Real-time functional magnetic resonance imaging (rtfMRI) is a novel technique that has allowed subjects to achieve self-regulation of circumscribed brain regions. Despite its anticipated therapeutic benefits, there is no report on successful application of this technique in psychiatric populations. The objectives of the present study were to train schizophrenia patients to achieve volitional control of bilateral anterior insula cortex on multiple days, and to explore the effect of learned self-regulation on face emotion recognition (an extensively studied deficit in schizophrenia) and on brain network connectivity. Nine patients with schizophrenia were trained to regulate the hemodynamic response in bilateral anterior insula with contingent rtfMRI neurofeedback, through a 2-weeks training. At the end of the training stage, patients performed a face emotion recognition task to explore behavioral effects of learned self-regulation. A learning effect in self-regulation was found for bilateral anterior insula, which persisted through the training. Following successful self-regulation, patients recognized disgust faces more accurately and happy faces less accurately. Improvements in disgust recognition were correlated with levels of self-activation of right insula. RtfMRI training led to an increase in the number of the incoming and outgoing effective connections of the anterior insula. This study shows for the first time that patients with schizophrenia can learn volitional brain regulation by rtfMRI feedback training leading to changes in the perception of emotions and modulations of the brain network connectivity. These findings open the door for further studies of rtfMRI in severely ill psychiatric populations, and possible therapeutic applications. Hum Brain Mapp, 2013. © 2011 Wiley Periodicals, Inc.

Hum Brain Mapp. 2013 Jan;34(1):200-12. doi: 10.1002/hbm.21427. Epub 2011 Oct 22. Ruiz S, Lee S, Soekadar SR, Caria A, Veit R, Kircher T, Birbaumer N, Sitaram R. Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany; Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile; Graduate School of Neural and Behavioral Sciences, International Max Planck Research School, Tübingen, Germany. smruiz@med.puc.cl.

PURPOSE OF REVIEW: Neuroimaging has become a central technique of biological psychiatry and is uniquely suited to assess functional and structural brain changes in psychiatric patients in vivo. In this review, we highlight several recent developments that may enable the transition of psychiatric neuroimaging from laboratory to clinic.

RECENT FINDINGS: We describe recent trends in refining imaging techniques for brain microstructure (diffusion imaging) and neurochemistry (magnetic resonance spectroscopy of neurotransmitters and metabolites) and their application to patients with mood disorders and individuals at risk, such as first-degree relatives. We also survey recent progress in imaging-guided deep brain stimulation (DBS), imaging-based (neurofeedback) therapies and studies looking at their convergent anatomical targets. These new interventional techniques, which aim to modulate brain circuits of emotion and motivation highlighted by functional imaging studies, have shown promising effects in several small studies.

SUMMARY: The mapping of brain patterns associated with risk to develop mood disorders may pave the way for diagnostic/prognostic applications of neuroimaging. The neuromodulation techniques of DBS and neurofeedback, which target dysfunctional or compensatory circuits identified by functional imaging, may take neuroimaging into a new, therapeutic domain.

Curr Opin Psychiatry. 2013 Jan;26(1):27-32. doi: 10.1097/YCO.0b013e32835a0b63. Keedwell PA, Linden DE. MRC Centre for Neuropsychiatric Genetics and Genomics and Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, UK.

Full title: Mind over chatter: Plastic up-regulation of the fMRI salience network directly after EEG neurofeedback.

Neurofeedback (NFB) involves a brain-computer interface that allows users to learn to voluntarily control their cortical oscillations, reflected in the electroencephalogram (EEG). Although NFB is being pioneered as a noninvasive tool for treating brain disorders, there is insufficient evidence on the mechanism of its impact on brain function. Furthermore, the dominant rhythm of the human brain is the alpha oscillation (8-12Hz), yet its behavioral significance remains multifaceted and largely correlative. In this study with 34 healthy participants, we examined whether during the performance of an attentional task, the functional connectivity of distinct fMRI networks would be plastically altered after a 30-min session of voluntary reduction of alpha rhythm (n=17) versus a sham-feedback condition (n=17). We reveal that compared to sham-feedback, NFB induced an increase of connectivity within regions of the salience network involved in intrinsic alertness (dorsal anterior cingulate), which was detectable 30min after termination of training. The increase in salience network (default-mode network) connectivity was negatively (positively) correlated with changes in 'on task' mind-wandering as well as resting state alpha rhythm. Crucially, we observed a causal dependence between alpha rhythm synchronization during NFB and its subsequent change at resting state, not exhibited by the SHAM group. Our findings provide neurobehavioral evidence for the brain's exquisite functional plasticity, and for a temporally direct impact of NFB on a key cognitive control network, suggesting a promising basis for its use to treat cognitive disorders under physiological conditions.

Neuroimage. 2013 Jan 15;65:324-35. doi: 10.1016/j.neuroimage.2012.09.046. Epub 2012 Sep 26. Ros T, Théberge J, Frewen PA, Kluetsch R, Densmore M, Calhoun VD, Lanius RA. Department of Psychiatry, University of Western Ontario, London, Ontario, Canada; Laboratory for Neurology and Imaging of Cognition, Department of Neurosciences, University of Geneva, Switzerland. Electronic address: dr.t.ros@gmail.com.

