•Neurofeedback is well investigated in the treatment of ADHD.•TBR, SMR and SCP neurofeedback have demonstrated specificity and efficacy in ADHD.•Studies investigating neurofeedback should adhere to ...principles of learning theory.
Among the clinical applications of neurofeedback, most research has been conducted in ADHD. As an introduction a short overview of the general history of neurofeedback will be given, while the main part of the paper deals with a review of the current state of neurofeedback in ADHD. A meta-analysis on neurofeedback from 2009 found large effect sizes for inattention and impulsivity and medium effects sizes for hyperactivity. Since 2009 several new studies, including 4 placebo-controlled studies, have been published. These latest studies are reviewed and discussed in more detail. The review focuses on studies employing (1) semi-active, (2) active, and (3) placebo-control groups. The assessment of specificity of neurofeedback treatment in ADHD is discussed and it is concluded that standard protocols such as theta/beta, SMR and slow cortical potentials neurofeedback are well investigated and have demonstrated specificity. The paper ends with an outlook on future questions and tasks. It is concluded that future controlled clinical trials should, in a next step, focus on such known protocols, and be designed along the lines of learning theory.
Purpose of Review
Current traditional treatments for ADHD present serious limitations in terms of long-term maintenance of symptom remission and side effects. Here, we provide an overview of the ...rationale and scientific evidence of the efficacy of neurofeedback in regulating the brain functions in ADHD. We also review the institutional and professional regulation of clinical neurofeedback implementations.
Recent Findings
Based on meta-analyses and (large multicenter) randomized controlled trials, three standard neurofeedback training protocols, namely theta/beta (TBR), sensori-motor rhythm (SMR), and slow cortical potential (SCP), turn out to be efficacious and specific. However, the practical implementation of neurofeedback as a clinical treatment is currently not regulated.
Summary
We conclude that neurofeedback based on standard protocols in ADHD should be considered as a viable treatment alternative and suggest that further research is needed to understand how specific neurofeedback protocols work. Eventually, we emphasize the need for standard neurofeedback training for practitioners and binding standards for use in clinical practice.
The P300 component of the event-related potential is a large positive waveform that can be extracted from the ongoing electroencephalogram using a two-stimuli oddball paradigm, and has been ...associated with cognitive information processing (e.g. memory, attention, executive function). This paper reviews the development of the auditory P300 across the lifespan.
A systematic review and meta-analysis on the P300 was performed including 75 studies (n = 2,811). Scopus was searched for studies using healthy subjects and that reported means of P300 latency and amplitude measured at Pz and mean age. These findings were validated in an independent, existing cross-sectional dataset including 1,572 participants from ages 6-87. Curve-fitting procedures were applied to obtain a model of P300 development across the lifespan. In both studies logarithmic Gaussian models fitted the latency and amplitude data best. The P300 latency and amplitude follow a maturational path from childhood to adolescence, resulting in a period that marks a plateau, after which degenerative effects begin. We were able to determine ages that mark a maximum (in P300 amplitude) or trough (in P300 latency) segregating maturational from degenerative stages. We found these points of deflection occurred at different ages.
It is hypothesized that latency and amplitude index different aspects of brain maturation. The P300 latency possibly indexes neural speed or brain efficiency. The P300 amplitude might index neural power or cognitive resources, which increase with maturation.
