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Birbaumer N. "Your Thoughts are (were) Free!": Brain-Computer-Interfaces, Neurofeedback, Detection of Deception, and the Future of Mind-Reading. Appl Psychophysiol Biofeedback 2024:10.1007/s10484-024-09648-z. [PMID: 38874845 DOI: 10.1007/s10484-024-09648-z] [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: 05/20/2024] [Indexed: 06/15/2024]
Abstract
This review describes the historical developement and rationale of clinically relevant research on neurophysiological "mind reading" paradims: Brain- Computer-Interfaces, detection of deception, brain stimulation and neurofeedback and the clinical applications in drug resistant epilepsy, chronic stroke, and communication with paralyzed locked-in persons. The emphasis lies on completely locked-in patients with amyotrophic lateral sclerosis using non-invasive and invasive brain computer interfaces and neurofeedback to restore verbal communication with the social environment. In the second part of the article we argue that success and failure of neurophysiological "mind reading" paradigms may be explained with a motor theory of thinking and emotion in combination with learning theory. The ethical implications of brain computer interface and neurofeedback approaches, particularly for severe chronic paralysis and loss of communication diseases and decisions on hastened death and euthanasia are discussed.
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Affiliation(s)
- Niels Birbaumer
- Department of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Silcherstrasse 5, 74072, Tübingen, Germany.
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2
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Poluha RL, Macário HS, Câmara-Souza MB, De la Torre Canales G, Ernberg M, Stuginski-Barbosa J. Benefits of the combination of digital and analogic tools as a strategy to control possible awake bruxism: A randomised clinical trial. J Oral Rehabil 2024; 51:917-923. [PMID: 38348534 DOI: 10.1111/joor.13667] [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: 06/02/2023] [Revised: 11/11/2023] [Accepted: 02/06/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Awake Bruxism (AB) management includes cognitive and behavioural changes. Digital and analogic tools can be used to remind the individual to control/avoid AB behaviours. However, no study addressed both tools together. OBJECTIVE To compare the efficacy of the combination of digital (smartphone application) and analogic (adhesive reminders) tools versus digital tool alone for AB management. METHODS Seventy-two individuals diagnosed with probable AB were divided into 3 groups: Group 1 (n = 24), used both digital and analogic tools during 30 days; Group 2 (n = 24), used only a digital tool during 30 days and Group 3 (n = 24), used only a digital tool for the first 15 days and then added the analogic tool for 15 days. The AB frequency was measured in real-time with a smartphone app, which sent alerts asking the individuals if they were doing any AB behaviours (bracing, teeth contact, clenching or grinding). Groups were compared using one-way ANOVA and before-after adding an analogic tool (group 3) by paired t-test, considering α = 0.05. RESULTS All groups showed a decrease in AB behaviours at the end of the evaluation period. Group 1 (digital and analogic tools) showed the lowest average of AB behaviours among all groups; however, statistically significant differences were found only for the comparison between groups 1 and 2. In group 3, a significantly greater reduction in AB behaviours was found after combining both approaches. CONCLUSION The combination of digital and analogic tools showed the greatest reduction of AB frequency and can be recommended for AB control.
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Affiliation(s)
| | | | | | - Giancarlo De la Torre Canales
- Ingá University Center, Maringá, Brazil
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, Cooperativa de Ensino Superior, CRL, Caparica, Portugal
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
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Marchi A, Guex R, Denis M, El Youssef N, Pizzo F, Bénar CG, Bartolomei F. Neurofeedback and epilepsy: Renaissance of an old self-regulation method? Rev Neurol (Paris) 2024; 180:314-325. [PMID: 38485630 DOI: 10.1016/j.neurol.2024.02.386] [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: 10/03/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 04/28/2024]
Abstract
Neurofeedback is a brain-computer interface tool enabling the user to self-regulate their neuronal activity, and ultimately, induce long-term brain plasticity, making it an interesting instrument to cure brain disorders. Although this method has been used successfully in the past as an adjunctive therapy in drug-resistant epilepsy, this approach remains under-explored and deserves more rigorous scientific inquiry. In this review, we present early neurofeedback protocols employed in epilepsy and provide a critical overview of the main clinical studies. We also describe the potential neurophysiological mechanisms through which neurofeedback may produce its therapeutic effects. Finally, we discuss how to innovate and standardize future neurofeedback clinical trials in epilepsy based on evidence from recent research studies.
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Affiliation(s)
- A Marchi
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France.
| | - R Guex
- Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - M Denis
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France
| | - N El Youssef
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France
| | - F Pizzo
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France; Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - C-G Bénar
- Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
| | - F Bartolomei
- Epileptology and Cerebral Rhythmology, Timone Hospital, AP-HM, Marseille, France; Inserm, INS, institut de neuroscience des systèmes, Aix-Marseille University, Marseille, France
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4
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Schmidt C, Laugesen H. Infra-low frequency neurofeedback training in Dravet syndrome: A case study. Epilepsy Behav Rep 2023; 22:100606. [PMID: 37252271 PMCID: PMC10213173 DOI: 10.1016/j.ebr.2023.100606] [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: 01/27/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Abstract
This case study examines how an intervention of infra-low frequency neurofeedback training (ILF-NFT) affects the symptomatology of an eight-year-old patient with Dravet syndrome (DS), a rare and highly disabling form of epilepsy. Our results demonstrate that ILF-NFT has improved the patient's sleep disturbance, has significantly reduced seizure frequency and severity, and has reversed neurodevelopmental decline, with positive development in intellectual and motor skills. No significant changes have been made to the patient's medication in the observed period of 2.5 years. Thus, we draw attention to ILF-NFT as a promising intervention in addressing DS symptomatology. Finally, we discuss the study's methodological limitations and warrant future studies to assess the effect of ILF-NFT in DS in more elaborate research designs.