Perception depends on the interplay of ongoing spontaneous activity and stimulus-evoked activity in sensory cortices. This raises the possibility that training ongoing spontaneous activity alone might be sufficient for enhancing perceptual sensitivity. To test this, we trained human participants to control ongoing spontaneous activity in circumscribed regions of retinotopic visual cortex using real-time functional MRI-based neurofeedback. After training, we tested participants using a new and previously untrained visual detection task that was presented at the visual field location corresponding to the trained region of visual cortex. Perceptual sensitivity was significantly enhanced only when participants who had previously learned control over ongoing activity were now exercising control and only for that region of visual cortex. Our new approach allows us to non-invasively and non-pharmacologically manipulate regionally specific brain activity and thus provide "brain training" to deliver particular perceptual enhancements.

J Neurosci. 2012 Dec 5;32(49):17830-41. doi: 10.1523/JNEUROSCI.6334-11.2012. Scharnowski F, Hutton C, Josephs O, Weiskopf N, Rees G. Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, and UCL Institute of Cognitive Neuroscience, University College London, London WC1N 3AR, United Kingdom, Institute of Bioengineering, Swiss Institute of Technology (EPFL), CH-1015 Lausanne, Switzerland, and Department of Radiology and Medical Informatics, Center for Biomedical Imaging (CIBM), University of Geneva, CH-1211 Geneva 14, Switzerland.

A controversy in the field of hypnosis has centered on the question of whether there is a uniquely hypnotic state of consciousness and, if so, whether it is causally related to responsiveness to suggestion. Evidence from brain imaging studies has been used to support claims for various altered state hypotheses, without resolving the debate. The designs of many neuroimaging studies confound the induction of hypnosis with the suggestions that can be given in or out of hypnosis, thus rendering them incapable of resolving the controversy. Brain imaging studies that do not have this confound support the hypothesis that hypnotic inductions produce changes in brain activity, but also indicate that these changes are not required for the experience of hypnotic suggestions or their neural correlates. The data remain equivocal as to whether there is a causal relation between the changes in brain activity produced by hypnotic inductions and those produced by other suggestions. It also remains uncertain whether the changes in activation produced by hypnotic inductions reflect a uniquely hypnotic state as opposed to more mundane processes.

Cortex. 2012 Sep 6. pii: S0010-9452(12)00244-4. doi: 10.1016/j.cortex.2012.08.005. Mazzoni G, Venneri A, McGeown WJ, Kirsch I. Department of Psychology, University of Hull, UK.

Full title: The mirror neuron system under hypnosis - Brain substrates of voluntary and involuntary motor activation in hypnotic paralysis.

The neurobiological basis of non-organic movement impairments is still unknown. As conversion disorder and hypnotic states share many characteristics, we applied an experimental design established in conversion disorder to investigate hypnotic paralysis. Movement imitation and observation were investigated by functional magnetic resonance imaging (fMRI) in 19 healthy subjects with and without hypnotically induced paralysis of their left hand. Paralysis-specific activation changes were explored in a multivariate model and functional interdependencies of brain regions by connectivity analysis. Hypnotic paralysis during movement imitation induced hypoactivation of the contralateral sensorimotor cortex (SMC) and ipsilateral cerebellum and increased activation of anterior cingulate cortex (ACC), frontal gyrus and insula. No paralysis-specific effects were revealed during movement observation. Hyperactivation of ACC, middle frontal gyrus (MFG), and insula might reflect attention (MFG), conflict-detection (ACC) and self-representation processes (insula) during hypnotic paralysis. The lack of effects in movement observation suggests that early motor processes are not disturbed due to the transient nature of the hypnotic impairment.

Cortex. 2012 Jun 20. [Epub ahead of print] Burgmer M, Kugel H, Pfleiderer B, Ewert A, Lenzen T, Pioch R, Pyka M, Sommer J, Arolt V, Heuft G, Konrad C. Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.

Tourette syndrome (TS) is a neuro-psychiatric disorder being characterized by motor and phonic tics typically preceded by sensory urges. Given the latter the role of the sensory system and sensorimotor interaction in TS has recently gained increased attention. 12 TS patients and 12 matched control subjects performed two tasks, requiring simple finger movements: a Go/NoGo task and a self paced movement task. Neurophysiological data was recorded using magnetoencephalography (MEG). Event related responses around movement onset, i.e. motor field (MF) occurring directly prior to the movement and movement evoked field (MEF) immediately after movement onset were analyzed using dipole modeling. MF peak amplitudes did not differ between groups in either task. In contrast, in both tasks MEF peak amplitudes were increased in TS patients. Moreover, larger MEF amplitudes during self paced movements were inversely correlated with motor tic frequency and severity. Enlarged MEF amplitudes as a marker of early sensory feedback of one's own movements probably represent enlarged sensory input from the periphery resulting from altered subcortical gating. We conclude that TS patients exhibit altered sensory-motor processing involved in voluntary movement control, which might also be successful in tic control.

Neuroimage. 2012 Oct 15;63(1):119-25. Epub 2012 Jul 6. Biermann-Ruben K, Miller A, Franzkowiak S, Finis J, Pollok B, Wach C, Südmeyer M, Jonas M, Thomalla G, Müller-Vahl K, Münchau A, Schnitzler A. Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.