Neurofeedback (NF) has gained increasing interest in the treatment of attention-deficit/hyperactivity disorder (ADHD). Given learning principles underlie NF, lasting clinical treatment effects may be ...expected. This systematic review and meta-analysis addresses the sustainability of neurofeedback and control treatment effects by considering randomized controlled studies that conducted follow-up (FU; 2–12 months) assessments among children with ADHD. PubMed and Scopus databases were searched through November 2017. Within-group and between-group standardized mean differences (SMD) of parent behavior ratings were calculated and analyzed. Ten studies met inclusion criteria (NF: ten studies,
N
= 256; control: nine studies,
N
= 250). Within-group NF effects on inattention were of medium effect size (ES) (SMD = 0.64) at post-treatment and increased to a large ES (SMD = 0.80) at FU. Regarding hyperactivity/impulsivity, NF ES were medium at post-treatment (SMD = 0.50) and FU (SMD = 0.61). Non-active control conditions yielded a small significant ES on inattention at post-treatment (SMD = 0.28) but no significant ES at FU. Active treatments (mainly methylphenidate), had large ES for inattention (post: SMD = 1.08; FU: SMD = 1.06) and medium ES for hyperactivity/impulsivity (post: SMD = 0.74; FU: SMD = 0.67). Between-group analyses also revealed an advantage of NF over non-active controls inattention (post: SMD = 0.38; FU: SMD = 0.57); hyperactivity–impulsivity (post: SMD = 0.25; FU: SMD = 0.39), and favored active controls for inattention only at pre-post (SMD = − 0.44). Compared to non-active control treatments, NF appears to have more durable treatment effects, for at least 6 months following treatment. More studies are needed for a properly powered comparison of follow-up effects between NF and active treatments and to further control for non-specific effects.
Personalized medicine in psychiatry is in need of biomarkers that resemble central nervous system function at the level of neuronal activity. Electroencephalography (EEG) during sleep or ...resting-state conditions and event-related potentials (ERPs) have not only been used to discriminate patients from healthy subjects, but also for the prediction of treatment outcome in various psychiatric diseases, yielding information about tailored therapy approaches for an individual. This review focuses on baseline EEG markers for two psychiatric conditions, namely major depressive disorder and attention deficit hyperactivity disorder. It covers potential biomarkers from EEG sleep research and vigilance regulation, paroxysmal EEG patterns and epileptiform discharges, quantitative EEG features within the EEG main frequency bands, connectivity markers and ERP components that might help to identify favourable treatment outcome. Further, the various markers are discussed in the context of their potential clinical value and as research domain criteria, before giving an outline for future studies that are needed to pave the way to an electrophysiological biomarker-based personalized medicine.
Stimulant medication and behaviour therapy are the most often applied and accepted treatments for Attention-Deficit/Hyperactivity-Disorder (ADHD). Here we explore where the non-pharmacological ...clinical intervention known as neurofeedback (NFB), fits on the continuum of empirically supported treatments, using standard protocols. In this quantitative review we utilized an updated and stricter version of the APA guidelines for rating ‘well-established’ treatments and focused on efficacy and effectiveness using effect-sizes (ES) and remission, with a focus on long-term effects. Efficacy and effectiveness are compared to medication and behaviour therapy using benchmark studies. Only recent systematic reviews and meta-analyses as well as multi-centre randomized controlled trials (RCT’s) will be included. Two meta-analyses confirmed significant efficacy of standard neurofeedback protocols for parent and teacher rated symptoms with a medium effect size, and sustained effects after 6–12 months. Four multicenter RCT’s demonstrated significant superiority to semi-active control groups, with medium-large effect sizes end of treatment or follow-up and remission rates of 32–47%. Effectiveness in open-label studies was confirmed, no signs of publication bias were found and no significant neurofeedback-specific side effects have been reported. Standard neurofeedback protocols in the treatment of ADHD can be concluded to be a well-established treatment with medium to large effect sizes and 32–47% remission rates and sustained effects as assessed after 6–12 months.
Here we review the paradigm-change from one-size-fits-all psychiatry to more personalized-psychiatry, where we distinguish between ‘precision psychiatry’ and ‘stratified psychiatry’. Using examples ...in Depression and ADHD we argue that stratified psychiatry, using biomarkers to facilitate patients to best ‘on-label’ treatments, is a more realistic future for implementing biomarkers in clinical practice.
