Comparison of QEEG Findings before and after Onset of Post-COVID-19 Brain Fog Symptoms

A systematic review of quantitative EEG findings in Fibromyalgia, Chronic Fatigue Syndrome and Long COVID

Fibromyalgia Syndrome (FMS), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long COVID (LC) are similar multisymptom clinical syndromes but with difference in dominant symptoms in each individual. There is existing and emerging literature on possible functional alterations of the central nervous system in these conditions. This review aims to synthesise and appraise the literature on resting-state quantitative EEG (qEEG) in FMS, ME/CFS and LC, drawing on previous research on FMS and ME/CFS to help understand neuropathophysiology of the new condition LC. A systematic search of MEDLINE, Embase, CINHAL, PsycINFO and Web of Science databases for articles published between December 1994 and September 2023 was performed. Out of the initial 2510 studies identified, 17 articles were retrieved that met all the predetermined selection criteria, particularly of assessing qEEG changes in one of the three conditions compared to healthy controls. All studies scored moderate to high quality on the Newcastle-Ottawa scale. There was a general trend for decreased low-frequency EEG band activity (delta, theta, and alpha) and increased high-frequency EEG beta activity in FMS, differing to that found in ME/CFS. The limited LC studies included in this review focused mainly on cognitive impairments and showed mixed findings not consistent with patterns observed in FMS and ME/CFS. Our findings suggest different patterns of qEEG brainwave activity in FMS and ME/CFS. Further research is required to explore whether there are phenotypes within LC that have EEG signatures similar to FMS or ME/CFS. This could inform identification of reliable diagnostic markers and possible targets for neuromodulation therapies tailored to each clinical syndrome.

The effect of physical exercise during competitions and in simulated conditions on hormonal-neurophysiological relationships in kickboxers

K1-format kickboxing is a widely followed combat sport that requires intense physical exercise. However, research into the body's response to this type of combat is sparse. This study aims to assess the alterations in hormone levels and brain activity in elite kickboxers following an actual K1 bout and compare these changes with those observed in a control group engaged in a simulated fight exercise with a punchbag. The study included 100 male professional kickboxers, randomly divided into two groups: an experimental group (K1 fight) and a control group (simulated fight with a punchbag). Blood samples were obtained before and after exercise to evaluate testosterone (T) and cortisol concentrations (C). Concurrently, brain activity was recorded using quantitative electroencephalography (QEEG). After the activity in the experimental group mean testosterone level slightly, non-significantly decreased from 13.7 nmol/l to 12.4 nmol/l, while mean cortisol significantly (p < 0.001) increased from 313 to 570 nmol/l. In the control group after the exertion against a punchbag mean cortisol significantly (p < 0.001) increased from 334 to 452 nmol/l and testosterone increased non-significantly, from 15.1 to 16.3 nmol/l. In both groups, the testosterone/cortisol ratio (T/C ratio) showed significantly lower levels after the intervention (p < 0.001 and p < 0.032) in the experimental and control group respectively. The comparison of groups after exercise revealed significantly higher cortisol levels (experimental group x = 570 nmol/l; control group x = 452 nmol/l) and a significantly lower T/C ratio (experimental group x = 2.7; control group x = 3.9), (p = 0.001) in the experimental group. Significantly higher brain activity was found in selected leads after a bout (experimental group). Furthermore, in the experimental group, significant associations of weak to moderate strength were found between hormone fluctuations and selected areas of brain activity (p < 0.05). K1-format kickboxing induces a stress response, evident in the sharp changes in cortisol and testosterone levels. A notable observation was the inverse direction of changes in both hormones. Brain activity analysis indicated the potential influence of raised cortisol concentrations on specific brain areas. This study augments our understanding of the physiological responses during K1 kickboxing bouts and may inform the future evolution of this sport.

Clinical Implication of Maumgyeol Basic Biotypes-Electroencephalography- and Photoplethysmogram-Based Bwave State Inventory

OBJECTIVE

The development of individual subtypes based on biomarkers offers a cost-effective and timely avenue to comprehending individual differences pertaining to mental health, independent from individuals' subjective insights. Incorporating 2-channel electroencephalography (EEG) and photoplethysmogram (PPG), we sought to establish a subtype classification system with clinical relevance.

METHODS

One hundred healthy participants and 99 patients with psychiatric disorders were recruited. Classification thresholds were determined using the EEG and PPG data from 2,278 individuals without mental disorders, serving to classify subtypes in our sample of 199 participants. Multivariate analysis of variance was applied to examine psychological distinctions among these subtypes. K-means clustering was employed to verify the classification system.

