Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis

Jessica van Doren, Martijn Arns, Hartmut Heinrich, Madelon A. Vollebregt, Ute Strehl, Sandra K.

European Child & Adolescent Psychiatry, 14 February 2018

Abstract

München, 26.02.2018. Eine Studie, die gerade in der medizinischen Fachzeitschrift European Child & Adolescent Psychiatry veröffentlicht wurde, zeigt, dass Neurofeedback langfristig positive Auswirkungen auf Kinder mit ADHS hat.

Neurofeedback ist eine nicht-invasive Therapie, mit der die Gehirnaktivität trainiert wird, indem EEG-Wellen über Elektroden auf einem Computerbildschirm visualisiert und dem Patienten in Echtzeit zurückgemeldet werden. Es ist nachgewiesen, dass Kinder mit AHS/ADHS durch Neurofeedback ihre ADHS-­Symptome, insbesondere die Unaufmerksamkeit und Impulsivität, verbessern können. Für die Wissenschaftler galt es nun zu überprüfen, ob die genannten Wirkungen dauerhaft sind und ob die Methode eine sinnvolle Alternative zur Verschreibung von Medikamenten darstellt.

In der vorliegenden Studie haben die Forscher die Daten von mehr als 500 Kindern mit ADHS zusammengestellt und die Ergebnisse von Neurofeedback, Medikamentengabe und “inaktiven” (keine Behandlung) Bedingungen verglichen. Um die Daten so kritisch wie möglich zu interpretieren, waren an der Auswertung Forscher mit ganz unterschiedlichen Ansichten zu Neurofeedback beteiligt.

Sie fanden heraus, dass die Wirkung von Neurofeedback über einen längeren Zeitraum anhält, wobei bedeutende Besserungen 6 Monate nach Ende der Therapie beobachtet wurden. Darüber hinaus zeigte sich, dass die Verbesserungen durch Neurofeedback nicht nur bestehen bleiben, sondern sich tendenziell nach dem Therapieende sogar weiter steigern, ohne dass weitere Trainingssitzungen erforderlich sind.

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Neurofeedback for subjective tinnitus patients

Andrea Crocetti - Stella Forti - Luca Del Bo

Abstract

Objective: Previous studies report that enhanced power in the delta range (1.5–4 Hz) and reduced power in the alpha frequency band (8–12 Hz) were most pronounced in the temporal regions. These studies referred to the 8–12 Hz activity as tau activity, and they created a new neurofeedback protocol to treat tinnitus using a temporally generated tau rhythm (8–12 Hz) and slow waves in the delta range (3–4 Hz) for feedback. This study aims to repeat this protocol and to evaluate its effect on tinnitus.

Methods: Fifteen normal-hearing patients with tinnitus were treated with the neurofeedback protocol. The Tinnitus Handicap Inventory and Visual Analogue Scales were administered before and after treatment and at 1, 3 and 6 months post-treatment.

Results: After therapy, all questionnaires scores were significant improved, and the improvements persisted throughout the followup period. Moreover, an increasing trend in the tau/delta ratio was observed; specifically, the trend was more stable respect of the pre-recording measure.
However, only in some subjects may the signal alone be enough to develop the correct behaviors.

Conclusion: Further studies are necessary to characterize the tinnitus subjects who recovered from and adapted to this psychophysical condition and, therefore, responded to neurofeedback therapy.

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Neurofeedback for Insomnia: A Pilot Study of Z-Score SMR and Individualized Protocols

