DBS, deep brain stimulation
Research Papers
Showing 6 of 7The efficacy of neurofeedback for alcohol use disorders - a systematic review
Background: Alcoholism is a serious social, economic and public health problem. Alcoholism can affect the gastrointestinal, neurological, cardiovascular and respiratory systems, and it can be fatal, costing the healthcare system huge amounts of money. Despite the availability of cognitive-behavioural and psychosocial therapies, alcoholism has a high recurrence rate and a dismal prognosis, with a wide inter-individual variation. As a result, better or adjuvant therapies that improve or facilitate alcoholism therapy are required. We conducted a systematic review to look into the published studies that reported the effectiveness of non-pharmacological neurofeedback (NF) interventions in patients with alcohol use disorders (AUDs). Methods: PubMed, Google Scholar, The Cochrane Library, Science Direct and Clinicaltrial.gov were searched until 4 April 2022. Original articles of any design reporting on the use of NF approaches in the treatment of AUDs were included. Information related to study design, participants, control group, neuromodulation therapy, number of sessions and key findings of the study were extracted. The Joanna Briggs Institute’s (JBI) Critical Appraisal Checklist for Studies was used to assess the quality of studies. Results: A total of 20 research articles (including 618 participants) were retrieved and included for qualitative analysis. The sample size ranged from 1 (case report) to 80, with years of publication ranging from 1977 to 2022. Nine of the 20 articles included in the study were conducted in the United States, followed by Germany, the United Kingdom, India, the Netherlands and South Korea. Out of the 20 studies included, 8 (40%) had a moderate risk of bias, while the other, i.e. 60% had a low risk of bias. The effectiveness of various neurological treatments in the treatment of AUDs was established in these 20 studies. There have been 11 studies on EEG NF training, three studies on real-time FMRI NF, two studies each on transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), and one study each on deep brain stimulation (DBS) and theta burst stimulation (TBS). These alternative neurological therapies have been demonstrated to lower alcohol cravings and consumption temporarily, reduce anxiety and depression scores, reduce relapse rates and increase control of brain activity. Conclusions: The use of various neuromodulation approaches to the treatment of AUD shows promise. However, more research with larger sample size is required.
View Full Paper →Deep brain electrical neurofeedback allows Parkinson patients to control pathological oscillations and quicken movements
Parkinsonian motor symptoms are linked to pathologically increased beta-oscillations in the basal ganglia. While pharmacological treatment and deep brain stimulation (DBS) reduce these pathological oscillations concomitantly with improving motor performance, we set out to explore neurofeedback as an endogenous modulatory method. We implemented real-time processing of pathological subthalamic beta oscillations through implanted DBS electrodes to provide deep brain electrical neurofeedback. Patients volitionally controlled ongoing beta-oscillatory activity by visual neurofeedback within minutes of training. During a single one-hour training session, the reduction of beta-oscillatory activity became gradually stronger and we observed improved motor performance. Lastly, endogenous control over deep brain activity was possible even after removing visual neurofeedback, suggesting that neurofeedback-acquired strategies were retained in the short-term. Moreover, we observed motor improvement when the learnt mental strategies were applied 2 days later without neurofeedback. Further training of deep brain neurofeedback might provide therapeutic benefits for Parkinson patients by improving symptom control using strategies optimized through neurofeedback.
View Full Paper →Efficacy of Invasive and Non-Invasive Brain Modulation Interventions for Addiction
It is important to find new treatments for addiction due to high relapse rates despite current interventions and due to expansion of the field with non-substance related addictive behaviors. Neuromodulation may provide a new type of treatment for addiction since it can directly target abnormalities in neurocircuits. We review literature on five neuromodulation techniques investigated for efficacy in substance related and behavioral addictions: transcranial direct current stimulation (tDCS), (repetitive) transcranial magnetic stimulation (rTMS), EEG, fMRI neurofeedback and deep brain stimulation (DBS) and additionally report on effects of these interventions on addiction-related cognitive processes. While rTMS and tDCS, mostly applied at the dorsolateral prefrontal cortex, show reductions in immediate craving for various addictive substances, placebo-responses are high and long-term outcomes are understudied. The lack in well-designed EEG-neurofeedback studies despite decades of investigation impedes conclusions about its efficacy. Studies investigating fMRI neurofeedback are new and show initial promising effects on craving, but future trials are needed to investigate long-term and behavioral effects. Case studies report prolonged abstinence of opioids or alcohol with ventral striatal DBS but difficulties with patient inclusion may hinder larger, controlled trials. DBS in neuropsychiatric patients modulates brain circuits involved in reward processing, extinction and negative-reinforcement that are also relevant for addiction. To establish the potential of neuromodulation for addiction, more randomized controlled trials are needed that also investigate treatment duration required for long-term abstinence and potential synergy with other addiction interventions. Finally, future advancement may be expected from tailoring neuromodulation techniques to specific patient (neurocognitive) profiles.