While neurofeedback (NF) has been extensively studied in the treatment of many disorders, there have been only three published reports, by D.C. Hammond, on its clinical effects in the treatment of obsessive compulsive disorder (OCD). In this paper the efficacy of qEEG-guided NF for subjects with OCD was studied as a case series. The goal was to examine the clinical course of the OCD symptoms and assess the efficacy of qEEG guided NF training on clinical outcome measures. Thirty-six drug resistant subjects with OCD were assigned to 9-84 sessions of QEEG-guided NF treatment. Daily sessions lasted 60 minutes where 2 sessions with half-hour applications with a 30 minute rest given between sessions were conducted per day. Thirty-three out of 36 subjects who received NF training showed clinical improvement according to the Yale-Brown obsessive-compulsive scale (Y-BOCS). The Minnesota multiphasic inventory (MMPI) was administered before and after treatment to 17 of the subjects. The MMPI results showed significant improvements not only in OCD measures, but all of the MMPI scores showed a general decrease. Finally, according to the physicians' evaluation of the subjects using the clinical global impression scale (CGI), 33 of the 36 subjects were rated as improved. Thirty-six of the subjects were followed for an average of 26 months after completing the study. According to follow-up interviews conducted with them and/or their family members 19 of the subjects maintained the improvements in their OCD symptoms. This study provides good evidence for the efficacy of NF treatment in OCD. The results of this study encourage further controlled research in this area.

Clin EEG Neurosci. 2011 Jul;42(3):195-201. Sürmeli T, Ertem A. Healthy Living Center for Research and Education, Istanbul, Turkey. neuropsychiatry@yahoo.com

Neurofeedback treatment has been demonstrated to reduce inattention, impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder (ADHD). However, previous studies did not adequately control confounding variables or did not employ a randomized reinforcer-controlled design. This study addresses those methodological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD: EEG neurofeedback (NF) aiming at theta/beta ratio reduction and EMG biofeedback (BF) aiming at forehead muscle relaxation. Thirty-five children with ADHD (26 boys, 9 girls; 6-14 years old) were randomly assigned to either the therapy group (NF; n = 18) or the control group (BF; n = 17). Treatment for both groups consisted of 30 sessions. Pre- and post-treatment assessment consisted of psychophysiological measures, behavioural rating scales completed by parents and teachers, as well as psychometric measures. Training effectively reduced theta/beta ratios and EMG levels in the NF and BF groups, respectively. Parents reported significant reductions in primary ADHD symptoms, and inattention improvements in the NF group were higher compared to the control intervention (BF, d (corr) = -.94). NF training also improved attention and reaction times on the psychometric measures. The results indicate that NF effectively reduced inattention symptoms on parent rating scales and reaction time in neuropsychological tests. However, regarding hyperactivity and impulsivity symptoms, the results imply that non-specific factors, such as behavioralcontingencies, self-efficacy, structured learning environment and feed-forward processes, may also contribute to the positive behavioural effects induced by neurofeedback training.

Eur Child Adolesc Psychiatry. 2011 Sep;20(9):481-91. Epub 2011 Aug 13. Bakhshayesh AR, Hänsch S, Wyschkon A, Rezai MJ, Esser G. Department of Psychology, Faculty of Humanities, Yazd University, Yazd, Iran.

CONTEXT: Neurofeedback represents an exciting complementary option in the treatment of depression that builds upon a huge body of research on electroencephalographic correlates of depression. OBJECTIVE: The objectives of this article are threefold: review the literature on neurofeedback protocols for depression; introduce a new protocol, which aims to synthesize the best qualities of the currently available protocols; and present the results of a small clinical experiment with the new protocol. METHOD: Structured survey of the literature; software development; clinical trial with one subject, submitted to ten sessions of neurofeedback (one hour each). RESULTS: Currently there are twenty-one articles in neurofeedback for depression, among which only six present original experimental results. All of them report positive results with the technique. The most used protocols focus on Alpha inter-hemispheric asymmetry, and Theta/Beta ratio within the left prefrontal cortex. Our new protocol integrates both dimensions in a single circuit, adding to it a third programming line, which divides Beta frequencies and reinforces the decrease of Beta-3, in order to reduce anxiety. The favorable outcome of our clinical experiment, suggests that new research with this protocol is worthwhile.

Span J Psychol. 2011 May;14(1):374-84. Dias AM, van Deusen A. Universidade Federal de São Paulo, Brazil. alvaromd@usp.br

A multitude of interventions is offered for the treatment of autism spectrum disorders (ASD). However, only few have demonstrated scientific evidence, and even the evaluated methods need further examination of their mechanisms and scope. This article provides a brief summary of the premises and principles of successful psychobiosocial ASD intervention. ABA, TEACCH, PECS, social skills and cognitive training are described as examples for established approaches to ASD. Training of µ-suppression using neurofeedback and reanimation of the fusiform gyrus and amygdala using computer-aided facial affect recognition training are introduced as neurobiologically based ASD interventions.

Nervenarzt. 2011 May;82(5):590-596. Bölte S. Department of Women's and Children's Health, Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Astrid Lindgren Children's Hospital (Q2:07), 17176, Stockholm, Schweden, sven.bolte@ki.se.

Full title: Neurofeedback in children with ADHD: specific event-related potential findings of a randomized controlled trial.

OBJECTIVE: In a randomized controlled trial, we could demonstrate clinical efficacy of neurofeedback (NF) training for children with ADHD (Gevensleben et al., 2009a). The present investigation aimed at learning more about the neuronal mechanisms of NF training. METHODS: Children with ADHD either completed a NF training or a computerized attention skills training (ratio 3:2). NF training consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training, each comprising 18 training units. At three times (pre-training, between the two training blocks and at post-training), event-related potentials (ERP) were recorded during the Attention Network Test. ERP analysis focused on the P3, reflecting inter alia attentional resources for stimulus evaluation, and the contingent negative variation (CNV), primarily related to cognitive preparation. RESULTS: After NF training, an increase of the CNV in cue trials could be observed, which was specific for the SCP training. A larger pre-training CNV was associated with a larger reduction of ADHD symptomatology for SCP training. CONCLUSIONS: CNV effects reflect neuronal circuits underlying resource allocation during cognitive preparation. These distinct ERP effects are closely related to a successful NF training in children with ADHD. In future studies, neurophysiological recordings could help to optimize and individualize NF training. SIGNIFICANCE: The findings contribute to a better understanding of the mechanisms underlying NF training in children with ADHD.