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Affiliation(s)
- Casper Schmidt
- Department of Communication and Psychology, Aalborg University, Rendsburggade 14, 9000 Aalborg, Denmark
| | - Henning Laugesen
- Addiction Psychiatric Clinic, Fuglebakkevej 54, 8210 Aarhus V, Denmark
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Hasslinger J, Meregalli M, Bölte S. How standardized are “standard protocols”? Variations in protocol and performance evaluation for slow cortical potential neurofeedback: A systematic review. Front Hum Neurosci 2022; 16:887504. [PMID: 36118975 PMCID: PMC9478392 DOI: 10.3389/fnhum.2022.887504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Neurofeedback (NF) aims to alter neural activity by enhancing self-regulation skills. Over the past decade NF has received considerable attention as a potential intervention option for many somatic and mental conditions and ADHD in particular. However, placebo-controlled trials have demonstrated insufficient superiority of NF compared to treatment as usual and sham conditions. It has been argued that the reason for limited NF effects may be attributable to participants' challenges to self-regulate the targeted neural activity. Still, there is support of NF efficacy when only considering so-called “standard protocols,” such as Slow Cortical Potential NF training (SCP-NF). This PROSPERO registered systematic review following PRISMA criteria searched literature databases for studies applying SCP-NF protocols. Our review focus concerned the operationalization of self-regulatory success, and protocol-details that could influence the evaluation of self-regulation. Such details included; electrode placement, number of trials, length per trial, proportions of training modalities, handling of artifacts and skill-transfer into daily-life. We identified a total of 63 eligible reports published in the year 2000 or later. SCP-NF protocol-details varied considerably on most variables, except for electrode placement. However, due to the increased availability of commercial systems, there was a trend to more uniform protocol-details. Although, token-systems are popular in SCP-NF for ADHD, only half reported a performance-based component. Also, transfer exercises have become a staple part of SCP-NF. Furthermore, multiple operationalizations of regulatory success were identified, limiting comparability between studies, and perhaps usefulness of so-called transfer-exercises, which purpose is to facilitate the transfer of the self-regulatory skills into every-day life. While studies utilizing SCP as Brain-Computer-Interface mainly focused on the acquisition of successful self-regulation, clinically oriented studies often neglected this. Congruently, rates of successful regulators in clinical studies were mostly low (<50%). The relation between SCP self-regulation and behavior, and how symptoms in different disorders are affected, is complex and not fully understood. Future studies need to report self-regulation based on standardized measures, in order to facilitate both comparability and understanding of the effects on symptoms. When applied as treatment, future SCP-NF studies also need to put greater emphasis on the acquisition of self-regulation (before evaluating symptom outcomes).
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Affiliation(s)
- John Hasslinger
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- *Correspondence: John Hasslinger
| | - Micaela Meregalli
- Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
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Schneider H, Riederle J, Seuss S. Therapeutic Effect of Infra-Low-Frequency Neurofeedback Training on Children and Adolescents with ADHD. ARTIF INTELL 2022. [DOI: 10.5772/intechopen.97938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this observational study the outcomes of an EEG-based infra-low-frequency (ILF) neurofeedback intervention on patients with attention deficit (hyperactivity) disorder (ADHD) are presented. The question is addressed whether this computer-aided treatment, which uses a brain-computer-interface to alleviate the clinical symptoms of mental disorders, is an effective non-pharmaceutical therapy for ADHD in childhood and adolescence. In a period of about 15 weeks 196 ADHD patients were treated with about 30 sessions of ILF neurofeedback in an ambulant setting. Besides regular evaluation of the severity of clinical symptoms, a continuous performance test (CPT) for parameters of attention and impulse control was conducted before and after the neurofeedback treatment. During and after the therapy, the patients did not only experience a substantial reduction in the severity of their ADHD-typical clinical symptoms, but also their performance in a continuous test procedure was significantly improved for all examined parameters of attention and impulse control, like response time, variability of reaction time, omission errors and commission errors. In a post neurofeedback intervention assessment 97% of patients reported improvement in symptoms of inattention, hyperactivity or impulsivity. Only 3% of the patients claimed no noticeable alleviation of ADHD-related symptoms. These results suggest that ILF neurofeedback is a clinically effective method that can be considered as a treatment option for ADHD and might help reducing or even avoiding psychotropic medication.
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Jiang Y, Jessee W, Hoyng S, Borhani S, Liu Z, Zhao X, Price LK, High W, Suhl J, Cerel-Suhl S. Sharpening Working Memory With Real-Time Electrophysiological Brain Signals: Which Neurofeedback Paradigms Work? Front Aging Neurosci 2022; 14:780817. [PMID: 35418848 PMCID: PMC8995767 DOI: 10.3389/fnagi.2022.780817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/08/2022] [Indexed: 09/19/2023] Open
Abstract
Growing evidence supports the idea that the ultimate biofeedback is to reward sensory pleasure (e.g., enhanced visual clarity) in real-time to neural circuits that are associated with a desired performance, such as excellent memory retrieval. Neurofeedback is biofeedback that uses real-time sensory reward to brain activity associated with a certain performance (e.g., accurate and fast recall). Working memory is a key component of human intelligence. The challenges are in our current limited understanding of neurocognitive dysfunctions as well as in technical difficulties for closed-loop feedback in true real-time. Here we review recent advancements of real time neurofeedback to improve memory training in healthy young and older adults. With new advancements in neuromarkers of specific neurophysiological functions, neurofeedback training should be better targeted beyond a single frequency approach to include frequency interactions and event-related potentials. Our review confirms the positive trend that neurofeedback training mostly works to improve memory and cognition to some extent in most studies. Yet, the training typically takes multiple weeks with 2-3 sessions per week. We review various neurofeedback reward strategies and outcome measures. A well-known issue in such training is that some people simply do not respond to neurofeedback. Thus, we also review the literature of individual differences in psychological factors e.g., placebo effects and so-called "BCI illiteracy" (Brain Computer Interface illiteracy). We recommend the use of Neural modulation sensitivity or BCI insensitivity in the neurofeedback literature. Future directions include much needed research in mild cognitive impairment, in non-Alzheimer's dementia populations, and neurofeedback using EEG features during resting and sleep for memory enhancement and as sensitive outcome measures.
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Affiliation(s)
- Yang Jiang
- Lexington Veteran Affairs Medical Center, Lexington, KY, United States
- College of Medicine, University of Kentucky, Lexington, KY, United States
| | - William Jessee
- College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Stevie Hoyng
- College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Soheil Borhani
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Ziming Liu
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Xiaopeng Zhao
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Lacey K. Price
- Lexington Veteran Affairs Medical Center, Lexington, KY, United States
| | - Walter High
- New Mexico Veteran Affairs Medical Center, Albuquerque, NM, United States
| | - Jeremiah Suhl
- Lexington Veteran Affairs Medical Center, Lexington, KY, United States
| | - Sylvia Cerel-Suhl
- Lexington Veteran Affairs Medical Center, Lexington, KY, United States
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Werneck-Rohrer SG, Lindorfer TM, Waleew C, Philipp J, Prillinger K, Konicar L. Effects of an intensive slow cortical potentials neurofeedback training in female and male adolescents with autism spectrum disorder : Are there sex differences? Wien Klin Wochenschr 2021; 134:60-68. [PMID: 34910250 PMCID: PMC8671879 DOI: 10.1007/s00508-021-01989-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/16/2021] [Indexed: 11/20/2022]
Abstract
Background This study aims to compare the effects of neurofeedback training on male and female adolescents with autism spectrum disorder (ASD). Furthermore, it examines sex differences regarding improvements in co-occurring psychopathological symptoms, cognitive flexibility and emotion recognition abilities. The study might provide first hints whether there is an influence of sex on treatment outcomes. Methods Six female and six male adolescents with ASD were matched according to age, IQ and symptom severity. All participants received 24 sessions of electroencephalography-based neurofeedback training. Before and after the intervention, psychological data for measuring co-occurring psychopathological symptoms as well as behavioral data for measuring cognitive flexibility and emotion recognition abilities were recorded. Results Caregivers rated statistically significant higher psychopathological problems in female than in male adolescents with ASD at baseline. Apart from that, no statistically significant sex-related differences were revealed in this sample; however, male adolescents tended to report greater improvements of externalizing, internalizing and total symptoms, whereas females experienced smaller improvements of externalizing and total problems, but no improvements of internalizing problems. Regarding caregivers’ assessments, more improvement of total problems was reported for females. For males, only improvements of internalizing and total problems were described. Conclusion This study reveals preliminary results that sex-related differences might play a role when evaluating treatment outcomes after neurofeedback training regarding comorbid psychopathological symptoms. Adolescents’ self-report and parental assessments, especially concerning psychopathological symptoms, should be combined and considered in future studies to help prevent sex bias in adolescents with ASD.