Abstract

Insomnia is an epidemic in the US. Neurofeedback (NFB) is a little used, psychophysiological treatment with demonstrated usefulness for treating insomnia. Our objective was to assess whether two distinct Z-Score NFB protocols, a modified sensorimotor (SMR) protocol and a sequential, quantitative EEG (sQEEG)-guided, individually designed (IND) protocol, would alleviate sleep and associated daytime dysfunctions of participants with insomnia. Both protocols used instantaneous Z scores to determine reward condition administered when awake. Twelve adults with insomnia, free of other mental and uncontrolled physical illnesses, were randomly assigned to the SMR or IND group. Eight completed this randomized, parallel group, single-blind study. Both groups received fifteen 20-min sessions of Z-Score NFB. Pre-post assessments included sQEEG, mental health, quality of life, and insomnia status. ANOVA yielded significant post-treatment improvement for the combined group on all primary insomnia scores: Insomnia Severity Index (ISI p<.005), Pittsburgh Sleep Quality Inventory (PSQI p<.0001), PSQI Sleep Efficiency (p<.007), and Quality of Life Inventory (p<.02). Binomial tests of baseline EEGs indicated a significant proportion of excessively high levels of Delta and Beta power (p<.001) which were lowered post-treatment (paired z-tests p<.001). Baseline EEGs showed excessive sleepiness and hyperarousal, which improved post-treatment. Both Z-Score NFB groups improved in sleep and daytime functioning. Post-treatment, all participants were normal sleepers. Because there were no significant differences in the findings between the two groups, our future large scale studies will utilize the less burdensome to administer Z-Score SMR protocol.

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EEG Biofeedback Treatment Improves Certain Attention and Somatic Symptoms in Fibromyalgia: A Pilot Study

Abstract

Fibromyalgia (FMS) is a chronic, painful disorder often associated with measurable deficiencies in attention. Since EEG biofeedback (EEG-BF) has been used successfully to treat attention problems, we reasoned that this modality might be helpful in the treatment of attention problems in FMS. We also speculated that improvement in central nervous system (CNS) function might be accompanied by improvement in FMS somatic symptoms. We studied fifteen FMS patients with attention problems, demonstrated by visual and auditory continuous performance testing (CPT), while completing 40 or more EEG-BF sessions. Training consisted of a "SMR protocol" that augmented 12-15 Hz brainwaves (sensory motor rhythm; SMR), while simultaneously inhibiting 4-7 Hz brainwaves (theta) and 22-30 Hz brainwaves (high beta). Serial measurements of pain, fatigue, psychological distress, morning stiffness, and tenderness were also obtained. Sixty-three FMS patients who received standard medical care, but who did not receive EEG-BF, served as controls. Visual, but not auditory, attention improved significantly (P < 0.008). EEG-BF treated subjects also showed improvement in tenderness, pain and fatigue. Somatic symptoms did not change significantly in controls. Visual attention parameters and certain somatic features of FMS appear to improve with an EEG-BF SMR protocol. EEG-BF training in FMS deserves further study.

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Effects of Neurofeedback Training with an Electroencephalogram-Based Brain-Computer Interface for Hand Paralysis in Patients with Chronic Stroke: A  Preliminary Case Series Study

Abstract

Objective:
To explore the effectiveness of neurorehabilitative training using an electroencephalogram-based brain- computer interface for hand paralysis following stroke.

Design:
A case series study.

Subjects:
Eight outpatients with chronic stroke demonstrating moderate to severe hemiparesis.

Methods:
Based on analysis of volitionally decreased amplitudes of sensory motor rhythm during motor imagery involving extending the affected fingers, real-time visual feedback was provided. After successful motor imagery, a mechanical orthosis partially extended the fingers. Brain-computer interface interventions were carried out once or twice a week for a period of 4-7 months, and clinical and neurophysiological examinations pre- and post-intervention were compared.

Results:
New voluntary electromyographic activity was measured in the affected finger extensors in 4 cases who had little or no muscle activity before the training, and the other participants exhibited improvement in finger function. Significantly greater suppression of the sensory motor rhythm over both hemispheres was observed during motor imagery. Transcranial magnetic stimulation showed increased cortical excitability in the damaged hemisphere. Success rates of brain-computer interface training tended to increase as the session progressed in 4 cases.

Conclusion:
Brain-computer interface training appears to have yielded some improvement in motor function and brain plasticity. Further controlled research is needed to clarify the role of the brain-computer interface system.

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zusammengestellt vom Schoresch-Zentrum für klinisch angewandtes Neurofeedback