures to understand the mechanisms of learning problems better. Methods and procedure: Fifty school-going children with complaints of learning problems were studied. EEG and other cognitive measures were used to assess children before and after PEABLS; a cognitive-behavioral intervention was imparted. EEG was recorded while hyperventilation, writing, and reading conditions, and the values for absolute and relative powers were calculated. Results: The results suggested that the post-intervention absolute (in the theta and alpha bands) and relative (delta, theta, and alpha) power values were higher, and the relative power beta value was significantly lower at most of the electrodes in comparison to pre-intervention EEG measures. A significant high positive correlation in the children with learning problems between the relative power of alpha, beta O1O2, the relative power of theta, delta T3T4, and the academic scores, IQ, working memory, DTLD, and BGT values. Conclusion: These quantitative electroencephalogram findings in children with learning problems are related to cognitive measures. The findings could be due to brain immaturity and lack of learning opportunities.

Effects of neurofeedback on the self-concept of children with learning disorders

Children with learning disorders (LDs) often have a lower self-concept than their typically developing peers. Neurofeedback (NFB) treatments seem to improve the cognitive and academic performance of these children, but the effects on self-concept have not been studied. In this exploratory study, 34 right-handed children (8-11 y.o.) with LD and delayed electroencephalographic maturation responded to the Piers-Harris Children's Self-Concept Scale. One group received NFB (n = 20), and another group (n = 14) served as control, which included 9 children treated with sham-NFB and 5 on a waiting-list. A nonparametric permutation approach was used to compare the academic performance and self-concept difference (postscores - prescores) between the NFB and control groups. Given the smaller size of the control subgroups, a comparison of the percent changes between sham-NFB and the waiting-list was performed with the non-overlap of all pairs (NAP) technique. In the NFB group, the scores of reading, math, and global self-concept increased significantly, highlighting the self-concept subdomains of physical appearance, nonanxiety, popularity, and happiness. Additionally, the sham-NFB subgroup showed better outcomes than the waiting-list subgroup, perhaps due to noncontrolled factors. We found improved academic performance and self-concept in children with LDs who received NFB treatment. This study is an important exploratory step in studying a relevant treatment that seems to ameliorate symptoms of LDs such as anxiety and low self-concept.

The Influence of an Alpha Band Neurofeedback Training in Heart Rate Variability in Athletes

Neurofeedback training is a technique which has seen a widespread use in clinical applications, but has only given its first steps in the sport environment. Therefore, there is still little information about the effects that this technique might have on parameters, which are relevant for athletes' health and performance, such as heart rate variability, which has been linked to physiological recovery. In the sport domain, no studies have tried to understand the effects of neurofeedback training on heart rate variability, even though some studies have compared the effects of doing neurofeedback or heart rate biofeedback training on performance. The main goal of the present study was to understand if alpha-band neurofeedback training could lead to increases in heart rate variability. 30 male student-athletes, divided into two groups, (21.2 ± 2.62 year 2/week protocol and 22.6 ± 1.1 year 3/week protocol) participated in the study, of which three subjects were excluded. Both groups performed a pre-test, a trial session and 12 neurofeedback sessions, which consisted of 25 trials of 60 s of a neurofeedback task, with 5 s rest in-between trials. The total neurofeedback session time for each subject was 300 min in both groups. Throughout the experiment, electroencephalography and heart rate variability signals were recorded. Only the three sessions/week group revealed significant improvements in mean heart rate variability at the end of the 12 neurofeedback sessions (p = 0.05); however, significant interaction was not found when compared with both groups. It is possible to conclude that neurofeedback training of individual alpha band may induce changes in heart rate variability in physically active athletes.

Effects of Neurofeedback on the Working Memory of Children with Learning Disorders-An EEG Power-Spectrum Analysis

Learning disorders (LDs) are diagnosed in children impaired in the academic skills of reading, writing and/or mathematics. Children with LDs usually exhibit a slower resting-state electroencephalogram (EEG), corresponding to a neurodevelopmental lag. Frequently, children with LDs show working memory (WM) impairment, associated with an abnormal task-related EEG with overall slower EEG activity (more delta and theta power, and less gamma activity in posterior sites). These EEG patterns indicate inefficient neural resource management. Neurofeedback (NFB) treatments aimed at normalizing the resting-state EEG of LD children have shown improvements in cognitive-behavioral indices and diminished EEG abnormalities. Given the typical findings of WM impairment in children with LDs, we aimed to explore the effects of an NFB treatment on the WM of children with LDs by analyzing the WM-related EEG power spectrum. EEGs of 18 children (8–11 y.o.) with LDs were recorded, pre- and post-treatment, during performance of a Sternberg-type WM task. Thirty sessions of an NFB treatment (NFB-group, n = 10) or 30 sessions of a placebo-sham treatment (sham-group, n = 8) were administered. We analyzed the before and after treatment group differences for the behavioral performance and the WM-related EEG power spectrum. The NFB group showed faster response times in the WM task post-treatment. They also exhibited a decreased theta power and increased beta and gamma power at the frontal and posterior sites post-treatment. We explain these findings in terms of NFB improving the efficiency of neural resource management, maintenance of memory representations, and improved subvocal memory rehearsal.