Clin Neurophysiol. 2011 May;122(5):942-50. Epub 2010 Sep 16. Wangler S, Gevensleben H, Albrecht B, Studer P, Rothenberger A, Moll GH, Heinrich H. Dept. of Child and Adolescent Mental Health, University of Erlangen-Nürnberg, Schwabachanlage 6+10, D-91054 Erlangen, Germany. Comment in Clin Neurophysiol. 2011 May;122(5):856-7.

Full title: Computer-Based Attention Training in the Schools for Children With Attention Deficit/Hyperactivity Disorder: A Preliminary Trial.

Objective. This study examined the efficacy of 2 computer-based training systems to teach children with attention deficit/hyperactivity disorder (ADHD) to attend more effectively. Design/methods. A total of 41 children with ADHD from 2 middle schools were randomly assigned to receive 2 sessions a week at school of either neurofeedback (NF) or attention training through a standard computer format (SCF), either immediately or after a 6-month wait (waitlist control group). Parents, children, and teachers completed questionnaires pre- and postintervention. Results. Primary parents in the NF condition reported significant (P < .05) change on Conners's Rating Scales-Revised (CRS-R) and Behavior Assessment Scales for Children (BASC) subscales; and in the SCF condition, they reported significant (P < .05) change on the CRS-R Inattention scale and ADHD index, the BASC Attention Problems Scale, and on the Behavioral Rating Inventory of Executive Functioning (BRIEF). Conclusion. This randomized control trial provides preliminary evidence of the effectiveness of computer-based interventions for ADHD and supports the feasibility of offering them in a school setting.

Clin Pediatr (Phila). 2011 May 10. Steiner NJ, Sheldrick RC, Gotthelf D, Perrin EC. Floating Hospital for Children, Boston, MA, USA.

This article reviews a technological advance that originates from two areas of ongoing neuroimaging innovation-(1) the use of multivariate supervised learning to decode brain states and (2) real-time functional magnetic resonance imaging (rtfMRI). The approach uses multivariate methods to train a model capable of decoding a subject's brain state from fMRI images. The decoded brain states can be used as a control signal for a brain computer interface (BCI) or to provide neurofeedback to the subject. The ability to adapt the stimulus during the fMRI experiment adds a new level of flexibility for task paradigms and has potential applications in a number of areas, including performance enhancement, rehabilitation, and therapy. Multivariate approaches to real-time fMRI are complementary to region-of-interest (ROI)-based methods and provide a principled method for dealing with distributed patterns of brain responses. Specifically, a multivariate approach is advantageous when network activity is expected, when mental strategies could vary from individual to individual, or when one or a few ROIs are not unequivocally the most appropriate for the investigation. Beyond highlighting important developments in rtfMRI and supervised learning, the article discusses important practical issues, including implementation considerations, existing resources, and future challenges and opportunities. Some possible future directions are described, calling for advances arising from increased experimental flexibility, improvements in predictive modeling, better comparisons across rtfMRI and other BCI implementations, and further investigation of the types of feedback and degree to which interface modulation is obtainable for various tasks.

Neuroimage. 2011 May 15;56(2):440-54. Epub 2010 Jun 30. LaConte SM. Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA. slaconte@cpu.bcm.edu

Full title: Clinical Neurofeedback: Case Studies, Proposed Mechanism, and Implications for Pediatric Neurology Practice.

Trends in alternative medicine use by American health care consumers are rising substantially. Extensive literature exists reporting on the effectiveness of neurofeedback in the treatment of autism, closed head injury, insomnia, migraine, depression, attention deficit hyperactivity disorder, epilepsy, and posttraumatic stress disorder. We speculated that neurofeedback might serve as a therapeutic modality for patients with medically refractory neurological disorders and have begun referring patients to train with clinical neurofeedback practitioners. The modality is not always covered by insurance. Confident their child's medical and neurological needs would continue to be met, the parents of 3 children with epilepsy spectrum disorder decided to have their child train in the modality. The children's individual progress following neurofeedback are each presented here. A proposed mechanism and practice implications are discussed.

J Child Neurol. 2011 May 16. Legarda SB, McMahon D, Othmer S, Othmer S. Georgetown University Medical Center, Departments of Pediatrics and Neurology, Washington, DC.

Electroencephalography (EEG)-neurofeedback has been shown to offer therapeutic benefits to patients with attention-deficit/hyperactivity disorder (ADHD) in several, mostly uncontrolled studies. This pilot study is designed to test the feasibility and safety of using a double-blind placebo feedback-controlled design and to explore the initial efficacy of individualized EEG-neurofeedback training in children with ADHD. Fourteen children (8-15 years) with ADHD defined according to the DSM-IV-TR criteria were randomly allocated to 30 sessions of EEG-neurofeedback (n = 8) or placebo feedback (n = 6). Safety measures (adverse events and sleep problems), ADHD symptoms and global improvement were monitored. With respect to feasibility, all children completed the study and attended all study visits and training sessions. No significant adverse effects or sleep problems were reported. Regarding the expectancy, 75% of children and their parent(s) in the active neurofeedback group and 50% of children and their parent(s) in the placebo feedback group thought they received placebo feedback training. Analyses revealed significant improvements of ADHD symptoms over time, but changes were similar for both groups. This pilot study shows that it is feasible to conduct a rigorous placebo-controlled trial to investigate the efficacy of neurofeedback training in children with ADHD. However, a double-blind design may not be feasible since using automatic adjusted reward thresholds may not work as effective as manually adjusted reward thresholds. Additionally, implementation of active learning strategies may be an important factor for the efficacy of EEG-neurofeedback training. Based on the results of this pilot study, changes are made in the design of the ongoing study.

