Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: a comparison with methylphenidate

Clinical trials have suggested that neurofeedback may be efficient in treating attention-deficit/hyperactivity disorder (ADHD). We compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm (12–15 Hz) and beta1 activity (15–18 Hz) with stimulant medication. Participants were N = 34 children aged 8–12 years, 22 of which were assigned to the neurofeedback group and 12 to the methylphenidate group according to their parents' preference. Both neurofeedback and methylphenidate were associated with improvements on all subscales of the Test of Variables of Attention, and on the speed and accuracy measures of the d2 Attention Endurance Test. Furthermore, behaviors related to the disorder were rated as significantly reduced in both groups by both teachers and parents on the IOWA-Conners Behavior Rating Scale. These findings suggest that neurofeedback was efficient in improving some of the behavioral concomitants of ADHD in children whose parents favored a nonpharmacological treatment.     

The effects of stimulant therapy,EEG biofeedback,and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder

One hundred children, ages 6–19, who were diagnosed with attention-deficit/hyperactivity disorder (ADHD), either inattentive or combined types, participated in a study examining the effects of Ritalin, EEG biofeedback, and parenting style on the primary symptoms of ADHD. All of the patients participated in a 1-year, multimodal, outpatient program that included Ritalin, parent counseling, and academic support at school (either a 504 Plan or an IEP). Fifty-one of the participants also received EEG biofeedback therapy. Posttreatment assessments were conducted both with and without stimulant therapy. Significant improvement was noted on the Test of Variables of Attention (TOVA; L. M. Greenberg, 1996) and the Attention Deficit Disorders Evaluation Scale (ADDES; S. B. McCarney, 1995) when participants were tested while using Ritalin. However, only those who had received EEG biofeedback sustained these gains when tested without Ritalin. The results of a Quantitative Electroencephalographic Scanning Process (QEEG-Scan; V. J. Monastra et al., 1999) revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback. Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school.     

Effect of Biofeedback Training of Sensorimotor and β1EEG Rhythms on Attention Parameters

The effects of the EEG–biofeedback (EEG–BFB) procedure, aimed at increasing the sensorimotor (12–15 Hz) and (15–18 Hz) rhythms on the psychological and electrophysiological parameters of attention, were studied using the methods of scalp recording of evoked potentials in the bistimulus paradigm Go/No–Go and a psychological attention test (Test of Variables of Attention; TOVA). Twenty-five children with attention disorders were included in the study. EEG–BFB sessions significantly improved the attention, behavior, and school study results in 19 (76%) children. In these cases, a significant increase in the amplitude of the inhibitory component in the frontocentral leads and improvement of the TOVA parameters were found.     

Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores,behavioral ratings,and WISC-R performance

A study with three component parts was performed to assess the effectiveness of neurofeedback treatment for Attention Deficit/Hyperactivity Disorder (ADHD). The subject pool consisted of 23 children and adolescents ranging in age from 8 to 19 years with a mean of 11.4 years who participated in a 2-to 3-month summer program of intensive neurofeedback training. Feedback was contingent on the production of 16–20 hertz (beta) activity in the absence of 4–8 hertz (theta) activity. Posttraining changes in EEG activity, T.O.V.A. performance, (ADDES) behavior ratings, and WISC-R performance were assessed. Part I indicated that subjects who successfully decreased theta activity showed significant improvement in T.O.V.A. performance; Part II revealed significant improvement in parent ratings following neurofeedback training; and Part III indicated significant increases in WISC-R scores following neurofeedback training. This study is significant in that it examines the effects of neurofeedback training on both objective and subjective measures under relatively controlled conditions. Our findings corroborate and extend previous research, indicating that neurofeedback training can be an appropriate and efficacious treatment for children with ADHD.The first author (Joel F. Lubar) has provided consultative services for both Lexicor and Stoelting-Autogenics Corporations in order to help them develop appropriate protocols for neurofeedback. He is not an owner, stockholder, or employee for either organization.     