ADHD: Reviewing the Causes and Evaluating Solutions

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in which patients present inattention, hyperactivity, and impulsivity. The etiology of this condition is diverse, including environmental factors and the presence of variants of some genes. However, a great diversity exists among patients regarding the presence of these ADHD-associated factors. Moreover, there are variations in the reported neurophysiological correlates of ADHD. ADHD is often treated pharmacologically, producing an improvement in symptomatology, albeit there are patients who are refractory to the main pharmacological treatments or present side effects to these drugs, highlighting the importance of developing other therapeutic options. Different non-pharmacological treatments are in this review addressed, finding diverse results regarding efficacy. Altogether, ADHD is associated with different etiologies, all of them producing changes in brain development, leading to the characteristic symptomatology of this condition. Given the heterogeneous etiology of ADHD, discussion is presented about the convenience of personalizing ADHD treatment, whether pharmacological or non-pharmacological, to reach an optimum effect in the majority of patients. Approaches to personalizing both pharmacological therapy and neurofeedback are presented.

Enhancing learning in a perceptual-cognitive training paradigm using EEG-neurofeedback

This paper provides the framework and supporting evidence for a highly efficient closed-loop paradigm that modifies a classic learning scenario using real-time brain activity in order to improve learning performance in a perceptual-cognitive training paradigm known as 3-dimensional multiple object tracking, or 3D-MOT. Results demonstrate that, over 10 sessions, when manipulating this novel task by using real-time brain signals, speed and degree of learning can be substantially improved compared with a classic learning system or an active sham-control group. Superior performance persists even once the feedback signal is removed, which suggests that the effects of enhanced training are consolidated and do not rely on continued feedback. This type of learning paradigm could contribute to overcoming one of the fundamental limitations of neurofeedback and other cognitive enhancement techniques, a lack of observable transfer effects, by utilizing a method that can be directly integrated into the context in which improved performance is sought.

Human enhancement through the lens of experimental and speculative neurotechnologies

Human enhancement deals with improving on and overcoming limitations of the human body and mind. Pharmaceutical compounds that alter consciousness and cognitive performance have been used and discussed for a long time. The prospect of neurotechnological applications such as brain-steered devices or using invasive and noninvasive electromagnetic stimulations of the human brain, however, has received less attention-especially outside of therapeutic practices-and remains relatively unexplored. Reflection and debates about neurotechnology for human enhancement are limited and remain predominantly with neurotech engineers, science-fiction enthusiasts and a small circle of academics in the field of neuroethics. It is well known, and described as the Collingridge dilemma, that at an early stage of development, changes can easily be enacted, but the need for changes can hardly be foreseen. Once the technology is entrenched, opportunities and risks start to materialize, and the need to adapt and change is clearly visible. However, carrying out these changes at such a late stage, in turn, becomes very difficult, tremendously expensive, and sometimes practically impossible. In this manuscript, we compile and categorize an overview of existing experimental and speculative applications of neurotechnologies, with the aim to find out, if these real or diegetic prototypes could be used to better understand the paths these applications are forging. In particular, we will investigate what kind of tools, motivations, and normative goals underpin experimental implementations by neurohackers, speculative designers and artists.

Integrating Clinical Hypnosis and Neurofeedback

Hypnosis and neurofeedback each provide unique therapeutic strengths and opportunities. This article provides an overview of some of the research on neurofeedback and hypnosis. The author's perspective and recommendations are provided on the relative clinical utility of using either neurofeedback or hypnosis as the initial treatment of choice with various clinical conditions.

Spectral Modification by Operant Conditioning of Cortical Theta Suppression in Rats

Objective

Brain activity is known to be voluntarily controllable by neurofeedback, a kind of electroencephalographic (EEG) operant conditioning. Although its efficacy in clinical effects has been reported, it is yet to be uncovered whether or how a specific band activity is controllable. Here, we examined EEG spectral profiles along with conditioning training of a specific brain activity, theta band (4–8 Hz) amplitude, in rats.