J Neural Transm. 2011 Feb;118(2):275-84. Epub 2010 Dec 17. Lansbergen MM, van Dongen-Boomsma M, Buitelaar JK, Slaats-Willemse D. Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. mariekelansbergen@hotmail.com

OBJECTIVE: Previous studies report that enhanced power in the delta range (1.5-4Hz) and reduced power in the alpha frequency band (8-12Hz) were most pronounced in the temporal regions. These studies referred to the 8-12Hz activity as tau activity, and they created a new neurofeedback protocol to treat tinnitus using a temporally generated tau rhythm (8-12Hz) and slow waves in the delta range (3-4Hz) 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.

Auris Nasus Larynx. 2011 May 16. Crocetti A, Forti S, Del Bo L. Fondazione Ascolta e Vivi, Via Foppa 15, 20144 Milan, Italy.

Full title: Neurofeedback-enhanced gamma brainwaves from the prefrontal cortical region of meditators and non-meditators and associated subjective experiences.

OBJECTIVES: This study had two aims: (1) to explore the inner experiences associated with increased production of gamma brainwaves in an initial neurofeedback experience; and (2) to measure and compare neurofeedback-enhanced increased output from the prefrontal cortical region of meditators and non-meditators, using the Peak Brain Happiness Trainer(™) neurofeedback system. DESIGN: This was a controlled pilot study; it involved a single session per subject. SETTING: The research was conducted in a nonprofit laboratory in the United States. SUBJECTS: There were 12 adults in 2 groups (N?=?12): 6 practitioners of Transcendental Meditation(™) and six controls. MEASURES: The measures were self-assessed inner experiences and measurements of clarified gamma output at the prefrontal cortical region. RESULTS: (1) Self-assessed descriptions were comparable for both groups; (2) the associations of 16 supplied descriptors with the initial neurofeedback experience were comparable for both groups and showed highest scores for "happy" (p? J Altern Complement Med. 2011 Feb;17(2):109-15. Epub 2011 Feb 8. Rubik B. Institute for Frontier Science, Oakland, CA 94611-2802, USA. brubik@earthlink.net

Animals can learn to voluntarily control neuronal activity within various brain areas through operant conditioning, but the relevance of that control to cognitive functions is unknown. We show that monkeys can control the activity of neurons within the frontal eye field (FEF), an oculomotor area of prefrontal cortex. However, operantly driven FEF activity was primarily associated with selective visual attention and not oculomotor preparation. Attentional effects were untrained and were observed both behaviorally and neurophysiologically. Furthermore, selective attention correlated with voluntary, but not spontaneous, fluctuations in FEF activity. Our results reveal a specific association of voluntarily driven neuronal activity with "top-down" attention and suggest a basis for the use of neurofeedback training to treat disorders of attention.

Science. 2011 May 26. Schafer RJ, Moore T. Department of Neurobiology, Stanford University School of Medicine, Stanford, CA 94305, USA.

"Real-time" functional magnetic resonance imaging is starting to be used in neurofeedback applications, enabling individuals to regulate their brain activity for therapeutic purposes. These applications use two-dimensional multislice echo planar or spiral readouts to image the entire brain volume, often with a much smaller region of interest within the brain monitored for feedback purposes. Given that such brain activity should be sampled rapidly, it is worthwhile considering alternative functional magnetic resonance imaging pulse sequences that trade spatial resolution for temporal resolution. We developed a prototype sequence localizing a column of magnetization by outer volume saturation, from which densely sampled transverse relaxation time decays are obtained at coarse voxel locations using an asymmetric gradient echo train. For 5×20×20 mm3 voxels, 256 echoes are sampled at ~1 msec and then combined in weighted summation to increase functional magnetic resonance imaging signal contrast. This multiecho coarse voxel pulse sequence is shown experimentally at 1.5 T to provide the same signal contrast to noise ratio as obtained by spiral imaging for a primary motor cortex region of interest, but with potential for enhanced temporal resolution. A neurofeedback experiment also illustrates measurement and calculation of functional magnetic resonance imaging signals within 1 sec, emphasizing the future potential of the approach.

Magn Reson Med. 2011 Mar;65(3):715-24. doi: 10.1002/mrm.22674. Epub 2010 Nov 3. Kuo AY, Chiew M, Tam F, Cunningham C, Graham SJ. Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.

Real-time fMRI permits simultaneous measurement and observation of brain activity during an ongoing task. One of the most challenging applications of real-time fMRI in neuroscientific and clinical research is the possibility of acquiring volitional control of localized brain activity using real-time fMRI-based neurofeedback protocols. Real-time fMRI allows the experimenter to noninvasively manipulate brain activity as an independent variable to observe the effects on behavior. Real-time fMRI neurofeedback studies demonstrated that learned control of the local brain activity leads to specific changes in behavior. Here, the authors describe the implementation and application of real-time fMRI with particular emphasis on the self-regulation of local brain activity and the investigation of brain-function relationships. Real-time fMRI represents a promising new approach to cognitive neuroscience that could complement traditional neuroimaging techniques by providing more causal insights into the functional role of circumscribed brain regions in behavior.