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Affiliation(s)
- Sonja G Werneck-Rohrer
- Department of Child and Adolescent Psychiatry. Währinger Gürtel 18-20, Medical University of Vienna, 1090, Vienna, Austria.
| | - Theresa M Lindorfer
- Department of Child and Adolescent Psychiatry. Währinger Gürtel 18-20, Medical University of Vienna, 1090, Vienna, Austria
| | - Carolin Waleew
- Department of Child and Adolescent Psychiatry. Währinger Gürtel 18-20, Medical University of Vienna, 1090, Vienna, Austria
| | - Julia Philipp
- Department of Child and Adolescent Psychiatry. Währinger Gürtel 18-20, Medical University of Vienna, 1090, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry. Währinger Gürtel 18-20, Medical University of Vienna, 1090, Vienna, Austria
| | - Lilian Konicar
- Department of Child and Adolescent Psychiatry. Währinger Gürtel 18-20, Medical University of Vienna, 1090, Vienna, Austria
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Hasslinger J, Bölte S, Jonsson U. Slow Cortical Potential Versus Live Z-score Neurofeedback in Children and Adolescents with ADHD: A Multi-arm Pragmatic Randomized Controlled Trial with Active and Passive Comparators. Res Child Adolesc Psychopathol 2021; 50:447-462. [PMID: 34478006 PMCID: PMC8940855 DOI: 10.1007/s10802-021-00858-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/25/2022]
Abstract
Neurofeedback (NF) as a treatment for Attention Deficit Hyperactivity Disorder (ADHD) has been evaluated in several trials, but the specificity and generalizability of effects remain unclear. This four-arm randomized controlled trial evaluated the efficacy of Slow Cortical Potential (SCP; standard NF protocol) and Live Z-score (LZS; non-standard NF protocol) delivered in high-frequency format (five sessions per week during five weeks), compared to Working-memory training (WMT; active comparator) and Treatment-as-usual (TAU; passive comparator). N = 202 children/adolescents aged 9 to 17 years with ADHD participated. The primary outcome measure was multi-report (self-, teacher-, and parent-report) ADHD core symptoms on the Conners-3, assessed at baseline, posttreatment, and 6-months follow-up. Data were analyzed using a linear mixed model. Between-group differences were scarce and did not show a distinct pattern. Superiority of LZS over TAU at endpoint were observed for teacher-rated measures only, while significant differences between SCP and TAU were restricted to posttreatment measurements. Contrary to our expectations, LZS outperformed SCP at endpoint for teacher-rated hyperactivity (-5.37; 95% CI: -10.14 to -0.60; p = .028; d = -.36) and overall ADHD symptoms (-2.20; -4.18 to -0.22; p = .030; d = -.41). There was no indication that either form of NF was superior to WMT. No severe adverse events were reported during the trial, whereas transient stress-related problems were quite frequent. Overall, the results from this pragmatic trial do not provide convincing support for broad implementation of NF in child and adolescent psychiatric services. Future research should try to clarify for whom and under what circumstances NF might be a viable treatment option.
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Affiliation(s)
- John Hasslinger
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Child and Adolescent Psychiatry, Stockholm Health Services, Region Stockholm, Stockholm, Sweden.
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Ulf Jonsson
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Services, Region Stockholm, Stockholm, Sweden
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
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Câmara-Souza MB, Carvalho AG, Figueredo OMC, Bracci A, Manfredini D, Rodrigues Garcia RCM. Awake bruxism frequency and psychosocial factors in college preparatory students. Cranio 2020; 41:178-184. [PMID: 33050845 DOI: 10.1080/08869634.2020.1829289] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the frequency of reported masticatory muscles activity during wakefulness (i.e., awake bruxism [AB]), levels of anxiety, depression, stress, and the oral health-related quality of life (OHRQoL) in college preparatory students. METHODS Sixty-nine college preparatory students participated in the study. AB was evaluated by the Oral Behaviors Checklist (OBC) and a smartphone-based ecological momentary assessment (EMA; [Bruxapp®]). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale, stress was evaluated by the Perceived Stress Scale, and OHRQoL was obtained by The Oral Health Impact Profile-14. Data were analyzed by Pearson's correlation coefficient (α = 0.05). RESULTS The average EMA-reported frequency of AB behaviors was 38.4%. Significant correlations were found between AB and the OBC, anxiety, depression, stress, and OHRQoL (p < 0.001). CONCLUSION College preparatory students demonstrated moderate frequency of AB, which was significantly correlated with psychosocial factors.
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Hasslinger J, D’Agostini Souto M, Folkesson Hellstadius L, Bölte S. Neurofeedback in ADHD: A qualitative study of strategy use in slow cortical potential training. PLoS One 2020; 15:e0233343. [PMID: 32497051 PMCID: PMC7272030 DOI: 10.1371/journal.pone.0233343] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/03/2020] [Indexed: 12/03/2022] Open
Abstract
Neurofeedback (NF) as a treatment for children and adolescents with attention deficit hyperactivity disorder (ADHD) has gained growing interest in recent years. Most research has been quantitative, focusing on treatment outcomes, while qualitative approaches exploring the treatment process and participants’ experiences are scarce. The objective of this study was to examine NF participants’ use of cognitive and other strategies for approaching and solving NF tasks, their development over the course of the training and the influence of participants’ compliance.