Methods

During training, the experimental group received electrical stimulation to the medial forebrain bundle contingent to suppression of theta activity, while the control group received stimulation non-contingent to its own band activity.

Results

In the experimental group, theta activity gradually decreased within the training session, while there was an increase of theta activity in the control group. There was a significant difference in theta activity during the sessions between the two groups. The spectral theta peak, originally located at 7 Hz, shifted further towards higher frequencies in the experimental group.

Conclusion

Our results showed that an operant conditioning technique could train rats to control their specific EEG activity indirectly, and it may be used as an animal model for studying how neuronal systems work in human neurofeedback.

Four Channel Multivariate Coherence Training: Development and Evidence in Support of a New Form of Neurofeedback

As the field of neurofeedback and neuromodulation grows, trends toward using neurofeedback to treat problems of brain dysfunction have emerged. While the use of connectivity based fMRI guided neurofeedback has shown itself to be efficacious, the expense related to the treatment calls for a more practical solution. The use of QEEG guided neurofeedback in the treatment has shown promise as an emerging treatment. To date, EEG based neurofeedback approaches have used technology with limited sophistication. We designed a new form of neurofeedback that uses four channels of EEG with a multivariate calculation of coherence metrics. Following a mathematical presentation of this model, we present findings of a multi-site study with clinical subjects with various diagnoses. We compared this form of multivariate coherence neurofeedback to the more standard two channel coherence training. Findings showed that there was a significant difference between the groups with four channel multivariate coherence neurofeedback leading to greater changes in EEG metrics. Compared to two channel coherence training, four channel multivariate coherence neurofeedback led to a greater than 50% change in power and 400% in coherence values per session. The significance of these findings is discussed in relation to complex calculations of effective connectivity and how this might lead to even greater enhancements in neurofeedback efficacy.

Quantitative Analysis of the Antiepileptogenic Effects of Low Frequency Stimulation Applied Prior or After Kindling Stimulation in Rats

Background and Objective: Developing quantitative measures based on spectral analysis of electroencephalograph (EEG) recordings of neural activities plays an important role in developing efficient treatments for epilepsy. Such biomarkers can be used for developing open or closed loop approaches for seizure prediction or prevention. This study aims to quantitatively evaluate antiepileptogenic effects of low frequency stimulation (LFS) applied immediately before or after kindling stimulations using spectral power analysis of extracellular EEG in rat. Methods: Nineteen adult rats were used: seven for kindle, six for LFS+Kindle (LFSK) and six for Kindle+LFS (KLFS). Four packages of LFS (1Hz) were applied immediately before or after rapid kindling stimulations. The power spectral densities of afterdischarge (AD) sections of EEG corresponding to different stages of kindling for delta (0-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), beta (12-28 Hz), gamma (28-40 Hz) sub-bands, and theta/alpha ratio were comparatively investigated. Moreover, correlation between AD duration (ADD) and its different frequency components was calculated. Results: Both LFSK and KLFS significantly increased delta and reduced beta and gamma oscillations, compared with kindle group. However, just the reduction in LFSK group was significant. Both protocols increased theta/alpha ratio, but just LFSK showed significant increase (p < 0.05). Although LFSK enhanced theta/alpha ratio more than KLFS, the difference was not statistically significant. Furthermore, strong correlation between each frequency sub band and ADD was not observed in kindle and LFS treated groups (both LFSK and KLFS). Conclusion: Although behavioral assessments showed relatively the same level of antiepileptogenic effects for KLFS and LFSK, quantitative assessments showed more significant differences in the quantitative measures between the two protocols. Developing more quantitative EEG based measures correlated with LFS-induced effects can facilitate developing open or closed loop seizure prevention modalities.

Full Protection Against Soman-Induced Seizures and Brain Damage by LY293558 and Caramiphen Combination Treatment in Adult Rats