Neuroscientist. 2011 Jun 7. Caria A, Sitaram R, Birbaumer N. Institute of Medical Psychology & Behavioral Neurobiology, Eberhard-Karls-University of Tübingen, Germany; Università di Trento, Trento, Italy.

Full title: Complementary medicine for children and young people who have attention deficit hyperactivity disorder.

PURPOSE OF REVIEW: Despite effectiveness of medication in treating children and young people who have attention deficit hyperactivity disorder (ADHD), concerns about the effects of medication on children's developing brains, adverse side-effects, possibility of long-term use, and compliance issues have all contributed to the continuing search for alternative therapies. This article reviews the latest scientific evidence of the effectiveness and safety of these treatments in ADHD. RECENT FINDINGS: Although there is evidence from a large randomized controlled study that neurofeedback has positive effects on reducing children's symptoms of ADHD, most recent randomized controlled trials have generally yielded negative results. Some positive results exist from a pilot study of repetitive transcranial magnetic stimulation. However, the sample size was far too small to enable any conclusions to be drawn about the evidence. Findings from the recent randomized controlled trials of supplements of essential fatty acids in children who have ADHD clearly demonstrated lack of superiority compared with placebo.SUMMARY: Notwithstanding efforts made to increase the scientific rigor of previous studies, more recent studies have generally been unsuccessful in demonstrating adequate treatment effects of complementary medicine on children who have ADHD. Currently, there is no proof that complementary medicine provides a better alternative for children who have ADHD than treatments that are currently available within multimodal therapy.

Curr Opin Psychiatry. 2011 Jul;24(4):291-300. Skokauskas N, McNicholas F, Masaud T, Frodl T. aDepartment of Psychiatry, Trinity College, Ireland bDepartment of Child Psychiatry, Our Lady's Children's Hospital, Crumlin, Lucena Clinic, Rathgar and University College, Ireland cDepartment of Psychiatry, Drug Treatment Centre Board, Ireland dDepartment of Psychiatry, Institute of Neuroscience, University of Dublin, Trinity College, Dublin, Ireland.

Full title: Changes in cognitive evoked potentials during non pharmacological treatment in children with attention deficit/hyperactivity disorder.

Attention deficit/hyperactivity disorder (ADHD) is one of the most widely spread condition of school aged children affecting 5% of children of this age. The unified consensus of the precise diagnosis of this condition is still absent. This fact encourages the researchers to seek the alternative neurometric tools which will help the clinicians in diagnosis making process of ADHD. The neurophysiologic approaches especially event-related potentials (ERPs) are mostly important from this point of view. The later response of ERPs (P3) reflects the most important parts of executive functioning frequently affected in ADHD children - the process of mental effortfullness to select the appropriate behavior and decision making. Besides the diagnosis the treatment of ADHD is also the point of concern of neurologists and neurophyschologists. In recent years EEG biofeedback ( Neurofeedback-NF) have become the alternative treatment as in some cases pharmacological drugs are non effective. The positive impact of NF was based on improvement detected by various questionnaires which are less valid but its effectiveness on ERPs parameters is still unknown. Thus we aimed to study the changes of ERPs after NF therapy. Methods: We have studied 93 children with ADHD of combined subtype (ADHDcom) without any kind of pharmacological treatment. Age range 9-12 years. The children were divided into two subgroups: The first ADHDcom-1 (48 children) were children where NF treatment was carried out and the second subgroup of ADHDcom-2 (45 children) were non treated children. Results: We have observed statistically significant improvement of parameters of later response like P3 in ADHD-1 compared with ADHD-2 whereas NF was non effective for earlier component like N1. Conclusions: NF can positively affect on the P3 parameters which is very important in ADHD children as P3 reflects the speed of information processing as well as selection of appropriate action and decision making which are frequently affected in ADHD children.

Georgian Med News. 2011 Mar;(192):47-57. Bakhtadze S, Janelidze M, Khachapuridze N. S. Khechinashvili Univeristy Clinic, Tbilisi, Georgia; G. Zhvania University Clinic, Tbilisi, Georgia.

Real-time functional magnetic resonance imaging can be used to feed back signal changes from the brain to participants such that they can train to modulate activation levels in specific brain areas. Here we present the first study combining up-regulation of brain areas for positive emotions with psychometric measures to assess the effect of successful self-regulation on subsequent mood. We localized brain areas associated with positive emotions through presentation of standardized pictures with positive valence. Participants up-regulated activation levels in their target area during specific periods, alternating with rest. Participants attained reliable self-control of the target area by the last of three seven-minute runs. This training effect was supported by an extensive network outside the targeted brain region, including higher sensory areas, paralimbic and orbitofrontal cortex. Self-control of emotion areas was not accompanied by clear changes in self-reported emotions; trend-level improvements on depression scores were counteracted by increases on measures of fatigue, resulting in no overall mood improvement. It is possible that benefits of self-control of emotion networks may only appear in people who display abnormal emotional homeostasis. The use of only a single, short, training session, overlap between positive and negative emotion networks and aversive reactions to the scanning environment may have prevented the detection of subtle changes in mood.

Cogn Affect Behav Neurosci. 2011 Mar;11(1):44-51. Johnston S, Linden DE, Healy D, Goebel R, Habes I, Boehm SG. School of Social Sciences, Psychology Department, Brunel University, Uxbridge, Middlesex UB8 3PH, UK. Stephen.Johnston@brunel.ac.uk

Full title: Predicting successful learning of SMR neurofeedback in healthy participants: methodological considerations.