RESULTS

The distribution of subtypes differed between healthy participants and those with psychiatric disorders. Cognitive abilities were contingent upon brain subtypes, while mind subtypes exhibited significant differences in symptom severity, overall health, and cognitive stress. K-means clustering revealed that the results of our theory-based classification and data-driven classification are comparable. The synergistic assessment of both brain and mind subtypes was also explored.

CONCLUSION

Our subtype classification system offers a concise means to access individuals' mental health. The utilization of EEG and PPG signals for subtype classification offers potential for the future of digital mental healthcare.

Resting-state EEG rhythms are abnormal in post COVID-19 patients with brain fog without cognitive and affective disorders

OBJECTIVES

Several persons experiencing post-covid-19 (post-COVID) with "brain fog" (e.g., fatigue, cognitive and psychiatric disorders, etc.) show abnormal resting-state electroencephalographic (rsEEG) rhythms reflecting a vigilance dysfunction. Here, we tested the hypothesis that in those post-COVID persons, abnormal rsEEG rhythms may occur even when cognitive and psychiatric disorders are absent.

METHODS

The experiments were performed on post-COVID participants about one year after hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Inclusion criteria included a "brain fog" claim, no pre-infection, and actual organic chronic disease. Matched controls (no COVID) were also enrolled. All participants underwent clinical/neuropsychological assessment (including fatigue assessment) and rsEEG recordings. The eLORETA freeware estimated regional rsEEG cortical sources at individual delta (<4 Hz), theta (4-7 Hz), and alpha (8-13 Hz) bands. Beta (14-30 Hz) and gamma (30-40 Hz) bands were pre-fixed.

RESULTS

More than 90% of all post-COVID participants showed no cognitive or psychiatric disorders, and 75% showed ≥ 2 fatigue symptoms. The post-COVID group globally presented lower posterior rsEEG alpha source activities than the Control group. This effect was more significant in the long COVID-19 patients with ≥ 2 fatigue symptoms.

CONCLUSIONS

In post-COVID patients with no chronic diseases and cognitive/psychiatric disorders, "brain fog" can be associated with abnormal posterior rsEEG alpha rhythms and subjective fatigue.

SIGNIFICANCE

These abnormalities may be related to vigilance and allostatic dysfunctions.

Effect of the COVID-19 Pandemic on Resting-State Brain Activity in Individuals with Tinnitus

This study looked at the possible effect of the COVID-19 pandemic on individuals who came to our clinic seeking relief from tinnitus. The performance of the subjects during the COVID-19 pandemic was compared with similar individuals who came to our clinic before the pandemic began. The study involved 50 adults with chronic tinnitus, made up of a study group (24 subjects tested during the COVID-19 pandemic of 2020-2021) and a control group before the pandemic began (26 subjects tested from 2013 to 2017). None of the 24 reported having contracted COVID-19. Data collection involved the Tinnitus Handicap Inventory (THI) questionnaire, audiological tests, and quantitative electroencephalography (qEEG). In terms of THI scores, there were no statistically significant differences between the two groups. However, with regard to qEEG, some changes were observed, with significant decreases in alpha and beta band activity in the study group compared to the control group, particularly over the auditory cortex. We conclude that COVID-19 did not have a discernible impact on the general well-being of individuals with tinnitus. However, it did appear to alter brain activity, specifically in the alpha and beta bands over the auditory cortex, and these reults warrant further investigation.

Cognitive function and quantitative electroencephalogram analysis in subjects recovered from COVID-19 infection

BACKGROUND & OBJECTIVES

Objective assessment of post-COVID-19 cognitive dysfunction is highly warranted. This study aimed to evaluate the cognitive dysfunction of COVID-19 survivors with cognitive complaints, both clinically and neurophysiologically, using Quantitative Electroencephalogram (QEEG).

METHODS

This case-control study was conducted on 50 recovered subjects from COVID-19 infection with cognitive complaints and 50 age, sex, and educational-matched healthy controls. Both groups were subjected to the following neurocognitive tests: Paired associate learning Test (PALT) and Paced Auditory Serial Addition Test (PASAT). The neurophysiological assessment was also done for both groups using QEEG.