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Affiliation(s)
- John Hasslinger
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- * E-mail:
| | - Manoela D’Agostini Souto
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lisa Folkesson Hellstadius
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia
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Coenen F, Scheepers FE, Palmen SJM, de Jonge MV, Oranje B. Serious Games as Potential Therapies: A Validation Study of a Neurofeedback Game. Clin EEG Neurosci 2020; 51:87-93. [PMID: 31423818 PMCID: PMC6963172 DOI: 10.1177/1550059419869471] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Serious (biofeedback) games offer promising ways to supplement or replace more expensive face-to-face interventions in health care. However, studies on the validity and effectiveness of EEG-based serious games remain scarce. In the current study, we investigated whether the conditions of the neurofeedback game "Daydream" indeed trained the brain activity as mentioned in the game manual. EEG activity was assessed in 14 healthy male volunteers while playing the 2 conditions of the game. The participants completed a training of 5 sessions. EEG frequency analyses were performed to verify the claims of the manual. We found significant differences in α- to β-ratio between the 2 conditions although only in the amplitude data, not in the power data. Within the conditions, mean α-amplitude only differed significantly from the β-amplitude in the concentration condition. Our analyses showed that neither α nor β brain activity differed significantly between game levels (higher level requiring increased brain activity) in either of the two conditions. In conclusion, we found only marginal evidence for the proposed claims stated in the manual of the game. Our research emphasizes that it is crucial to validate the claims that serious games make, especially before implementing them in the clinic or as therapeutic devices.
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Affiliation(s)
- Femke Coenen
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Floortje E Scheepers
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Saskia J M Palmen
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Maretha V de Jonge
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.,Faculty of Social and Behavioural Sciences, Department Education and Child Studies, Leiden University, the Netherlands
| | - Bob Oranje
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
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Abstract
PURPOSE OF REVIEW Behavioral intervention describes multiple modalities of treatments which are of increasing interest in epilepsy. This review addresses recent behavioral clinical trials in epilepsy including cognitive behavioral therapy (CBT), mindfulness, progressive muscle relaxation (PMR), and self-management. Results and conclusions from updated Cochrane reviews and the recent International League Against Epilepsy Psychology task force are presented. RECENT FINDINGS Two recent large randomized controlled trials (mindfulness and progressive muscle relaxation) reported improved seizure frequency with behavioral treatments. In both studies, participants in both the active and the attentional control arms showed significant seizure reduction, whereas quality of life and stress reduction were better noted in the active arms. Additional behavioral modalities have reported improved seizure control including yoga, bio/neurofeedback, and music therapy.Significant improvements in multiple quality of life, cognitive domains, and medication adherence have been reported from randomized and open label trials of cognitive behavioral therapy, and self-management programs. Multiple promising self-management programs have been recently reported, often utilizing the power of web-based apps, and digitally delivered group therapy. In 2018, the International League Against Epilepsy Psychology task force recommended that 'psychological interventions should be incorporated into comprehensive epilepsy care.' SUMMARY Behavioral treatments are successful and likely underutilized in the treatment of epilepsy. Given the challenge of conducting randomized clinical trials of behavioral therapy, much remains to be studied. However, for motivated and interested patients, appropriately chosen behavioral therapies appear to be important adjuncts to standard therapy. The timing is currently optimal to take best advantage of smartphone apps and web-based delivery systems, both for research and therapeutic purposes.
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Affiliation(s)
- Sheryl R Haut
- Montefiore-Einstein Epilepsy Center.,Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan M Gursky
- Montefiore-Einstein Epilepsy Center.,Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Michael Privitera
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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14
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Morales-Quezada L, Martinez D, El-Hagrassy MM, Kaptchuk TJ, Sterman MB, Yeh GY. Neurofeedback impacts cognition and quality of life in pediatric focal epilepsy: An exploratory randomized double-blinded sham-controlled trial. Epilepsy Behav 2019; 101:106570. [PMID: 31707107 PMCID: PMC7203763 DOI: 10.1016/j.yebeh.2019.106570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/28/2019] [Accepted: 09/13/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Children with epilepsy experience cognitive deficits and well-being issues that have detrimental effects on their development. Pharmacotherapy is the standard of care in epilepsy; however, few interventions exist to promote cognitive development and to mitigate disease burden. We aimed to examine the impact of two different modalities of neurofeedback (NFB) on cognitive functioning and quality-of-life (QOL) measurements in children and adolescents with controlled focal epilepsy. The study also explored the effects of NFB on clinical outcomes and electroencephalography (EEG) quantitative analysis. METHODS Participants (n = 44) with controlled focal epilepsy were randomized to one of three arms: sensorimotor rhythm (SMR) NFB (n = 15), slow cortical potentials (SCP) NFB (n = 16), or sham NFB (n = 13). All participants received 25 sessions of intervention. The attention switching task (AST), Liverpool Seizure Severity Scale (LSSS), seizure frequency (SF), EEG power spectrum, and coherence were measured at baseline, postintervention, and at 3-month follow-up. RESULTS In children and adolescents with controlled focal epilepsy, SMR training significantly reduced reaction time in the AST (p = 0.006), and this was correlated with the difference of change for theta power on EEG (p = 0.03); only the SMR group showed a significant decrease in beta coherence (p = 0.03). All groups exhibited improvement in QOL (p = <0.05). CONCLUSIONS This study provides the first data on two NFB modalities (SMR and SCP) including cognitive, neurophysiological, and clinical outcomes in pediatric epilepsy. Sensorimotor rhythm NFB improved cognitive functioning, while all the interventions showed improvements in QOL, demonstrating a powerful placebo effect in the sham group.
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Affiliation(s)
- Leon Morales-Quezada
- Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - Diana Martinez
- Boston Neurodynamics, Brookline, Massachussetss, USA.,Neocemod, Centro de Neuromodulacion, Aguascalientes, Mexico
| | - Mirret M. El-Hagrassy
- Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Ted J. Kaptchuk
- Program in Placebo Studies and Therapeutic Encounter, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - M. Barry Sterman
- Department of Neurobiology, UCLA School of Medicine, USA; Department of Biobehavioral Psychiatry, UCLA School of Medicine, USA
| | - Gloria Y. Yeh
- Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Osher Center for Integrative Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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15
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Omejc N, Rojc B, Battaglini PP, Marusic U. Review of the therapeutic neurofeedback method using electroencephalography: EEG Neurofeedback. Bosn J Basic Med Sci 2019; 19:213-220. [PMID: 30465705 DOI: 10.17305/bjbms.2018.3785] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022] Open
Abstract
Electroencephalographic neurofeedback (EEG-NFB) represents a broadly used method that involves a real-time EEG signal measurement, immediate data processing with the extraction of the parameter(s) of interest, and feedback to the individual in a real-time. Using such a feedback loop, the individual may gain better control over the neurophysiological parameters, by inducing changes in brain functioning and, consequently, behavior. It is used as a complementary treatment for a variety of neuropsychological disorders and improvement of cognitive capabilities, creativity or relaxation in healthy subjects. In this review, various types of EEG-NFB training are described, including training of slow cortical potentials (SCPs) and frequency and coherence training, with their main results and potential limitations. Furthermore, some general concerns about EEG-NFB methodology are presented, which still need to be addressed by the NFB community. Due to the heterogeneity of research designs in EEG-NFB protocols, clear conclusions on the effectiveness of this method are difficult to draw. Despite that, there seems to be a well-defined path for the EEG-NFB research in the future, opening up possibilities for improvement.