Modulation of attention in healthy children using a course of EEG-feedback sessions

We studied changes in the power spectra of EEG in the course of sessions of feedback by EEG characteristics (neurofeedback sessions) and estimated the effects of neurofeedback on psychological and EEG correlates of voluntary attention. Indices of the latter were estimated using Bourdon’s test (a correcture test) and Schulte’s tables. Twenty-nine reasonably healthy 10-to 13-year-old children took part in the study; they were divided into two groups, an experimental group (n = 12) and a control group (n = 15). The results obtained support the statement on noticeable changes in the functional state of the brain both immediately in the course of a neurofeedback session and after a course of such trainings. Changes in the ratios of the spectral powers of the beta₁ vs theta rhythms and the low-frequency beta vs theta rhythms were found in EEG recorded from the sensorimotor zone of the right hemisphere (C4). The observed changes in the spectral characteristics of EEG induced by the course of neurofeedback sessions were accompanied by the improvement of a few indices of voluntary attention. Neirofiziologiya/Neurophysiology, Vol. 38, Nos. 5/6, pp. 458–465, September–December, 2006.     

The Effects of QEEG-Informed Neurofeedback in ADHD: An Open-Label Pilot Study

In ADHD several EEG biomarkers have been described before, with relevance to treatment outcome to stimulant medication. This pilot-study aimed at personalizing neurofeedback treatment to these specific sub-groups to investigate if such an approach leads to improved clinical outcomes. Furthermore, pre- and post-treatment EEG and ERP changes were investigated in a sub-group to study the neurophysiological effects of neurofeedback. Twenty-one patients with ADHD were treated with QEEG-informed neurofeedback and post-treatment effects on inattention (ATT), hyperactivity/impulsivity (HI) and comorbid depressive symptoms were investigated. There was a significant improvement for both ATT, HI and comorbid depressive complaints after QEEG-informed neurofeedback. The effect size for ATT was 1.78 and for HI was 1.22. Furthermore, anterior individual alpha peak frequency (iAPF) demonstrated a strong relation to improvement on comorbid depressive complaints. Pre- and post-treatment effects for the SMR neurofeedback sub-group exhibited increased N200 and P300 amplitudes and decreased SMR EEG power post-treatment. This pilot study is the first study demonstrating that it is possible to select neurofeedback protocols based on individual EEG biomarkers and suggests this results in improved treatment outcome specifically for ATT, however these results should be replicated in further controlled studies. A slow anterior iAPF at baseline predicts poor treatment response on comorbid depressive complaints in line with studies in depression. The effects of SMR neurofeedback resulted in specific ERP and EEG changes.     

Neocortical Dynamics: Implications for Understanding the Role of Neurofeedback and Related Techniques for the Enhancement of Attention

For nearly 25 years, EEG biofeedback (neurofeedback) has been utilized in research and clinical settings for the treatment and investigation of a number of disorders ranging from attention deficit hyperactivity disorder to seizure disorders as well as many other established and investigational applications. Until recently, mechanisms underlying the generation and origins of EEG have been poorly understood but now are beginning to become much more clarified. Now it is important to combine the information gathered on the genesis of EEG and neocortical dynamics with the findings from neurofeedback investigations. This will help us to develop models of how neurofeedback might operate in producing the changes in EEG and in clinical symptomatology. We know that the cortex operates in terms of resonant loops between neocortical columns of cells known as local, regional, and global resonances. These resonances determine the specific EEG frequencies and are often activated by groups of cells in the thalamus known as pacemakers. There are complex excitatory and inhibitory interactions within the cortex and between the cortex and the thalamus that allow these loops to operate and provide the basis for learning. Neurofeedback is a technique for modifying these resonant loops, and hence, modifying the neurophysiological and neurological basis for learning and for the management of a number of neurologically based disorders. This paper provides an introduction to understanding EEG and neocortical dynamics and how these concepts can be used to explain the results of neurofeedback training and other interventions particularly in the context of understanding attentive mechanisms and for the management of attention deficit/hyperactivity disorders.     

Changes in EEG Rhythms and Spike Activity of Brainstem Dopaminergic Neurons Induced by Neurofeedback Sessions in Cats

We examined the dynamics of the ratios of spectral power densities (SPDs) of the alpha vs theta rhythms (α/θ ratio). of EEG and of the spiking frequency of supposedly dopaminergic (DA) neurons of the ventral tegmentum in the course of neurofeedback sessions directed toward changes in the EEG characteristics. Trainings were performed using techniques analogous to that used in neurofeedback sessions in humans. The level of the noise acoustic signal presented to the animal decreased with increase in the α/θ ratio in the occipital leads. In the control realizations, there were no dependences between the intensity of the acoustic signal and modulation of the current EEG. It was found that the animals learned, in a conditioned-reflex mode, to correlate changes in the intensity of the sound signal and power of the EEG rhythms and to control the latter; a high sound intensity was probably considered a factor of discomfort. The α/θ ratio in the course of neurofeedback sessions changed due to some increase in the SPD of the alpha EEG component and a noticeable drop in the SPD of theta oscillations. In a parallel manner with such modifications, augmentation of the spike activity of DA neurons was observed. Probable mechanisms of the involvement of the cerebral DA system in the formation of the effects of neurofeedback sessions are discussed.     