Acute exposure to nerve agents induces status epilepticus (SE), which causes brain damage or death. LY293558, an antagonist of AMPA and GluK1 kainate receptors is a very effective anticonvulsant and neuroprotectant against soman; however, some neuronal damage is still present after treatment of soman-exposed rats with LY293558. Here, we have tested whether combining LY293558 with an NMDA receptor antagonist can eliminate the residual damage. For this purpose, we chose caramiphen (CRM), an antimuscarinic compound with NMDA receptor antagonistic properties. Adult male rats were exposed to 1.2 × LD₅₀ soman, and at 20 min after soman exposure, were injected with atropine + HI-6, or atropine + HI-6 + LY293558 (15 mg/kg), or atropine + HI-6 + LY293558 + CRM (50 mg/kg). We found that (1) the LY293558 + CRM treatment terminated SE significantly faster than LY293558 alone; (2) after cessation of the initial SE, seizures did not return in the LY293558 + CRM-treated group, during 72 h of monitoring; (3) power spectrum analysis of continuous EEG recordings for 7 days post-exposure showed increased delta and decreased gamma power that lasted beyond 24 h post-exposure only in the rats who did not receive anticonvulsant treatment; (4) spontaneous recurrent seizures appeared on day 7 only in the group that did not receive anticonvulsant treatment; (5) significant neuroprotection was achieved by LY293558 administration, while the rats who received LY293558 + CRM displayed no neurodegeneration; (6) body weight loss and recovery in the LY293558 + CRM-treated rats did not differ from those in control rats who were not exposed to soman. The data show that treatment with LY293558 + CRM provides full antiseizure and neuroprotective efficacy against soman.

Cognitive control in children with learning disabilities: neuromarker for deficient executive functions

The neural underpinnings of learning disabilities (LD) are still not known. Recent discussions focus over whether domain-specific and/or domain-unspecific reasons might be responsible for LD either alone or in combination with each other. This study applied standard nonverbal Go-NoGo tasks (visual continuous performance test) to LD and healthy control children to examine whether they show deficient executive functions. During this Go-NoGo task, electroencephalogram was measured in addition to reaction times, hits, omissions, and commissions to the Go and NoGo stimuli. It was shown that children with LD reacted slower with variable responses to Go stimuli and made more omission errors in comparison with the healthy control children. The analysis of the event-related potential indicated that the deficient behavior in this task is associated with smaller - and in part nonexistent - P3d amplitudes. This neural activation indicates a different neural activation pattern during action inhibition in LD children. The neural networks involved in controlling action inhibition are mostly located in frontal brain areas, for which it has been shown that children with LD show neural activation deficiencies. This is possibly a consequence of a maturational delay of the frontal cortex.

Neurofeedback in Learning Disabled Children: Visual versus Auditory Reinforcement

Children with learning disabilities (LD) frequently have an EEG characterized by an excess of theta and a deficit of alpha activities. NFB using an auditory stimulus as reinforcer has proven to be a useful tool to treat LD children by positively reinforcing decreases of the theta/alpha ratio. The aim of the present study was to optimize the NFB procedure by comparing the efficacy of visual (with eyes open) versus auditory (with eyes closed) reinforcers. Twenty LD children with an abnormally high theta/alpha ratio were randomly assigned to the Auditory or the Visual group, where a 500 Hz tone or a visual stimulus (a white square), respectively, was used as a positive reinforcer when the value of the theta/alpha ratio was reduced. Both groups had signs consistent with EEG maturation, but only the Auditory Group showed behavioral/cognitive improvements. In conclusion, the auditory reinforcer was more efficacious in reducing the theta/alpha ratio, and it improved the cognitive abilities more than the visual reinforcer.

Classifying amygdala kindling stages using quantitative assessments of extracellular recording of EEG in rats

PURPOSE

Determining different seizure stage specific features in a kindling model is a crucial step in developing efficient objective techniques for early prediction and treatment of seizures. This study identified and categorized kindling stages based on their electrophysiological features through processing extracellular field potentials of Amygdala rapid kindling.

METHODS

Thirteen Wistar rats (200±10g) were divided into 2 groups including kindle (n=7) and sham (n=6) and respectively underwent an amygdala rapid kindling and placebo stimulation. EEG signals in each stage were classified into 7 bands: delta (0-4Hz), theta (4-8Hz), alpha (8-12Hz), low beta (12-16Hz), mid beta (16-20Hz), high beta (20-28Hz) and gamma (28-40Hz). Spectral power and power of sub bands of stage 3 (localized seizure stage (SS)) and stages 4 and 5 (generalized SSs) were compared between kindling and sham groups.

RESULT

Spectral analyses showed larger spikes in delta and theta subbands in the stages of 3, 4, and 5 of kindling, compared with sham animals. Generalized SSs contained more spikes than the localized SS in the kindling. Kindling process was accompanied by reduction in high beta and gamma oscillations and increase in delta sub band power which were significant in the generalized SSs. The theta/alpha ratio in the localized SS was higher than the generalized SSs and sham group, but the difference with the sham group was statistically significant.

CONCLUSION

Our results showed that reduced high beta and gamma and increased delta oscillations power are associated with behavioral seizure progression.