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Affiliation(s)
- Nina Omejc
- Department of Psychology, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia Graduate School of Neural and Behavioural Sciences, University of Tübingen, Germany.
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16
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17
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The history of BCI: From a vision for the future to real support for personhood in people with locked-in syndrome. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09409-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Papo D. Neurofeedback: Principles, appraisal, and outstanding issues. Eur J Neurosci 2019; 49:1454-1469. [PMID: 30570194 DOI: 10.1111/ejn.14312] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 12/16/2022]
Abstract
Neurofeedback is a form of brain training in which subjects are fed back information about some measure of their brain activity which they are instructed to modify in a way thought to be functionally advantageous. Over the last 20 years, neurofeedback has been used to treat various neurological and psychiatric conditions, and to improve cognitive function in various contexts. However, in spite of a growing popularity, neurofeedback protocols typically make (often covert) assumptions on what aspects of brain activity to target, where in the brain to act and how, which have far-reaching implications for the assessment of its potential and efficacy. Here we critically examine some conceptual and methodological issues associated with the way neurofeedback's general objectives and neural targets are defined. The neural mechanisms through which neurofeedback may act at various spatial and temporal scales, and the way its efficacy is appraised are reviewed, and the extent to which neurofeedback may be used to control functional brain activity discussed. Finally, it is proposed that gauging neurofeedback's potential, as well as assessing and improving its efficacy will require better understanding of various fundamental aspects of brain dynamics and a more precise definition of functional brain activity and brain-behaviour relationships.
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Affiliation(s)
- David Papo
- SCALab, CNRS, Université de Lille, Villeneuve d'Ascq, France
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19
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Ros T, Frewen P, Théberge J, Michela A, Kluetsch R, Mueller A, Candrian G, Jetly R, Vuilleumier P, Lanius RA. Neurofeedback Tunes Scale-Free Dynamics in Spontaneous Brain Activity. Cereb Cortex 2018; 27:4911-4922. [PMID: 27620975 DOI: 10.1093/cercor/bhw285] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/19/2016] [Indexed: 11/13/2022] Open
Abstract
Brain oscillations exhibit long-range temporal correlations (LRTCs), which reflect the regularity of their fluctuations: low values representing more random (decorrelated) while high values more persistent (correlated) dynamics. LRTCs constitute supporting evidence that the brain operates near criticality, a state where neuronal activities are balanced between order and randomness. Here, healthy adults used closed-loop brain training (neurofeedback, NFB) to reduce the amplitude of alpha oscillations, producing a significant increase in spontaneous LRTCs post-training. This effect was reproduced in patients with post-traumatic stress disorder, where abnormally random dynamics were reversed by NFB, correlating with significant improvements in hyperarousal. Notably, regions manifesting abnormally low LRTCs (i.e., excessive randomness) normalized toward healthy population levels, consistent with theoretical predictions about self-organized criticality. Hence, when exposed to appropriate training, spontaneous cortical activity reveals a residual capacity for "self-tuning" its own temporal complexity, despite manifesting the abnormal dynamics seen in individuals with psychiatric disorder. Lastly, we observed an inverse-U relationship between strength of LRTC and oscillation amplitude, suggesting a breakdown of long-range dependence at high/low synchronization extremes, in line with recent computational models. Together, our findings offer a broader mechanistic framework for motivating research and clinical applications of NFB, encompassing disorders with perturbed LRTCs.
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Affiliation(s)
- T Ros
- Geneva Neuroscience Center, Department of Neuroscience, University of Geneva, CH-1202 Geneva, Switzerland
| | - P Frewen
- Department of Psychiatry, Western University, London N6A 5A5, Ontario, Canada
| | - J Théberge
- Department of Medical Imaging, Lawson Health Research Institute, London N6C 2R5, Ontario, Canada
| | - A Michela
- Geneva Neuroscience Center, Department of Neuroscience, University of Geneva, CH-1202 Geneva, Switzerland
| | - R Kluetsch
- Department of Psychosomatic Medicine and Psychotherapy, Mannheim-Heidelberg University, 68159 Mannheim, Germany
| | - A Mueller
- Brain and Trauma Foundation, CH-7000 Chur, Switzerland
| | - G Candrian
- Brain and Trauma Foundation, CH-7000 Chur, Switzerland
| | - R Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa K1A 0K6, Canada
| | - P Vuilleumier
- Geneva Neuroscience Center, Department of Neuroscience, University of Geneva, CH-1202 Geneva, Switzerland
| | - R A Lanius
- Department of Psychiatry, Western University, London N6A 5A5, Ontario, Canada
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20
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Alkoby O, Abu-Rmileh A, Shriki O, Todder D. Can We Predict Who Will Respond to Neurofeedback? A Review of the Inefficacy Problem and Existing Predictors for Successful EEG Neurofeedback Learning. Neuroscience 2018; 378:155-164. [DOI: 10.1016/j.neuroscience.2016.12.050] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/25/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
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21
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Kotwas I, McGonigal A, Khalfa S, Bastien-Toniazzo M, Bartolomei F, Micoulaud-Franchi JA. A case-control study of skin conductance biofeedback on seizure frequency and emotion regulation in drug-resistant temporal lobe epilepsy. Int J Psychophysiol 2018; 123:103-110. [DOI: 10.1016/j.ijpsycho.2017.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/25/2017] [Accepted: 10/12/2017] [Indexed: 12/11/2022]
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22
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Hohenfeld C, Nellessen N, Dogan I, Kuhn H, Müller C, Papa F, Ketteler S, Goebel R, Heinecke A, Shah NJ, Schulz JB, Reske M, Reetz K. Cognitive Improvement and Brain Changes after Real-Time Functional MRI Neurofeedback Training in Healthy Elderly and Prodromal Alzheimer's Disease. Front Neurol 2017; 8:384. [PMID: 28848488 PMCID: PMC5552678 DOI: 10.3389/fneur.2017.00384] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/19/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive decline is characteristic for Alzheimer's disease (AD) and also for healthy ageing. As a proof-of-concept study, we examined whether this decline can be counteracted using real-time fMRI neurofeedback training. Visuospatial memory and the parahippocampal gyrus (PHG) were targeted. METHODS Sixteen healthy elderly subjects (mean age 63.5 years, SD = 6.663) and 10 patients with prodromal AD (mean age 66.2 years, SD = 8.930) completed the experiment. Four additional healthy subjects formed a sham-feedback condition to validate the paradigm. The protocol spanned five examination days (T1-T5). T1 contained a neuropsychological pre-test, the encoding of a real-world footpath, and an anatomical MRI scan of the brain. T2-T4 included the fMRI neurofeedback training paradigm, in which subjects learned to enhance activation of the left PHG while recalling the path encoded on T1. At T5, the neuropsychological post-test and another anatomical MRI brain scan were performed. The neuropsychological battery included the Montreal Cognitive Assessment (MoCA); the Visual and Verbal Memory Test (VVM); subtests of the Wechsler Memory Scale (WMS); the Visual Patterns Test; and Trail Making Tests (TMT) A and B. RESULTS Healthy elderly and patients with prodromal AD showed improved visuospatial memory performance after neurofeedback training. Healthy subjects also performed better in a working-memory task (WMS backward digit-span) and in the MoCA. Both groups were able to elicit parahippocampal activation during training, but no significant changes in brain activation were found over the course of the training. However, Granger-causality-analysis revealed changes in cerebral connectivity over the course of the training, involving the parahippocampus and identifying the precuneus as main driver of activation in both groups. Voxel-based morphometry showed increases in grey matter volumes in the precuneus and frontal cortex. Neither cognitive enhancements, nor parahippocampal activation were found in the control group undergoing sham-feedback. CONCLUSION These findings suggest that cognitive decline, either related to prodromal AD or healthy ageing, could be counteracted using fMRI-based neurofeedback. Future research needs to determine the potential of this method as a treatment tool.