Mapping of Changes in EEG Spectrum Power during a Session of Biofeedback Training of the β1 Rhythm

Changes in EEG spectrum power from 19 electrode sites were studied in 19 children with attention disorders during one session of EEG–biofeedback (EEG–BFB). EEG–BFB was aimed at increasing the relative power of the ₁ rhythm (15–18 Hz) in sites Fz–C ₃ with a bipolar electrode assembly. Comparison of the EEG spectrum powers at relaxation versus training periods in one BFB session revealed significant changes in the left parasagittal frontoparietal area (F ₃, Fz, C ₃, C ₄, P ₃).     

Age-Related Changes in Attention and Impulsivity in Young Schoolchildren

Normative values of attention, impulsivity, response time, and response time variability were determined for seven- to ten-year-old children with the continuous performance Test of Variables of Attention (TOVA). An age-related increase in attention and a decrease in impulsivity, response time, and its variability were revealed. Differences in TOVA scores were studied for students of gymnasia and schools providing general education.     

Expression of the Na+-K+-2Cl- cotransporter in the rat endolymphatic sac

The endolymphatic sac (ES) is a part of the membranous labyrinth that contains the cochlea, vestibular organs, and semicircular canals, and is believed to absorb endolymphatic fluid. Na⁺–K⁺–2Cl⁻ (NKCC) is a cotransporter that occurs as two isoforms (NKCC-1 and NKCC-2). Especially, NKCC-2 is suggested to participate in ES endolymph absorption. In the present study, the expression and cellular localization of NKCC-1 and NKCC-2 in the rat ES were examined by RT-PCR and in situ hybridization, respectively. The findings indicate that both NKCC-1 and NKCC-2 are expressed in the rat ES and suggest that NKCC is involved in ES homeostasis. NKCC-2 may be particularly involved in endolymph absorption. This is the first report confirming NKCC expression in the ES.     

Electrophysiological Correlates of Attentional Disorders in 12- to 13-Year-Old Adolescents

The EEG was recorded in 12- to 13-year-old adolescents with attention deficit hyperactivity disorder (ADHD). During the EEG recording, the subjects performed an attention test. Pairs of tone stimuli in the combinations low–low and low–high were presented in random order with equal probabilities with intervals of 2.3 s. Subjects had to press a button as soon as possible in response to low–low tone pair presentation (a go trial) and not to press the button when a pair consisting of low and high tones was presented (a no-go trial). On the basis of the results of the test performance (the numbers of omissions and false alarms), the subjects were divided into three groups characterized by the degree of severity of the attentional disorder. The evoked potentials in go and no-go trials were detected individually for the subject groups and each derivation. The components N1, N2, P2, P3-go, and P3-no-go were identified in the evoked potentials. These components had different latencies and were differently localized over the head surface. Only the amplitudes of P3-go and P3-no-go in the subjects were statistically significantly correlated with the severity of the attentional disorder.     

A Brain-Computer Interface Based Attention Training Program for Treating Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) symptoms can be difficult to treat. We previously reported that a 20-session brain-computer interface (BCI) attention training programme improved ADHD symptoms. Here, we investigated a new more intensive BCI-based attention training game system on 20 unmedicated ADHD children (16 males, 4 females) with significant inattentive symptoms (combined and inattentive ADHD subtypes). This new system monitored attention through a head band with dry EEG sensors, which was used to drive a feed forward game. The system was calibrated for each user by measuring the EEG parameters during a Stroop task. Treatment consisted of an 8-week training comprising 24 sessions followed by 3 once-monthly booster training sessions. Following intervention, both parent-rated inattentive and hyperactive-impulsive symptoms on the ADHD Rating Scale showed significant improvement. At week 8, the mean improvement was −4.6 (5.9) and −4.7 (5.6) respectively for inattentive symptoms and hyperactive-impulsive symptoms (both p<0.01). Cohen’s d effect size for inattentive symptoms was large at 0.78 at week 8 and 0.84 at week 24 (post-boosters). Further analysis showed that the change in the EEG based BCI ADHD severity measure correlated with the change ADHD Rating Scale scores. The BCI-based attention training game system is a potential new treatment for ADHD.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01344044","term_id":"NCT01344044"}}NCT01344044     

Exercise training in childhood-onset systemic lupus erythematosus: a controlled randomized trial

Introduction

Exercise training has emerged as a promising therapeutic strategy to counteract physical dysfunction in adult systemic lupus erythematosus. However, no longitudinal studies have evaluated the effects of an exercise training program in childhood-onset systemic lupus erythematosus (C-SLE) patients. The objective was to evaluate the safety and the efficacy of a supervised aerobic training program in improving the cardiorespiratory capacity in C-SLE patients.