RESULTS

COVID-19 survivors had significantly lower PALT scores than controls (P < 0.001). QEEG analysis found significantly higher levels of Theta / Beta ratio in both central and parietal areas in patients than in the controls (P < 0.001 for each). The interhemispheric coherence for the frontal, central, and parietal regions was also significantly lower in patients than in the control group regarding alpha and beta bands. There were statistically significant lower scores of PALT and PASAT among cases with severe COVID-19 infection (P = 0.011, 0.005, respectively) and those who needed oxygen support (P = 0.04, 0.01, respectively). On the other hand, a statistically significantly lower mean of frontal alpha inter-hemispheric coherence among patients with severe COVID-19 infection (P = 0.01) and those needing mechanical ventilation support (P = 0.04).

CONCLUSION

Episodic memory deficit is evident in COVID-19 survivors with subjective cognitive complaints accompanied by lower inter-hemispheric coherence in frontal regions. These clinical and neurophysiological changes are associated with hypoxia and COVID-19 severity.

Epidemiology of neurocognitive disorders in adults from urban-marginalized areas: a door-to-door population-based study in Puente Piedra, Lima, Peru

Background

In Latin America (LA), the prevalence of dementia is expected to triple to 150 million people by 2050. The 2020 Lancet Commission report identified several modifiable dementia risk factors, yet few social and environmental factors, most relevant to vulnerable regions of LA, were highlighted in this report. We sought to assess the epidemiology of neurocognitive disorders (NCD) in Puente Piedra, one of the most socially and economically vulnerable districts of Lima, the capital of Peru.

Methodology

This was a cross-sectional door-to-door observational study that used two-stage household sampling. One young adult (30-59 years) and one older adult (>60 years) per household were enrolled. We collected demographic, clinical, and neurocognitive data. Addenbrooke's Cognitive Examination (young adults) and the RUDAS-PE (older adults) were used, classifying participants as cognitively normal, possible mild NCD, or possible major NCD.

Results

We enrolled 247 participants (median age 46 years; 67% female). One-fourth had not completed secondary school and more than 50% completed only secondary school. Most participants were housewives (46%) and 21% did not have health insurance. The overall prevalence of possible NCD was 30% (25.6 and 41.8% among younger adults and older adults, respectively). Among younger adults, those ages 55-59 years more frequently had NCD (70%) compared to younger age ranges. Among older adults, only 3 subjects (4.5%) had major NCD.

Conclusion

We found a high frequency of possible NCDs in a socially and economically vulnerable community in Lima, Peru, with younger adults showing levels of NCD higher than expected. Our findings support the need for health systems to incorporate cognitive screenings programs for NCD in younger ages. Future research on NCD would include younger populations, particularly in vulnerable communities.

COVID-19 as a polymorphic inflammatory spectrum of diseases: a review with focus on the brain

There appear to be huge variations and aberrations in the reported data in COVID-19 2 years now into the pandemic. Conflicting data exist at almost every level and also in the reported epidemiological statistics across different regions. It is becoming clear that COVID-19 is a polymorphic inflammatory spectrum of diseases, and there is a wide range of inflammation-related pathology and symptoms in those infected with the virus. The host's inflammatory response to COVID-19 appears to be determined by genetics, age, immune status, health status and stage of disease. The interplay of these factors may decide the magnitude, duration, types of pathology, symptoms and prognosis in the spectrum of COVID-19 disorders, and whether neuropsychiatric disorders continue to be significant. Early and successful management of inflammation reduces morbidity and mortality in all stages of COVID-19.

The Use of Quantitative Electroencephalography (QEEG) to Assess Post-COVID-19 Concentration Disorders in Professional Pilots: An Initial Concept

Announced by WHO in 2020, the global COVID-19 pandemic caused by SARS-CoV-2 has affected many people, leading to serious health consequences. These consequences are observed in the daily lives of infected patients as various dysfunctions and limitations. More and more people are suffering post-COVID-19 complications that interfere with or completely prevent them from working or even functioning independently on a daily basis. The aim of our study was to demonstrate that innovative quantitative electroencephalography (QEEG) can be used to assess cognitive function disorders reported after the COVID-19 pandemic. It is worth noting that no similar study has been conducted to date in a group of pilots. The QEEG method we used is currently one of the basic neurological examinations, enabling easy observation of post-COVID-19 changes in the nervous system. With the innovativeness of this technique, our study shows that the use of quantitative electroencephalography can be a precursor in identifying complications associated with cognitive function disorders after COVID-19. Our study was conducted on twelve 26-year-old pilots. All participants had attended the same flight academy and had contracted SARS-CoV-2 infection. The pilots began to suspect COVID-19 infection when they developed typical symptoms such as loss of smell and taste, respiratory problems, and rapid fatigue. Quantitative electroencephalography (QEEG), which is one of the most innovative forms of diagnostics, was used to diagnose the patients. Comparison of the results between the study and control groups showed significantly higher values of all measurements of alpha, theta, and beta2 waves in the study group. In the case of the sensorimotor rhythm (SMR), the measurement results were significantly higher in the control group compared to the study group. Our study, conducted on pilots who had recovered from COVID-19, showed changes in the amplitudes of brain waves associated with relaxation and concentration. The results confirmed the issues reported by pilots as evidenced by the increased amplitudes of alfa, theta, and beta2 waves. It should be emphasized that the modern diagnostic method (QEEG) presented here has significant importance in the medical diagnosis of various symptoms and observation of treatment effects in individuals who have contracted the SARS-CoV-2 virus. The present study demonstrated an innovative approach to the diagnosis of neurological complications after COVID-19.