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Affiliation(s)
- Christian Hohenfeld
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-4, 6), Research Centre Jülich GmbH, Jülich, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Nils Nellessen
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-4, 6), Research Centre Jülich GmbH, Jülich, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-4, 6), Research Centre Jülich GmbH, Jülich, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Hanna Kuhn
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-4, 6), Research Centre Jülich GmbH, Jülich, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Christine Müller
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-4, 6), Research Centre Jülich GmbH, Jülich, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Federica Papa
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-4, 6), Research Centre Jülich GmbH, Jülich, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Simon Ketteler
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-4, 6), Research Centre Jülich GmbH, Jülich, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Centre, Maastricht University, Maastricht, Netherlands.,Brain Innovation, Maastricht, Netherlands
| | | | - N Jon Shah
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-4, 6), Research Centre Jülich GmbH, Jülich, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Martina Reske
- Institute of Neuroscience and Medicine (INM-4, 6), Research Centre Jülich GmbH, Jülich, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-4, 6), Research Centre Jülich GmbH, Jülich, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
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23
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Kotwas I, McGonigal A, Bastien-Toniazzo M, Bartolomei F, Micoulaud-Franchi JA. Stress regulation in drug-resistant epilepsy. Epilepsy Behav 2017; 71:39-50. [PMID: 28494323 DOI: 10.1016/j.yebeh.2017.01.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/29/2016] [Accepted: 01/25/2017] [Indexed: 12/17/2022]
Abstract
The prevalence of psychological distress, especially depressive and anxiety disorders, is higher in epilepsy than in other chronic health conditions. These comorbid conditions contribute even more than epileptic seizures themselves to impaired quality of life in patients with epilepsy (PWE). The link between these comorbidities and epilepsy appears to have a neurobiological basis, which is at least partly mediated by stress through psychological and pathophysiological pathways. The impact of stress in PWE is also particularly important because it is the most frequently reported seizure trigger. It is therefore crucial for clinicians to take stress-related conditions and psychiatric comorbidities into account when managing PWE and to propose clinical support to enhance self-control of stress. Screening tools have been specially designed and validated in PWE for depressive disorders and anxiety disorders (e.g. NDDI-E, GAD-7). Other instruments are useful for measuring stress-related variables (e.g. SRRS, PSS, SCS, MHLCS, DSR-15, ERP-R, QOLIE-31) in order to help characterize the individual "stress profile" and thus orientate patients towards the most appropriate treatment. Management includes both pharmacological treatment and nonpharmacological methods for enhancing self-management of stress (e.g. mindfulness-based therapies, yoga, cognitive-behavioral therapies, biofeedback), which may not only protect against psychiatric comorbidities but also reduce seizure frequency.
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Affiliation(s)
- Iliana Kotwas
- Laboratoire Parole et Langage UMR 7309, Aix-Marseille Université, Marseille, France.
| | - Aileen McGonigal
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Unité mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | | | - Fabrice Bartolomei
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Unité mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Jean-Arthur Micoulaud-Franchi
- Service d'explorations fonctionnelles du système nerveux, Clinique du sommeil, CHU de, Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, CHU Pellegrin, Université de Bordeaux, France
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24
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Abstract
PURPOSE OF REVIEW Cognitive and behavioral treatments for epilepsy offer several advantages, as they are relatively low cost, are non-invasive, lack serious side effects, and facilitate patient participation. Their role in the management of epilepsy, however, is unclear. The following manuscript will critically review the efficacy data regarding psychological treatments for seizure reduction. RECENT FINDINGS Encouraging results have been found for the cognitive behavioral therapy-based Reiter/Andrews approach and mindfulness or arousal-based programs (e.g., yoga, meditation, relaxation, and biofeedback). Most studies attained responder rates between 45 and 90%. Cognitive and behavioral interventions may be considered as low-risk adjuncts to standard therapies. Efficacy data are limited, however, by small numbers of subjects, inadequate randomization, controls, and blinding, brief trial durations, varying methodologies, and variability in the presentation of results. Additional clinical trials are warranted.
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Affiliation(s)
- Beth A Leeman-Markowski
- NYU Comprehensive Epilepsy Center, Department of Neurology, New York University, 223 E. 34th St, New York, NY, 10016, USA.
- VA New York Harbor Healthcare System-Manhattan Campus, Research Service, 423 E. 23rd St, New York, NY, 10010, USA.
| | - Steven C Schachter
- Departments of Neurology, Beth Israel Deaconess Medical Center, Massachusetts General Hospital and Harvard Medical School, 125 Nashua St., Suite 324, Boston, MA, 02114, USA
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25
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Abstract
Although evidence supports the efficacy of biofeedback for treating a number of disorders and for enhancing performance, significant barriers block both needed research and payer support for this method. Biofeedback has demonstrated effects in changing psychophysiological substrates of various emotional, physical, and psychosomatic problems, but payers are reluctant to reimburse for biofeedback services. A considerable amount of biofeedback research is in the form of relatively small well-controlled trials (Phase II trials). This article argues for greater payer support and research support for larger trials in the “real life” clinical environment (Phase III trials) and meta-analytic reviews.