Resting State EEG in Children With Learning Disabilities: An Independent Component Analysis Approach

In this study, the neurophysiological underpinnings of learning disabilities (LD) in children are examined using resting state EEG. We were particularly interested in the neurophysiological differences between children with learning disabilities not otherwise specified (LD-NOS), learning disabilities with verbal disabilities (LD-Verbal), and healthy control (HC) children. We applied 2 different approaches to examine the differences between the different groups. First, we calculated theta/beta and theta/alpha ratios in order to quantify the relationship between slow and fast EEG oscillations. Second, we used a recently developed method for analyzing spectral EEG, namely the group independent component analysis (gICA) model. Using these measures, we identified substantial differences between LD and HC children and between LD-NOS and LD-Verbal children in terms of their spectral EEG profiles. We obtained the following findings: (a) theta/beta and theta/alpha ratios were substantially larger in LD than in HC children, with no difference between LD-NOS and LD-Verbal children; (b) there was substantial slowing of EEG oscillations, especially for gICs located in frontal scalp positions, with LD-NOS children demonstrating the strongest slowing; (c) the estimated intracortical sources of these gICs were mostly located in brain areas involved in the control of executive functions, attention, planning, and language; and (d) the LD-Verbal children demonstrated substantial differences in EEG oscillations compared with LD-NOS children, and these differences were localized in language-related brain areas. The general pattern of atypical neurophysiological activation found in LD children suggests that they suffer from neurophysiological dysfunction in brain areas involved with the control of attention, executive functions, planning, and language functions. LD-Verbal children also demonstrate atypical activation, especially in language-related brain areas. These atypical neurophysiological activation patterns might provide a helpful guide for rehabilitation strategies to treat the deficiencies in these children with LD.

Classifying Children with Learning Disabilities on the Basis of Resting State EEG Measures Using a Linear Discriminant Analysis

Abstract. This study examines the usefulness of easy to obtain EEG measures to discriminate learning-disabled children (LD) from healthy control children. Here the spectral power in the delta, theta, alpha, and beta EEG bands and various power ratios (theta/alpha, theta/beta, beta/alpha, beta/theta, beta/[alpha+theta], [delta+theta]/alpha, alpha/delta, and [theta+alpha]/beta) are applied. These measures were subjected to a factor analysis with varimax rotation revealing four factors explaining 90 % of the entire variance. Factor 1 represents the power of the slow EEG frequency bands delta and theta, factor 2 the relationship between fast and slow frequency bands, factor 3 the slow to fast ratios, and factor 4 the absolute power of nearly all frequency bands. Group differences were found for three factor scores (1, 3, and 4). The linear discriminant analysis with the four factor scores as dependent and the group allocation as independent variables revealed a correct classification of 86 %. Although this classification is far from being perfect it is nevertheless reasonable high and statistically significant. Thus, EEG measures like the one used in this study might support the diagnosis of this difficult to diagnose disability. In addition, the EEG measures identified provide a deeper insight into the neural underpinnings of this disability. Based on this knowledge it might be possible to design new therapeutic strategies to treat LD.

Quantitative EEG neurofeedback for the treatment of pediatric attention-deficit/hyperactivity disorder, autism spectrum disorders, learning disorders, and epilepsy

Neurofeedback (NF) using surface electroencephalographic signals has been used to treat various child psychiatric disorders by providing patients with video/audio information about their brain's electrical activity in real-time. Research data are reviewed and clinical recommendations are made regarding NF treatment of youth with attention deficit/hyperactivity disorder, autism, learning disorders, and epilepsy. Most NF studies are limited by methodological issues, such as failure to use or test the validity of a full-blind or sham NF. The safety of NF treatment has not been thoroughly investigated in youth or adults, although clinical experience suggests reasonable safety.

Self-reported efficacy of neurofeedback treatment in a clinical randomized controlled study of ADHD children and adolescents

BACKGROUND

Many non-pharmacological treatments for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have been attempted, but reports indicate that most are ineffective. Although neurofeedback (NF) is a treatment approach for children with ADHD that remains promising, a variety of appropriate measures have been used in reporting and evaluating its effect.

OBJECTIVE

To report the self-evaluations of NF treatment by children and adolescents with ADHD.

METHODS

Randomized controlled trial in 91 children and adolescents with ADHD, aged less than 18 years (mean, 11.2 years) participated in a 30-session program of intensive NF treatment. Participants were randomized and allocated by sequentially numbered sealed envelopes into three groups: methylphenidate (MPH) as an active control group, and two trial groups NF with MPH, and NF alone. ADHD core symptoms and school performance were given on a scale of 1 to 10 using a self-reporting questionnaire, and the changes in these scores after treatment were used as the self-reported evaluation. Basic statistical methods (descriptive, analyses of variance, exact χ (2) test, and paired t-test) were used to investigate the baseline data. Changes in ADHD core symptoms and treatment effects were investigated using a general linear model for repeated measures.