Antidepressants are widely prescribed, but their efficacy relative to placebo is modest, in part because the clinical diagnosis of major depression encompasses biologically heterogeneous conditions. ...Here, we sought to identify a neurobiological signature of response to antidepressant treatment as compared to placebo. We designed a latent-space machine-learning algorithm tailored for resting-state electroencephalography (EEG) and applied it to data from the largest imaging-coupled, placebo-controlled antidepressant study (n = 309). Symptom improvement was robustly predicted in a manner both specific for the antidepressant sertraline (versus placebo) and generalizable across different study sites and EEG equipment. This sertraline-predictive EEG signature generalized to two depression samples, wherein it reflected general antidepressant medication responsivity and related differentially to a repetitive transcranial magnetic stimulation treatment outcome. Furthermore, we found that the sertraline resting-state EEG signature indexed prefrontal neural responsivity, as measured by concurrent transcranial magnetic stimulation and EEG. Our findings advance the neurobiological understanding of antidepressant treatment through an EEG-tailored computational model and provide a clinical avenue for personalized treatment of depression.
Frontal alpha asymmetry (FAA) has frequently been reported as potential discriminator between depressed and healthy individuals, although contradicting results have been published. The aim of the ...current study was to provide an up to date meta-analysis on the diagnostic value of FAA in major depressive disorder (MDD) and to further investigate discrepancies in a large cross-sectional dataset.
SCOPUS database was searched through February 2017. Studies were included if the article reported on both MDD and controls, provided an FAA measure involving EEG electrodes F3/F4, and provided data regarding potential covariates. Hedges' d was calculated from FAA means and standard deviations (SDs). Potential covariates, such as age and gender, were explored. Post hoc analysis was performed to elucidate interindividual differences that could explain interstudy discrepancies.
16 studies were included (MDD:
= 1883, controls:
= 2161). After resolving significant heterogeneity by excluding studies, a non-significant Grand Mean effect size (ES) was obtained (d = - 0.007;CI = - 0.090-0.075). Crosssectional analyses showed a significant three-way interaction for Gender × Age × Depression severity in the depressed group, which was prospectively replicated in an independent sample.
The main result was a non-significant, negligible ES, demonstrating limited diagnostic value of FAA in MDD. The high degree of heterogeneity across studies indicates covariate influence, as was confirmed by crosssectional analyses, suggesting future studies should address this Gender × Age × Depression severity interaction. Upcoming studies should focus more on prognostic and research domain usages of FAA rather than a pure diagnostic tool.
Repetitive transcranial magnetic stimulation (rTMS) is considered an efficacious non-invasive neuromodulation treatment for major depressive disorder (MDD). However, little is known about the ...clinical outcome of combined rTMS and psychotherapy (rTMS + PT). Through common neurobiological brain mechanisms, rTMS + PT may exert enhanced antidepressant effects compared to the respective monotherapies.
The current naturalistic study aimed to evaluate feasibility and clinical outcome of rTMS + PT in a large group of MDD patients. The second aim was to identify clinical predictors of response and remission.
A total of 196 patients with MDD were treated with at least 10 sessions of simultaneous rTMS and PT. rTMS was applied over the DLPFC, either 10 Hz left or 1 Hz right. Psychotherapy was based on principles of cognitive behavioral therapy (CBT). Symptoms were measured using the BDI each fifth session until end of treatment and at 6-month follow-up. Comparisons were made between responders and non-responders, as well as between the 10 Hz and 1 Hz protocol. Additionally, baseline variables and early BDI change were evaluated as predictors of response/remission.
1) Combining rTMS and PT resulted in a 66% response and a 56% remission rate at the end of treatment with 60% sustained remission at follow-up. Compared to previous findings in RCTs, these rates are relatively high; 2) No differences were found between the 10 Hz and 1 Hz TMS regarding clinical outcome; 3) Clinical baseline variables were not predictive of treatment outcomes; 4) Early symptom improvement (at session 10) was highly predictive of response, and may therefore be used to guide rTMS + PT continuation; 5) Based on the current findings in a large naturalistic study, future studies employing a more standardized method are warranted to draw solid conclusions on the unique effect of rTMS + PT.
•Simultaneous application of rTMS and psychotherapy may exert enhanced effects.•rTMS + PT resulted in relatively high response (66%) and remission (56%) rates.•No differences were found between patients treated with high vs. low frequency rTMS.•Symptom change after 10 sessions could predict positive treatment response.
PDF