Neurofeedback (NF) is a tool that has proven helpful in the treatment of various disorders such as epilepsy or attention deficit disorder (ADHD). Depending on the respective application, a high number of training sessions might be necessary before participants can voluntarily modulate the electroencephalographic (EEG) rhythms as instructed. In addition, many individuals never learn to do so despite numerous training sessions. Thus, we are interested in determining whether or not performance during the early training sessions can be used to predict if a participant will learn to regulate the EEG rhythms. Here, we propose an easy to use, but accurate method for predicting the performance of individual participants. We used a sample set of sensorimotor rhythm (SMR 12-15 Hz) NF training sessions (experiment 1) to predict the performance of the participants of another study (experiment 2). We then used the data obtained in experiment 2 to predict the performance of participants in experiment 1. We correctly predicted the performance of 12 out of 13 participants in the first group and all 14 participants in the second group; however, we were not able to make these predictions before the end of the eleventh training session.

Appl Psychophysiol Biofeedback. 2011 Mar;36(1):37-45. Weber E, Köberl A, Frank S, Doppelmayr M. Department of Physiological Psychology, University of Salzburg, Hellbrunnerstrasse 34, Salzburg, Austria.

In this paper, we present a new, low-cost dry electrode for EEG that is made of flexible metal-coated polymer bristles. We examine various standard EEG paradigms, such as capturing occipital alpha rhythms, testing for event-related potentials in an auditory oddball paradigm and performing a sensory motor rhythm-based event-related (de-) synchronization paradigm to validate the performance of the novel electrodes in terms of signal quality. Our findings suggest that the dry electrodes that we developed result in high-quality EEG recordings and are thus suitable for a wide range of EEG studies and BCI applications. Furthermore, due to the flexibility of the novel electrodes, greater comfort is achieved in some subjects, this being essential for long-term use.

J Neural Eng. 2011 Apr;8(2):025008. Epub 2011 Mar 24. Grozea C, Voinescu CD, Fazli S. Fraunhofer Institute FIRST, Kekulestrasse 7, Berlin 12489, Germany. cristian.grozea@first.fraunhofer.de

Full title: European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions.

This clinical guideline provides recommendations for the behavioural and psychosocial interventions (BPI) of children and adolescents with tic disorders prepared by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted to obtain an update on the efficacy of BPI for tics. Relevant studies were identified using computerised searches of the Medline and PsycINFO databases and the Cochrane Library for the years 1950-2010. The search identified no meta-analyses, yet twelve (systematic) reviews and eight randomised controlled trials provided evidence for the current review. Most evidence was found for habit reversal training (HRT) and the available but smaller evidence also supports the efficacy of exposure with response prevention (ERP). Both interventions are considered first line behavioural treatments for tics for both children and adults and should be offered to a patient, taking into account his preference. Treatments that are considered second line or add-on behavioural treatments are contingency management, function based interventions and relaxation training. Neurofeedback is still experimental. Almost no research was identified that examined the efficacy of psychosocial interventions, e.g., psychoeducation and group work. Based on clinical practice, this guideline recommends behavioural treatment as first line offer to patients in most cases. It should be embedded within a psychoeducational and supportive context and can be combined with drug treatment.

Eur Child Adolesc Psychiatry. 2011 Apr;20(4):197-207. Verdellen C, van de Griendt J, Hartmann A, Murphy T; ESSTS Guidelines Group. Collaborators: Androutsos C, Aschauer H, Baird G, Bos-Veneman N, Brambilla A, Cardona F, Cath DC, Cavanna AE, Czernecki V, Dehning S, Eapter A, Farkas L, Gadaros J, Hartmann A, Hauser E, Heyman I, Hedderly T, Hoekstra PJ, Korsgaard A, Jackson GM, Larsson L, Ludolph AG, Martino D, Menghetti C, Mol Debes N, Muller N, Muller-Vahl K, Munchau A, Murphy T, Musil R, Nagy P, Nurnberger J, Oostra B, Paschou P, Pasquini M, Plessen KJ, Porta M, Rickards H, Rizzo R, Robertson MM, Roessner V, Rothenberger A, Servello D, Skov L, Stern JS, Strand G, Tarnok Z, Termine C, Van der Griendt J, Verdellen C, Visser-Vandewalle V, Wannag E, Wolanczyck T. HSK Group/Expertise Centre Tics, Hambakenwetering 5B, 5231 DD Den Bosch, The Netherlands. c.verdellen@hsk.nl

Social learning is essential for adaptive behavior in humans. Neurofeedback based on functional magnetic resonance imaging (fMRI) trains control over localized brain activity. It can disentangle learning processes at the neural level and thus investigate the mechanisms of operant conditioning with explicit social reinforcers. In a pilot study, a computer-generated face provided a positive feedback (smiling) when activity in the anterior cingulate cortex (ACC) increased and gradually returned to a neutral expression when the activity dropped. One female volunteer without previous experience in fMRI underwent training based on a social reinforcer. Directly before and after the neurofeedback runs, neural responses to a cognitive interference task (Simon task) were recorded. We observed a significant increase in activity within ACC during the neurofeedback blocks, correspondent with the a-priori defined anatomical region of interest. In the course of the neurofeedback training, the subject learned to regulate ACC activity and could maintain the control even without direct feedback. Moreover, ACC was activated significantly stronger during Simon task after the neurofeedback training when compared to before. Localized brain activity can be controlled by social reward. The increased ACC activity transferred to a cognitive task with the potential to reduce cognitive interference. Systematic studies are required to explore long-term effects on social behavior and clinical applications.