RESULTS

Eighty participants completed the treatment study and 73 (91%) responded sufficiently on the self-reporting questionnaires. The treatment groups were comparable in age, sex, and cognition as well as in the baseline levels of core ADHD symptoms. All treatments resulted in significant improvements regarding attention and hyperactivity (P<0.001), and did not differ from each other in effectiveness. However, a significant treatment effect in school performance was observed (P=0.042), in which only the NF group showed a significant improvement.

CONCLUSION

The self-reported improvements in ADHD core symptoms and school performance shortly after treatment indicate NF treatment being promising in comparison with medication, suggesting NF as an alternative treatment for children and adolescents who do not respond to MPH, or who suffer side effects. Further long-term follow-up is needed.

The effectiveness of neurofeedback training on EEG coherence and neuropsychological functions in children with reading disability

Neurofeedback training (NFT) is an effective intervention in regulating electroencephalogram (EEG) abnormalities leading to improvements in behavioral deficits, which exist in children with reading disabilities. This single-subject study explores our evaluation of the improvements in the reading ability and phonological awareness deficit, as well as the changes in the EEG in children with reading disabilities as a result of NFT. Participants were 6 children, aged between 8 and 10 years, who completed twenty 30-minute sessions of NFT and follow-up measurement sessions 2 months subsequent to the completion of the training sessions. The results showed significant improvement in reading and phonological awareness skills. Furthermore, EEG analysis did not show notable changes in the power of the targeted bands (delta, theta, and beta), rather there was normalization of coherence of the theta band at T3-T4, delta band at Cz-Fz, and beta band at Cz-Fz, Cz-Pz, and Cz-C4. These significant changes in coherence possibly indicate integration of sensory and motor areas that explains the improvements in reading skills and phonological awareness.

Schizophrenia and the efficacy of qEEG-guided neurofeedback treatment: a clinical case series

Schizophrenia is sometimes considered one of the most devastating of mental illnesses because its onset is early in a patient's life and its symptoms can be destructive to the patient, the family, and friends. Schizophrenia affects 1 in 100 people at some point during their lives, and while there is no cure, it is treatable with antipsychotic medications. According to the Clinical Antipsychotic Trials for Interventions Effectiveness (CATIE), about 74% of the patients who have discontinued the first medication prescribed within a year will have a relapse afterward. This shows an enormous need for developing better treatment methods and better ways to manage the disease, since current therapies do not have sufficient impact on negative symptoms, cognitive dysfunction, and compliance to treatment. In this clinical case series, we investigate the efficacy of quantitative electroencephalography (qEEG)-guided neurofeedback (NF) treatment in this population, and whether this method has an effect on concurrent medical treatment and on the patients. Fifty-one participants (25 males and 26 females) ranging from 17 to 54 years of age (mean: 28.82 years and SD: 7.94 years) were included. Signed consent was received from all patients. Most of the participants were previously diagnosed with chronic schizophrenia, and their symptoms did not improve with medication. All 51 patients were evaluated using qEEG, which was recorded at baseline and following treatment. Before recording the qEEG, participants were washed out for up to 7 half-lives of the medication. After Food and Drug Administration (FDA)-approved Nx-Link Neurometric analysis, qEEGs suggested a diagnosis of chronic schizophrenia for all participants. This was consistent with the clinical judgment of the authors. The participants' symptoms were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Besides the PANSS, 33 out of 51 participants were also evaluated by the Minnesota Multiphasic Personality Inventory (MMPI) and the Test of Variables of Attention (TOVA), both at baseline and following treatment. Each participant was prescribed an NF treatment protocol based on the results of their qEEG neurometric analysis. Each session was 60 minutes in duration, with 1 to 2 sessions per day. When 2 sessions were administered during a single day, a 30-minute rest was given between the sessions. Changes in the PANSS, MMPI, and TOVA were analyzed to evaluate the effectiveness of NF treatment. The mean number of sessions completed by the participants was 58.5 sessions within 24 to 91 days. Three dropped out of treatment between 30 and 40 sessions of NF, and one did not show any response. Of the remaining 48 participants 47 showed clinical improvement after NF treatment, based on changes in their PANSS scores. The participants who were able to take the MMPI and the TOVA showed significant improvements in these measures as well. Forty were followed up for more than 22 months, 2 for 1 year, 1 for 9 months, and 3 for between 1 and 3 months after completion of NF. Overall NF was shown to be effective. This study provides the first evidence for positive effects of NF in schizophrenia.