Lowered Delta Activity in Post-COVID-19 Patients with Fatigue and Cognitive Impairment

In post-COVID-19 syndrome (PCS), neurocognitive symptoms and fatigue are often associated with alterations in electroencephalographic (EEG) activity. The present study investigates the brain source activity at rest in PCS patients (PCS-pts) perceiving cognitive deficits and fatigue. A total of 18 PCS-pts and 18 healthy controls (HCs) were enrolled. A Montreal Cognitive Assessment (MoCA), Perceived Cognitive Difficulties Scale (PDCS) and Fatigue Severity Scale (FSS) were administered for assessing the symptoms' severity. Brain activity at rest, both with open (OE) and closed eyes (CE), was recorded by high-density EEG (Hd-EEG) and localized by source estimation. Compared to HCs, PCS-pts exhibited worse performance in executive functions, language and memory, and reported higher levels of fatigue. At resting OE state, PCS-pts showed lower delta source activity over brain regions known to be associated with executive processes, and these changes were negatively associated with PDCS scores. Consistent with recent literature data, our findings could indicate a dysfunction in the neuronal networks involved in executive functions in PCS-pts complaining of fatigue and cognitive impairment.

Preliminary Development of a Brainwave Model for K1 Kickboxers Using Quantitative Electroencephalography (QEEG) with Open Eyes

K1 kickboxing fighting is characterised by high injury rates due to the low restrictions of fighting rules. In recent years, much attention has been paid to research on changes in brain function among athletes, including those in combat sports. One of the tools that are likely to help diagnose and assess brain function is quantitative electroencephalography (QEEG). Therefore, the aim of the present study was an attempt to develop a brainwave model using quantitative electroencephalography in competitive K1 kickboxers. A total of thirty-six male individuals were purposefully selected and then comparatively divided into two groups. The first group consisted of specialised K1 kickboxing athletes exhibiting a high level of sports performance (experimental group, n = 18, mean age: 29.83 ± 3.43), while the second group comprised healthy individuals not training competitively (control group, n = 18, mean age: 26.72 ± 1.77). Body composition assessment was performed in all participants before the main measurement process. Measurements were taken for kickboxers during the de-training period, after the sports competition phase. Quantitative electroencephalography of Delta, Theta, Alpha, sensimotor rhytm (SMR), Beta1 and Beta2 waves was performed using electrodes placed on nine measurement points (frontal: FzF3F4, central: CzC3C4, and parietal: PzP3P4) with open eyes. In the course of the analyses, it was found that the level of brain activity among the study population significantly differentiated the K1 formula competitors compared with the reference standards and the control group in selected measurement areas. For kickboxers, all results of the Delta amplitude activity in the area of the frontal lobe were significantly above the normative values for this wave. The highest value was recorded for the average value of the F3 electrode (left frontal lobe), exceeding the norm by 95.65%, for F4 by 74.45% and Fz by 50.6%, respectively. In addition, the Alpha wave standard value for the F4 electrode was exceeded by 14.6%. Normative values were found for the remaining wave amplitudes. Statistically significant differentiation of results, with a strong effect (d = 1.52-8.41), was shown for the activity of Delta waves of the frontal area and the central part of the parietal area (Fz,F3,F4,Cz-p < 0.001), Theta for the frontal area as well as the central and left parietal lobes (Fz,F3,F4-p < 0.001, Cz-p = 0.001, C3-p = 0.018; d = 1.05-3.18), Alpha for the frontal, parietal and occipital areas (for: Fz,F3-p < 0.001, F4-p = 0.036, Cz-p < 0.001, C3-p = 0.001, C4-p = 0.025, Pz-p = 0.010, P3-p < 0.001, P4-p = 0.038; d = 0.90-1.66), SMR for the central parietal and left occipital lobes (Cz-p = 0.043; d = 0.69, P3-p < 0.001; d = 1.62), Beta for the frontal area, occipital and central lobes and left parietal segment (Fz,F3-p < 0.001, F4-p = 0.008, Cz, C3, Pz, P3,P4-p < 0.001; d = 1.27-2.85) and Beta 2 for all measurement areas (Fz, F3, F4, Cz, C3, C4, Pz, P3, P4-p < 0.001; d = 1.90-3.35) among the study groups. Significantly higher results were shown in the kickboxer group compared to the control. In addition to problems with concentration or over-stimulation of neural structures, high Delta waves, with elevated Alpha, Theta and Beta 2 waves, can cause disorders in the limbic system and problems in the cerebral cortex.