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Affiliation(s)
- Paul Lehrer
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
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26
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27
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Zhigalov A, Kaplan A, Palva JM. Modulation of critical brain dynamics using closed-loop neurofeedback stimulation. Clin Neurophysiol 2016; 127:2882-2889. [DOI: 10.1016/j.clinph.2016.04.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/05/2016] [Accepted: 04/30/2016] [Indexed: 11/16/2022]
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28
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Ushiba J, Soekadar SR. Brain-machine interfaces for rehabilitation of poststroke hemiplegia. PROGRESS IN BRAIN RESEARCH 2016; 228:163-83. [PMID: 27590969 DOI: 10.1016/bs.pbr.2016.04.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Noninvasive brain-machine interfaces (BMIs) are typically associated with neuroprosthetic applications or communication aids developed to assist in daily life after loss of motor function, eg, in severe paralysis. However, BMI technology has recently been found to be a powerful tool to promote neural plasticity facilitating motor recovery after brain damage, eg, due to stroke or trauma. In such BMI paradigms, motor cortical output and input are simultaneously activated, for instance by translating motor cortical activity associated with the attempt to move the paralyzed fingers into actual exoskeleton-driven finger movements, resulting in contingent visual and somatosensory feedback. Here, we describe the rationale and basic principles underlying such BMI motor rehabilitation paradigms and review recent studies that provide new insights into BMI-related neural plasticity and reorganization. Current challenges in clinical implementation and the broader use of BMI technology in stroke neurorehabilitation are discussed.
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Affiliation(s)
- J Ushiba
- Faculty of Science and Technology, Keio University, Kohoku-ku, Yokohama, Kanagawa, Japan.
| | - S R Soekadar
- Applied Neurotechnology Laboratory, University Hospital of Tübingen, Tübingen, Germany
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29
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Dimitriadis SI, Linden D. Modulation of brain criticality via suppression of EEG long-range temporal correlations (LRTCs) in a closed-loop neurofeedback stimulation. Clin Neurophysiol 2016; 127:2878-2881. [PMID: 27323657 DOI: 10.1016/j.clinph.2016.05.359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 05/28/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Stavros I Dimitriadis
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, CF24 4HQ, UK; Cardiff University Brain Research Imaging Center (CUBRIC), School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK; Artificial Intelligence and Information Analysis Laboratory, Department of Informatics, Aristotle University, 54124 Thessaloniki, Greece; NeuroInformatics Group, AUTH, Thessaloniki, Greece.
| | - David Linden
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, CF24 4HQ, UK; Cardiff University Brain Research Imaging Center (CUBRIC), School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK
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30
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Kotwas I, McGonigal A, Trebuchon A, Bastien-Toniazzo M, Nagai Y, Bartolomei F, Micoulaud-Franchi JA. Self-control of epileptic seizures by nonpharmacological strategies. Epilepsy Behav 2016; 55:157-64. [PMID: 26780213 DOI: 10.1016/j.yebeh.2015.12.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/12/2015] [Accepted: 12/14/2015] [Indexed: 02/04/2023]
Abstract
Despite the unpredictability of epileptic seizures, many patients report that they can anticipate seizure occurrence. Using certain alert symptoms (i.e., auras, prodromes, precipitant factors), patients can adopt behaviors to avoid injury during and after the seizure or may implement spontaneous cognitive and emotional strategies to try to control the seizure itself. From the patient's view point, potential means of enhancing seizure prediction and developing seizure control supports are seen as very important issues, especially when the epilepsy is drug-resistant. In this review, we first describe how some patients anticipate their seizures and whether this is effective in terms of seizure prediction. Secondly, we examine how these anticipatory elements might help patients to prevent or control their seizures and how the patient's neuropsychological profile, specifically parameters of perceived self-control (PSC) and locus of control (LOC), might impact these strategies and quality of life (QOL). Thirdly, we review the external supports that can help patients to better predict seizures. Finally, we look at nonpharmacological means of increasing perceived self-control and achieving potential reduction of seizure frequency (i.e., stress-based and arousal-based strategies). In the past few years, various approaches for detection and control of seizures have gained greater interest, but more research is needed to confirm a positive effect on seizure frequency as well as on QOL.
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Affiliation(s)
- Iliana Kotwas
- Laboratoire Parole et Langage UMR 7309, Aix-Marseille Université, Marseille, France
| | - Aileen McGonigal
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, Rue Saint-Pierre, 13005 Marseille, France; Unité Mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Agnès Trebuchon
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, Rue Saint-Pierre, 13005 Marseille, France; Unité Mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | | | - Yoko Nagai
- Psychiatry, Brighton and Sussex Medical School, University of Sussex, UK; Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, UK
| | - Fabrice Bartolomei
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, Rue Saint-Pierre, 13005 Marseille, France; Unité Mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Jean-Arthur Micoulaud-Franchi
- Service d'Explorations Fonctionnelles du Système Nerveux, Clinique du Sommeil, CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, CHU Pellegrin, Université de Bordeaux, France
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Dyck MS, Mathiak KA, Bergert S, Sarkheil P, Koush Y, Alawi EM, Zvyagintsev M, Gaebler AJ, Shergill SS, Mathiak K. Targeting Treatment-Resistant Auditory Verbal Hallucinations in Schizophrenia with fMRI-Based Neurofeedback - Exploring Different Cases of Schizophrenia. Front Psychiatry 2016; 7:37. [PMID: 27014102 PMCID: PMC4791600 DOI: 10.3389/fpsyt.2016.00037] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/29/2016] [Indexed: 01/13/2023] Open
Abstract
Auditory verbal hallucinations (AVHs) are a hallmark of schizophrenia and can significantly impair patients' emotional, social, and occupational functioning. Despite progress in psychopharmacology, over 25% of schizophrenia patients suffer from treatment-resistant hallucinations. In the search for alternative treatment methods, neurofeedback (NF) emerges as a promising therapy tool. NF based on real-time functional magnetic resonance imaging (rt-fMRI) allows voluntarily change of the activity in a selected brain region - even in patients with schizophrenia. This study explored effects of NF on ongoing AVHs. The selected participants were trained in the self-regulation of activity in the anterior cingulate cortex (ACC), a key monitoring region involved in generation and intensity modulation of AVHs. Using rt-fMRI, three right-handed patients, suffering from schizophrenia and ongoing, treatment-resistant AVHs, learned control over ACC activity on three separate days. The effect of NF training on hallucinations' severity was assessed with the Auditory Vocal Hallucination Rating Scale (AVHRS) and on the affective state - with the Positive and Negative Affect Schedule (PANAS). All patients yielded significant upregulation of the ACC and reported subjective improvement in some aspects of AVHs (AVHRS) such as disturbance and suffering from the voices. In general, mood (PANAS) improved during NF training, though two patients reported worse mood after NF on the third day. ACC and reward system activity during NF learning and specific effects on mood and symptoms varied across the participants. None of them profited from the last training set in the prolonged three-session training. Moreover, individual differences emerged in brain networks activated with NF and in symptom changes, which were related to the patients' symptomatology and disease history. NF based on rt-fMRI seems a promising tool in therapy of AVHs. The patients, who suffered from continuous hallucinations for years, experienced symptom changes that may be attributed to the NF training. In order to assess the effectiveness of NF as a therapeutic method, this effect has to be studied systematically in larger groups; further, long-term effects need to be assessed. Particularly in schizophrenia, future NF studies should take into account the individual differences in reward processing, fatigue, and motivation to develop individualized training protocols.