Clinical neurofeedback: case studies, proposed mechanism, and implications for pediatric neurology practice

Trends in alternative medicine use by American health care consumers are rising substantially. Extensive literature exists reporting on the effectiveness of neurofeedback in the treatment of autism, closed head injury, insomnia, migraine, depression, attention deficit hyperactivity disorder, epilepsy, and posttraumatic stress disorder. We speculated that neurofeedback might serve as a therapeutic modality for patients with medically refractory neurological disorders and have begun referring patients to train with clinical neurofeedback practitioners. The modality is not always covered by insurance. Confident their child's medical and neurological needs would continue to be met, the parents of 3 children with epilepsy spectrum disorder decided to have their child train in the modality. The children's individual progress following neurofeedback are each presented here. A proposed mechanism and practice implications are discussed.

Neurofeedback fMRI-mediated learning and consolidation of regional brain activation during motor imagery

We report the long-term effect of real-time functional MRI (rtfMRI) training on voluntary regulation of the level of activation from a hand motor area. During the performance of a motor imagery task of a right hand, blood-oxygenation-level-dependent (BOLD) signal originating from a primary motor area was presented back to the subject in real-time. Demographically matched individuals also received the same procedure without valid feedback information. Followed by the initial rtfMRI sessions, both groups underwent two-week long, daily-practice of the task. Off-line data analysis revealed that the individuals in the experimental group were able to increase the level of BOLD signal from the regulatory target to a greater degree compared to the control group. Furthermore, the learned level of activation was maintained after the two-week period, with the recruitment of additional neural circuitries such as the hippocampus and the limbo-thalamo-cortical pathway. The activation obtained from the control group, in the absence of proper feedback, was indifferent across the training conditions. The level of BOLD activity from the target regulatory region was positively correlated with a self evaluative score within the experimental group, while the majority of control subjects had difficulty adopting a strategy to attain the desired level of functional regulation. Our results suggest that rtfMRI helped individuals learn how to increase region-specific cortical activity associated with a motor imagery task, and the level of increased activation in motor areas was consolidated after the two-week self-practice period, with the involvement of neural circuitries implicated in motor skill learning.

Annotation: neurofeedback - train your brain to train behaviour

BACKGROUND

Neurofeedback (NF) is a form of behavioural training aimed at developing skills for self-regulation of brain activity. Within the past decade, several NF studies have been published that tend to overcome the methodological shortcomings of earlier studies. This annotation describes the methodical basis of NF and reviews the evidence base for its clinical efficacy and effectiveness in neuropsychiatric disorders.

METHODS

In NF training, self-regulation of specific aspects of electrical brain activity is acquired by means of immediate feedback and positive reinforcement. In frequency training, activity in different EEG frequency bands has to be decreased or increased. Training of slow cortical potentials (SCPs) addresses the regulation of cortical excitability.

RESULTS

NF studies revealed paradigm-specific effects on, e.g., attention and memory processes and performance improvements in real-life conditions, in healthy subjects as well as in patients. In several studies it was shown that children with attention-deficit hyperactivity disorder (ADHD) improved behavioural and cognitive variables after frequency (e.g., theta/beta) training or SCP training. Neurophysiological effects could also be measured. However, specific and unspecific training effects could not be disentangled in these studies. For drug-resistant patients with epilepsy, significant and long-lasting decreases of seizure frequency and intensity through SCP training were documented in a series of studies. For other child psychiatric disorders (e.g., tic disorders, anxiety, and autism) only preliminary investigations are available.

CONCLUSIONS

There is growing evidence for NF as a valuable treatment module in neuropsychiatric disorders. Further, controlled studies are necessary to establish clinical efficacy and effectiveness and to learn more about the mechanisms underlying successful training.

Follow-up study of learning-disabled children treated with neurofeedback or placebo

This report is a 2-year follow-up to a previous study describing positive behavioral changes and a spurt of EEG maturation with theta/alpha neurofeedback (NFB) training in a group of Learning Disabled (LD) children. In a control paired group, treated with placebo, behavioral changes were not observed and the smaller maturational EEG changes observed were easily explained by increased age. Two years later, the EEG maturational lag in Control Group children increased, reaching abnormally high theta Relative Power values; the absence of positive behavioral changes continued and the neurological diagnosis remained LD. In contrast, after 2 years EEG maturation did continue in children who belonged to the Experimental Group with previous neurofeedback training; this was accompanied by positive behavioral changes, which were reflected in remission of LD symptoms.