Effects of Multidisciplinary Rehabilitation Enhanced with Neuropsychological Treatment on Post-Acute SARS-CoV-2 Cognitive Impairment (Brain Fog): An Observational Study

Concentration and memory impairment (named "brain fog") represents a frequent and disabling neuropsychological sequela in post-acute COVID-19 syndrome (PACS) patients. The aim of this study was to assess whether neurocognitive function could improve after a multidisciplinary rehabilitation program enhanced with individualized neuropsychological treatment. A prospective monocentric registry of PACS patients consecutively admitted to our Rehabilitation Unit was created. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive impairment at admission and discharge. A total of sixty-four (64) PACS patients, fifty-six (56) of them with brain fog, were treated with a day-by-day individualized psychological intervention of cognitive stimulation (45 min) on top of a standard in-hospital rehabilitation program. The mean duration of the acute-phase hospitalization was 55.8 ± 25.8 days and the mean in-hospital rehabilitation duration was 30 ± 10 days. The mean age of the patients was 67.3 ± 10.4 years, 66% of them were male, none had a previous diagnosis of dementia, and 66% of the entire sample had experienced severe COVID-19. At admission, only 12% of the patients had normal cognitive function, while 57% showed mild, 28% moderate, and 3% severe cognitive impairment. After psychological treatment, a significant improvement in the MoCA score was found (20.4 ± 5 vs. 24.7 ± 3.7; p < 0.0001) as a result of significant amelioration in the following domains: attention task (p = 0.014), abstract reasoning (p = 0.003), language repetition (p = 0.002), memory recall (p < 0.0001), orientation (p < 0.0001), and visuospatial abilities (p < 0.0001). Moreover, the improvement remained significant after multivariate analysis adjusted for several confounding factors. Finally, at discharge, 43% of the patients with cognitive impairment normalized their cognitive function, while 4.7% were discharged with residual moderate cognitive impairment. In conclusion, our study provides evidence of the effects of multidisciplinary rehabilitation enhanced with neuropsychological treatment on improvement in the cognitive function of post-acute COVID-19 patients.

An Attempt to Develop a Model of Brain Waves Using Quantitative Electroencephalography with Closed Eyes in K1 Kickboxing Athletes-Initial Concept

BACKGROUND

Brain injuries are a common problem in combat sports, especially in disciplines such as kickboxing. Kickboxing is a combat sport that has several variations of competition, with the most contact-oriented fights being carried out under the format of K-1 rules. While these sports require a high level of skill and physical endurance, frequent micro-traumas to the brain can have serious consequences for the health and well-being of athletes. According to studies, combat sports are one of the riskiest sports in terms of brain injuries. Among the sports disciplines with the highest number of brain injuries, boxing, mixed martial arts (MMA), and kickboxing are mentioned.

METHODS

The study was conducted on a group of 18 K-1 kickboxing athletes who demonstrate a high level of sports performance. The subjects were between the ages 18 and 28. QEEG (quantitative electroencephalogram) is a numeric spectral analysis of the EEG record, where the data is digitally coded and statistically analysed using the Fourier transform algorithm. Each examination of one person lasts about 10 min with closed eyes. The wave amplitude and power for specific frequencies (Delta, Theta, Alpha, Sensorimotor Rhythm (SMR), Beta 1, and Beta2) were analysed using 9 leads.

RESULTS

High values were shown in the Alpha frequency for central leads, SMR in the Frontal 4 (F4 lead), Beta 1 in leads F4 and Parietal 3 (P3), and Beta2 in all leads.