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Affiliation(s)
- Miriam S Dyck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Krystyna A Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susanne Bergert
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Pegah Sarkheil
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Yury Koush
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Eliza M Alawi
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Mikhail Zvyagintsev
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Arnim J Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Sukhi S Shergill
- Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Jülich-Aachen Research Alliance (JARA)-Brain, RWTH Aachen University, Aachen, Germany; Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Kotwas I, Micoulaud-Franchi JA, Bartolomei F, Nagai Y. Commentary: Integrating electrodermal biofeedback into pharmacologic treatment of grand mal seizures. Front Hum Neurosci 2015; 9:666. [PMID: 26778991 PMCID: PMC4689128 DOI: 10.3389/fnhum.2015.00666] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/23/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Iliana Kotwas
- Laboratoire Parole et Langage (UMR 7309), Aix-Marseille UniversitéMarseille, France
| | - Jean-Arthur Micoulaud-Franchi
- Service d'Explorations Fonctionnelles du Système Nerveux, Clinique du Sommeil, Centre Hospitalier Universitaire de BordeauxBordeaux, France
- Centre National de la Recherche Scientifique, USR 3413 SANPSY, Centre Hospitalier Universitaire Pellegrin, Université de BordeauxBordeaux, France
| | - Fabrice Bartolomei
- Service de Neurophysiologie Clinique, Centre Hospitalier Universitaire de la TimoneMarseille, France
- Institut National de la Santé et de la Recherche Médicale, UMR 751 Epilepsie et CognitionMarseille, France
| | - Yoko Nagai
- Psychiatry, Brighton and Sussex Medical School, University of SussexLondon, UK
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College LondonLondon, UK
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Caria A, de Falco S. Anterior insular cortex regulation in autism spectrum disorders. Front Behav Neurosci 2015; 9:38. [PMID: 25798096 PMCID: PMC4351628 DOI: 10.3389/fnbeh.2015.00038] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/02/2015] [Indexed: 11/13/2022] Open
Abstract
Autism spectrum disorders (ASDs) comprise a heterogeneous set of neurodevelopmental disorders characterized by dramatic impairments of interpersonal behavior, communication, and empathy. Recent neuroimaging studies suggested that ASD are disorders characterized by widespread abnormalities involving distributed brain network, though clear evidence of differences in large-scale brain network interactions underlying the cognitive and behavioral symptoms of ASD are still lacking. Consistent findings of anterior insula cortex hypoactivation and dysconnectivity during tasks related to emotional and social processing indicates its dysfunctional role in ASD. In parallel, increasing evidence showed that successful control of anterior insula activity can be attained using real-time fMRI paradigms. More importantly, successful regulation of this region was associated with changes in behavior and brain connectivity in both healthy individuals and psychiatric patients. Building on these results we here propose and discuss the use of real-time fMRI neurofeedback in ASD aiming at improving emotional and social behavior.
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Affiliation(s)
- Andrea Caria
- Institut für Medizinische Psychologie und Verhaltensneurobiologie, Eberhard Karls Universität Tübingen Tübingen, Germany ; Fondazione Ospedale San Camillo IRCCS Venezia, Italy
| | - Simona de Falco
- Department of Psychology and Cognitive Science, University of Trento Rovereto, Italy
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Ros T, J Baars B, Lanius RA, Vuilleumier P. Tuning pathological brain oscillations with neurofeedback: a systems neuroscience framework. Front Hum Neurosci 2014; 8:1008. [PMID: 25566028 PMCID: PMC4270171 DOI: 10.3389/fnhum.2014.01008] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/26/2014] [Indexed: 12/03/2022] Open
Abstract
Neurofeedback (NFB) is emerging as a promising technique that enables self-regulation of ongoing brain oscillations. However, despite a rise in empirical evidence attesting to its clinical benefits, a solid theoretical basis is still lacking on the manner in which NFB is able to achieve these outcomes. The present work attempts to bring together various concepts from neurobiology, engineering, and dynamical systems so as to propose a contemporary theoretical framework for the mechanistic effects of NFB. The objective is to provide a firmly neurophysiological account of NFB, which goes beyond traditional behaviorist interpretations that attempt to explain psychological processes solely from a descriptive standpoint whilst treating the brain as a “black box”. To this end, we interlink evidence from experimental findings that encompass a broad range of intrinsic brain phenomena: starting from “bottom-up” mechanisms of neural synchronization, followed by “top-down” regulation of internal brain states, moving to dynamical systems plus control-theoretic principles, and concluding with activity-dependent as well as homeostatic forms of brain plasticity. In support of our framework, we examine the effects of NFB in several brain disorders, including attention-deficit hyperactivity (ADHD) and post-traumatic stress disorder (PTSD). In sum, it is argued that pathological oscillations emerge from an abnormal formation of brain-state attractor landscape(s). The central thesis put forward is that NFB tunes brain oscillations toward a homeostatic set-point which affords an optimal balance between network flexibility and stability (i.e., self-organised criticality (SOC)).
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Affiliation(s)
- Tomas Ros
- Laboratory for Neurology and Imaging of Cognition, Department of Neurosciences, University of Geneva Geneva, Switzerland
| | - Bernard J Baars
- Theoretical Neurobiology, The Neurosciences Institute La Jolla, CA, USA
| | - Ruth A Lanius
- Department of Psychiatry, University of Western Ontario London, ON, Canada
| | - Patrik Vuilleumier
- Laboratory for Neurology and Imaging of Cognition, Department of Neurosciences, University of Geneva Geneva, Switzerland
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Strehl U. What learning theories can teach us in designing neurofeedback treatments. Front Hum Neurosci 2014; 8:894. [PMID: 25414659 PMCID: PMC4222234 DOI: 10.3389/fnhum.2014.00894] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/19/2014] [Indexed: 11/13/2022] Open
Abstract
Popular definitions of neurofeedback point out that neurofeedback is a process of operant conditioning which leads to self-regulation of brain activity. Self-regulation of brain activity is considered to be a skill. The aim of this paper is to clarify that not only operant conditioning plays a role in the acquisition of this skill. In order to design the learning process additional references have to be derived from classical conditioning, two-process-theory and in particular from skill learning and research into motivational aspects. The impact of learning by trial and error, cueing of behavior, feedback, reinforcement, and knowledge of results as well as transfer of self-regulation skills into everyday life will be analyzed in this paper. In addition to these learning theory basics this paper tries to summarize the knowledge about acquisition of self-regulation from neurofeedback studies with a main emphasis on clinical populations. As a conclusion it is hypothesized that learning to self-regulate has to be offered in a psychotherapeutic, i.e., behavior therapy framework.
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Affiliation(s)
- Ute Strehl
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen Tuebingen, Germany
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