Methods

Nineteen physically inactive C-SLE patients were randomly assigned into two groups: trained (TR, n = 10, supervised moderate-intensity aerobic exercise program) and non-trained (NT, n = 9). Gender-, body mass index (BMI)- and age-matched healthy children were recruited as controls (C, n = 10) for baseline (PRE) measurements only. C-SLE patients were assessed at PRE and after 12 weeks of training (POST). Main measurements included exercise tolerance and cardiorespiratory measurements in response to a maximal exercise (that is, peak VO₂, chronotropic reserve (CR), and the heart rate recovery (ΔHRR) (that is, the difference between HR at peak exercise and at both the first (ΔHRR1) and second (ΔHRR2) minutes of recovery after exercise).

Results

The C-SLE NT patients did not present changes in any of the cardiorespiratory parameters at POST (P > 0.05). In contrast, the exercise training program was effective in promoting significant increases in time-to-exhaustion (P = 0.01; ES = 1.07), peak speed (P = 0.01; ES = 1.08), peak VO₂ (P = 0.04; ES = 0.86), CR (P = 0.06; ES = 0.83), and in ΔHRR1 and ΔHRR2 (P = 0.003; ES = 1.29 and P = 0.0008; ES = 1.36, respectively) in the C-SLE TR when compared with the NT group. Moreover, cardiorespiratory parameters were comparable between C-SLE TR patients and C subjects after the exercise training intervention, as evidenced by the ANOVA analysis (P > 0.05, TR vs. C). SLEDAI-2K scores remained stable throughout the study.

Conclusion

A 3-month aerobic exercise training was safe and capable of ameliorating the cardiorespiratory capacity and the autonomic function in C-SLE patients.

Trial registration

NCT01515163.     

Negative Potentials of the Human Brain Elicited in Saccadic Latency during Stimulation of the Leading and Nonleading Eyes with an Overlap

Fast presaccadic EEG potentials in saccadic latency were studied with the use of inverse averaging during monocular stimulation of the leading or nonleading eye. Two paradigms were followed, with presentation of visual stimuli consecutively or with a 200-ms overlap. Irrespective of the paradigm and the stimulated eye, the negative N ^–1 potential in the interval of 50–20 ms preceding the beginning of the saccade predominated in the hemisphere contralateral to the saccade direction, reflecting the command processes of saccadic initiation. The N ^–2 potential was more pronounced in the case of direct averaging, starting from the stimulus. Its amplitude increased with increasing concentration of attention on the fixation stimulus under the overlap conditions, and its foci predominated in the left hemisphere, in the frontal, central, and parietosagittal regions. Hence, the N ^–2 potential was assumed to reflect spatial perception and attention as initial stages of saccadic programming. The findings testify to the priority of the leading eye both in fixation and in spatial attention.     

Self-Regulation of Brain Activity in Patients with Postherpetic Neuralgia: A Double-Blind Randomized Study Using Real-Time fMRI Neurofeedback

Background

A pilot study has shown that real-time fMRI (rtfMRI) neurofeedback could be an alternative approach for chronic pain treatment. Considering the relative small sample of patients recruited and not strictly controlled condition, it is desirable to perform a replication as well as a double-blinded randomized study with a different control condition in chronic pain patients. Here we conducted a rtfMRI neurofeedback study in a subgroup of pain patients – patients with postherpetic neuralgia (PHN) and used a different sham neurofeedback control. We explored the feasibility of self-regulation of the rostral anterior cingulate cortex (rACC) activation in patients with PHN through rtfMRI neurofeedback and regulation of pain perception.

Methods

Sixteen patients (46–71 years) with PHN were randomly allocated to a experimental group (n = 8) or a control group (n = 8). 2 patients in the control group were excluded for large head motion. The experimental group was given true feedback information from their rACC whereas the control group was given sham feedback information from their posterior cingulate cortex (PCC). All subjects were instructed to perform an imagery task to increase and decrease activation within the target region using rtfMRI neurofeedback.