CONCLUSIONS

The high activity of brainwaves such as SMR, Beta and Alpha can have a negative effect on the athletic performance of kickboxing athletes by affecting focus, stress, anxiety, and concentration. Therefore, it is important for athletes to monitor their brainwave activity and use appropriate training strategies to achieve optimal results.

Investigating brain cortical activity in patients with post-COVID-19 brain fog

Brain fog is a kind of mental problem, similar to chronic fatigue syndrome, and appears about 3 months after the infection with COVID-19 and lasts up to 9 months. The maximum magnitude of the third wave of COVID-19 in Poland was in April 2021. The research referred here aimed at carrying out the investigation comprising the electrophysiological analysis of the patients who suffered from COVID-19 and had symptoms of brain fog (sub-cohort A), suffered from COVID-19 and did not have symptoms of brain fog (sub-cohort B), and the control group that had no COVID-19 and no symptoms (sub-cohort C). The aim of this article was to examine whether there are differences in the brain cortical activity of these three sub-cohorts and, if possible differentiate and classify them using the machine-learning tools. he dense array electroencephalographic amplifier with 256 electrodes was used for recordings. The event-related potentials were chosen as we expected to find the differences in the patients' responses to three different mental tasks arranged in the experiments commonly known in experimental psychology: face recognition, digit span, and task switching. These potentials were plotted for all three patients' sub-cohorts and all three experiments. The cross-correlation method was used to find differences, and, in fact, such differences manifested themselves in the shape of event-related potentials on the cognitive electrodes. The discussion of such differences will be presented; however, an explanation of such differences would require the recruitment of a much larger cohort. In the classification problem, the avalanche analysis for feature extractions from the resting state signal and linear discriminant analysis for classification were used. The differences between sub-cohorts in such signals were expected to be found. Machine-learning tools were used, as finding the differences with eyes seemed impossible. Indeed, the A&B vs. C, B&C vs. A, A vs. B, A vs. C, and B vs. C classification tasks were performed, and the efficiency of around 60-70% was achieved. In future, probably there will be pandemics again due to the imbalance in the natural environment, resulting in the decreasing number of species, temperature increase, and climate change-generated migrations. The research can help to predict brain fog after the COVID-19 recovery and prepare the patients for better convalescence. Shortening the time of brain fog recovery will be beneficial not only for the patients but also for social conditions.

MiniQEEG and Neurofeedback in Diagnosis and Treatment of COVID-19-Related Panic Attacks: A Case Report

BACKGROUND

Both the global COVID-19 pandemic situation, as well as the current political situation in Eastern Europe may exacerbate anxiety and contribute to stress-related disorders such as panic disorder. Electroencephalography (EEG)-based neurofeedback provides both assessment of the subject's brainwave activity as well as the possibility of its therapeutic correction. It is possible that it can be implemented as an auxiliary treatment in panic disorders of different origin. The aim of this feasibility study was to demonstrate (both short- and long-term) effectiveness of neurofeedback therapy in a patient with previously diagnosed panic attacks, related to fear of COVID-19 infection.

METHODS

We report the case study of a 47-year-old man affected by panic attacks, related to his profound, constant fear of COVID-19 infection and its sequelae. For the initial diagnostic workup, several clinical and research tools were used: 1. Baseline psychological exam; 2. Anxiety-targeted interview performed by miniQEEG therapist; 3. Analysis of previous clinical test results (EEG record/lab blood test); and 4. The miniQEEG exam (central strip recording Cz-C3-C4), The patient was subjected to regular EEG Neurofeedback sessions for two consecutive months. After completing the treatment, follow-up tests, as listed above were repeated immediately after completing the whole treatment program, as well as 1 and 2 years later. MiniQEEG results were compared with healthy control (age-matched male subject not affected with panic attacks) and evaluated over the time that the subject was involved in the study.

RESULTS

Initially, the patient was suffering from severe panic attacks accompanied by vegetative symptoms and from destructive and negative thoughts. After 8 consecutive weeks of treatment encompassing sixteen QEEG neurofeedback training sessions (each lasting 30 min), a subjective improvement of his complaints was reported. More importantly, QEEG records of the patient also improved, approximating the pattern of QEEG recorded in the healthy control.

CONCLUSION

In this single case-based feasibility analysis, we demonstrate that systematic application of QEEG-Neurofeedback may result in manifest and durable therapeutic effect. Of note, use of this treatment may be a valuable option for patients with panic attack/panic disorder, especially if related to the psychological burden of the COVID-19/war era. Future studies on a larger patient population, especially with a longitudinal/prospective design, are warranted.