Sleep disturbances in Ube3a maternal-deficient mice modeling Angelman syndrome

BACKGROUND

Angelman syndrome (AS) is a severe neurodevelopmental disorder with electroencephalographic (EEG) abnormalities and sleep disturbances. It results from lack of the functional maternal allele of UBE3A, which encodes a ubiquitin-protein ligase. Different mechanisms of UBE3A inactivation correlate with clinical phenotypes of varying severity; the majority of cases of AS are due to a de novo maternal deletion of the 15q11-q13 region.

METHODS

Ube3a maternal-deficient mice (Ube3a m-/p+) were generated in a C57Bl/6J background. This study compares cortical EEG and architecture of the sleep-waking cycle in adult Ube3a m-/p+ mice compared with those of age-matched WT (m+/p+) mice, under baseline conditions or after 4-h sleep deprivation (SD).

RESULTS

Ube3a m-/p+ mice exhibited: reduced slow-wave sleep (SWS) amount with increase waking (W) at the dark/light transitions; increased SWS and W episode numbers; and deterioration of paradoxical sleep (PS) over 24 h [amount: -44%; episode duration: -46%; episode number: -40%; theta peak frequency (TPF) acceleration: 7.6 Hz vs. 7.0 Hz in WT mice]. Characteristic paroxysmal EEG discharges are observed during W and SWS associated with synchronous muscle bursting activity during hypoactive W. During the recovery period following SD, Ube3a m-/p+ mice exhibited no rebound either in slow-wave activity (+89% in WT) or in delta-power spectra but a slight rebound in PS amount (+20%).

CONCLUSIONS

These data validate the mouse model produced by null mutation of the maternal Ube3a gene and provide useful results to investigate and better understand the molecular basis of sleep disturbances in AS patients.

Interictal Regional Cerebral Blood Flow and Electrical Source Analysis in Patients with Complex Partial Seizures

BACKGROUND

Recently, new methods of EEG source analysis have been developed. Dipole modeling and brain distributed source analysis localize in three-dimensions the origin of the electrical source of spikes registered in EEG. With single photon emission computed tomography (SPECT), it is possible to detect hypo- and hyperperfusion zones. Our aim in this study is to compare the regions where the electrical sources are detected, with the hypoperfusion regions in patients with complex partial seizures (CPS).

METHODS

The concordance of localization with dipole analysis, brain distributed source analysis and regional cerebral flow blood in patients with CPS was studied. The hypoperfusion zones detected with interictal SPECT were compared with electrical sources localized with brain electric source analysis (BESA) and brain distributed source analysis with variable resolution electromagnetic tomography (VARETA).

RESULTS

Hypoperfusion zones were found to localize with the origin of dipoles in 18 cases (90%), between lobes in 17 (85%) and between mesial or lateral regions in the temporal lobe in 12 cases (60%). With VARETA, agreement between side of hypoperfusion and electrical current source localization was found in 18/20 cases (90%), with lobes in 17 (85%) and with mesial or lateral regions of the temporal lobe only in 2 cases (10%).

CONCLUSIONS

Hypoperfusion zones in interictal SPECT of patients with CPS are in agreement with the origin of dipoles in 85% of the cases, but in specifics zones of temporal lobe the agreement falls to 60%. The concordance of hypoperfusion zones was better with dipole analysis than with VARETA.

Effects of caffeine on the electrophysiological, cognitive and motor responses of the central nervous system

Caffeine is the most consumed psychoactive substance in the world. The effects of caffeine have been studied using cognitive and motor measures, quantitative electroencephalography (qEEG) and event-related potentials. However, these methods are not usually employed in combination, a fact that impairs the interpretation of the results. The objective of the present study was to analyze changes in electrophysiological, cognitive and motor variables with the ingestion of caffeine, and to relate central to peripheral responses. For this purpose we recorded event-related potentials and eyes-closed, resting EEG, applied the Stroop test, and measured reaction time. Fifteen volunteers took caffeine (400 mg) or placebo in a randomized, crossover, double-blind design. A significant reduction of alpha absolute power over the entire scalp and of P300 latency at the Fz electrode were observed after caffeine ingestion. These results are consistent with a stimulatory effect of caffeine, although there was no change in the attention (Stroop) test or in reaction time. The qEEG seems to be the most sensitive index of the changes produced by caffeine in the central nervous system since it proved to be capable of detecting changes that were not evident in the tests of cognitive or motor performance.