Results

Online analysis showed 6/8 patients in the experimental group were able to increase and decrease the blood oxygen level dependent (BOLD) fMRI signal magnitude during intermittent feedback training. However, this modulation effect was not observed in the control group. Offline analysis showed that the percentage of BOLD signal change of the target region between the last and first training in the experimental group was significantly different from the control group’s and was also significantly different than 0. The changes of pain perception reflected by numerical rating scale (NRS) in the experimental group were significantly different from the control group. However, there existed no significant correlations between BOLD signal change and NRS change.

Conclusion

Patients with PHN could learn to voluntarily control over activation in rACC through rtfMRI neurofeedback and alter their pain perception level. The present study may provide new evidence that rtfMRI neurofeedback training may be a supplemental approach for chronic clinical pain management.     

Markers for Routine Assessment of Fatigue and Recovery in Male and Female Team Sport Athletes during High-Intensity Interval Training

Aim

Our study aimed to investigate changes of different markers for routine assessment of fatigue and recovery in response to high-intensity interval training (HIIT).

Methods

22 well-trained male and female team sport athletes (age, 23.0 ± 2.7 years; V̇O_2max, 57.6 ± 8.6 mL·min·kg⁻¹) participated in a six-day running-based HIIT-microcycle with a total of eleven HIIT sessions. Repeated sprint ability (RSA; criterion measure of fatigue and recovery), countermovement jump (CMJ) height, jump efficiency in a multiple rebound jump test (MRJ), 20-m sprint performance, muscle contractile properties, serum concentrations of creatinkinase (CK), c-reactive protein (CRP) and urea as well as perceived muscle soreness (DOMS) were measured pre and post the training program as well as after 72 h of recovery.

Results

Following the microcycle significant changes (p < 0.05) in RSA as well as in CMJ and MRJ performance could be observed, showing a decline (%Δ ± 90% confidence limits, ES = effect size; RSA: -3.8 ± 1.0, ES = -1.51; CMJ: 8.4 ± 2.9, ES = -1.35; MRJ: 17.4 ± 4.5, ES = -1.60) and a return to baseline level (RSA: 2.8 ± 2.6, ES = 0.53; CMJ: 4.1 ± 2.9, ES = 0.68; MRJ: 6.5 ± 4.5, ES = 0.63) after 72 h of recovery. Athletes also demonstrated significant changes (p < 0.05) in muscle contractile properties, CK, and DOMS following the training program and after the recovery period. In contrast, CRP and urea remained unchanged throughout the study. Further analysis revealed that the accuracy of markers for assessment of fatigue and recovery in comparison to RSA derived from a contingency table was insufficient. Multiple regression analysis also showed no correlations between changes in RSA and any of the markers.

Conclusions

Mean changes in measures of neuromuscular function, CK and DOMS are related to HIIT induced fatigue and subsequent recovery. However, low accuracy of a single or combined use of these markers requires the verification of their applicability on an individual basis.     

Stimulation of somatic embryo formation by mutagens and darkness in culture of immature zygotic embryos of Arabidopsis thaliana (L.) Heynh.

The aim of the study was to evaluate the influence of light conditions,physical state of the induction medium and the mutagenic treatment on theembryogenic ability of Arabidopsis thaliana (L.) immaturezygotic embryos differing in developmental stage. The efficiency of directsomatic embryogenesis (DSE) was analysed in a culture of immature zygoticembryos at an early (ES) and a late (LS) developmental stage. The efficiency ofDSE was scored as a percentage of the explants producing somatic embryos. Theexperiments indicated that the physical state of the induction medium (solid orliquid) did not influence the embryogenic ability of the cultured explants. Inthe cultures on both solid and liquid induction medium, the ES explantsproducedsomatic embryos with a frequency of 25.8–37.3% i.e. 2.5–3-timeslower than LS explants. However, an increase in the embryogenic ability of ESexplants (up to 69.8%) was observed when DSE was induced in darkness. Moreover,the stimulation of DSE efficiency in culture of ES explants was also observedafter mutagenic treatment. The chemical mutagens, MNH and EMS, applied forexplant treatment, both stimulated efficiency of somatic embryo formation inculture of ES explants. The most effective DSE induction was observed when MNHand EMS were applied in doses of 0.125–1.0 mM × 3h and0.05–0.2% × 18h, respectively. In these treatment combinations thefrequency of ES explants forming somatic embryos was found to be about 2 timeshigher than in the control culture.