View Full Paper →Neuromodulation for tinnitus treatment: an overview of invasive and non-invasive techniques
Tinnitus is defined as a perception of sound without any external sound source. Chronic tinnitus is a frequent condition that can affect the quality of life. So far, no causal cure for tinnitus has been documented, and most pharmacologic and psychosomatic treatment modalities aim to diminish tinnitus' impact on the quality of life. Neuromodulation, a novel therapeutic modality, which aims at alternating nerve activity through a targeted delivery of a stimulus, has emerged as a potential option in tinnitus treatment. This review provides a brief overview of the current neuromodulation techniques as tinnitus treatment options. The main intention is to provide updated knowledge especially for medical professionals counselling tinnitus patients in this emerging field of medicine. Non-invasive methods such as repetitive transcranial magnetic stimulation, transcranial electrical stimulation, neurofeedback, and transcutaneous vagus nerve stimulation were included, as well as invasive methods such as implanted vagus nerve stimulation and invasive brain stimulation. Some of these neuromodulation techniques revealed promising results; nevertheless, further research is needed, especially regarding the pathophysiological principle as to how these neuromodulation techniques work and what neuronal change they induce. Various studies suggest that individually different brain states and networks are involved in the generation and perception of tinnitus. Therefore, in the future, individually tailored neuromodulation strategies could be a promising approach in tinnitus treatment for achieving a more substantial and longer lasting improvement of complaints.
View Full Paper →Real-Time Neurofeedback to Modulate β-Band Power in the Subthalamic Nucleus in Parkinson's Disease Patients
The β-band oscillation in the subthalamic nucleus (STN) is a therapeutic target for Parkinson's disease. Previous studies demonstrated that l-DOPA decreases the β-band (13-30 Hz) oscillations with improvement of motor symptoms. However, it has not been elucidated whether patients with Parkinson's disease are able to control the β-band oscillation voluntarily. Here, we hypothesized that neurofeedback training to control the β-band power in the STN induces plastic changes in the STN of individuals with Parkinson's disease. We recorded the signals from STN deep-brain stimulation electrodes during operations to replace implantable pulse generators in eight human patients (3 male) with bilateral electrodes. Four patients were induced to decrease the β-band power during the feedback training (down-training condition), whereas the other patients were induced to increase (up-training condition). All patients were blinded to their assigned condition. Adjacent contacts that showed the highest β-band power were selected for the feedback. During the 10 min training, patients were shown a circle whose diameter was controlled by the β-band power of the selected contacts. Powers in the β-band during 5 min resting sessions recorded before and after the feedback were compared. In the down-training condition, the β-band power of the selected contacts decreased significantly after feedback in all four patients (p < 0.05). In contrast, the β-band power significantly increased after feedback in two of four patients in the up-training condition. Overall, the patients could voluntarily control the β-band power in STN in the instructed direction (p < 0.05) through neurofeedback.
View Full Paper →Robust desynchronization of Parkinson's disease pathological oscillations by frequency modulation of delayed feedback deep brain stimulation
The hyperkinetic symptoms of Parkinson's Disease (PD) are associated with the ensembles of interacting oscillators that cause excess or abnormal synchronous behavior within the Basal Ganglia (BG) circuitry. Delayed feedback stimulation is a closed loop technique shown to suppress this synchronous oscillatory activity. Deep Brain Stimulation (DBS) via delayed feedback is known to destabilize the complex intermittent synchronous states. Computational models of the BG network are often introduced to investigate the effect of delayed feedback high frequency stimulation on partially synchronized dynamics. In this study, we develop a reduced order model of four interacting nuclei of the BG as well as considering the Thalamo-Cortical local effects on the oscillatory dynamics. This model is able to capture the emergence of 34 Hz beta band oscillations seen in the Local Field Potential (LFP) recordings of the PD state. Train of high frequency pulses in a delayed feedback stimulation has shown deficiencies such as strengthening the synchronization in case of highly fluctuating neuronal activities, increasing the energy consumed as well as the incapability of activating all neurons in a large-scale network. To overcome these drawbacks, we propose a new feedback control variable based on the filtered and linearly delayed LFP recordings. The proposed control variable is then used to modulate the frequency of the stimulation signal rather than its amplitude. In strongly coupled networks, oscillations reoccur as soon as the amplitude of the stimulus signal declines. Therefore, we show that maintaining a fixed amplitude and modulating the frequency might ameliorate the desynchronization process, increase the battery lifespan and activate substantial regions of the administered DBS electrode. The charge balanced stimulus pulse itself is embedded with a delay period between its charges to grant robust desynchronization with lower amplitudes needed. The efficiency of the proposed Frequency Adjustment Stimulation (FAS) protocol in a delayed feedback method might contribute to further investigation of DBS modulations aspired to address a wide range of abnormal oscillatory behavior observed in neurological disorders.
View Full Paper →Ready to Optimize Your Brain?
Schedule a free consultation to discuss dbs, deep brain stimulation and how neurofeedback training can help
Or call us directly at 855-88-BRAIN
View Programs & Pricing →