Eur Arch Psychiatry Clin Neurosci. 2010 Nov;260 Suppl 2:S132-6. Epub 2010 Oct 9. Mathiak KA, Koush Y, Dyck M, Gaber TJ, Alawi E, Zepf FD, Zvyagintsev M, Mathiak K. Department of Psychiatry and Psychotherapy, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany. kamathiak@ukaachen.de

The advent of real-time neurofeedback techniques has allowed us to begin to map the controllability of sensory and cognitive and, more recently, affective centers in the brain. The subgenual anterior cingulate cortex (sACC) is thought to be involved in generation of affective states and has been implicated in psychopathology. In this study, we examined whether individuals could use real-time fMRI neurofeedback to modulate sACC activity. Following a localizer task used to identify an sACC region of interest, an experimental group of eight women participated in four scans: (1) a pretraining scan in which they were asked to decrease activity in the sACC without neurofeedback; (2) two training scans in which sACC neurofeedback was presented along with instructions to decrease sACC activity; and (3) a neurofeedback-free post-training scan. An additional nine women in a yoked feedback control group saw sACC activity from the participants in the experimental group. Activity in the sACC was significantly reduced during neurofeedback training in the experimental group, but not in the control group. This training effect in the experimental group, however, did not generalize to the neurofeedback-free post-training scan. A psychophysiological interaction analysis showed decreased correlation in the experimental group relative to the sham control group between activity in the sACC and the posterior cingulate cortex during neurofeedback training relative to neurofeedback-free scans. The finding that individuals can down-modulate the sACC shows that a primary emotion center in which functional abnormality has been strongly implicated in affective disorders can be controlled with the aid of neurofeedback. Copyright © 2010 Wiley-Liss, Inc.

Hum Brain Mapp. 2011 Jan;32(1):22-31. doi: 10.1002/hbm.20997. Hamilton JP, Glover GH, Hsu JJ, Johnson RF, Gotlib IH. Department of Psychology, Stanford University, Stanford, California 94305, USA. paul.hamilton@stanford.edu paul.hamilton@stanford.edu

Natural movements are corrected in part by the generation of submovements, occurring early in a movement such that they amend an ongoing action. Submovements are associated with activity of the basal ganglia, implying a role for the structures in error correction. In parallel, the basal ganglia are linked to the generation and control of force amplitude, change, and duration. Here, we tested whether activity in human basal ganglia is associated with submovements generally, or was specific to a condition where the submovements only occurred in the face of unexpected proprioceptive error. Submovements were induced by introducing unexpected and variable viscous loads (augmenting the need for trial-specific grip forces) or by reducing target size (augmenting the need for visually guided on-line control) in a one-dimensional target-capture task. In both cases, subjects compensated for the increased task difficulty by generating corrective submovements, which were closely matched in frequency and type. Activity in the internal segment of the globus pallidus and subthalamic nucleus correlated strongly with the number of submovements during the viscous challenge but not with the target challenge. The effects could not be explained by kinematic differences, i.e., movement amplitude or average number of submovements. The results support a specific role for the basal ganglia in error correction under conditions of variable load where there is a need for the dynamic control of force within an ongoing movement.

J Neurosci. 2011 Feb 2;31(5):1600-5. Grafton ST, Tunik E. Sage Center for the Study of Mind, Department of Psychology, University of California, Santa Barbara, California 93106, USA. grafton@psych.ucsb.edu

Seventy-one patients with recurrent migraine headaches, aged 17-62, from one neurological practice, completed a quantitative electroencephalogram (QEEG) procedure. All QEEG results indicated an excess of high-frequency beta activity (21-30 Hz) in 1-4 cortical areas. Forty-six of the 71 patients selected neurofeedback training while the remaining 25 chose to continue on drug therapy. Neurofeedback protocols consisted of reducing 21-30 Hz activity and increasing 10 Hz activity (5 sessions for each affected site). All the patients were classified as migraine without aura. For the neurofeedback group the majority (54%) experienced complete cessation of their migraines, and many others (39%) experienced a reduction in migraine frequency of greater than 50%. Four percent experienced a decrease in headache frequency of < 50%. Only one patient did not experience a reduction in headache frequency. The control group of subjects who chose to continue drug therapy as opposed to neurofeedback experienced no change in headache frequency (68%), a reduction of less than 50% (20%), or a reduction greater than 50% (8%). QEEG-guided neurofeedback appears to be dramatically effective in abolishing or significantly reducing headache frequency in patients with recurrent migraine.

Clin EEG Neurosci. 2011 Jan;42(1):59-61. Walker JE. Neurotherapy Center of Dallas, 12870 Hillcrest, Suite 201, Dallas, Texas 75230, USA. admin@neurotherapydallas.com

BACKGROUND: By enabling individuals to self-regulate their brainwave activity in the field of optimal performance in healthy individuals, neurofeedback has been found to improve cognitive and artistic performance. Here we assessed whether two distinct EEG neurofeedback protocols could develop surgical skill, given the important role this skill plays in medicine. RESULTS: National Health Service trainee ophthalmic microsurgeons (N = 20) were randomly assigned to either Sensory Motor Rhythm-Theta (SMR) or Alpha-Theta (AT) groups, a randomized subset of which were also part of a wait-list 'no-treatment' control group (N = 8). Neurofeedback groups received eight 30-minute sessions of EEG training. Pre-post assessment included a skills lab surgical procedure with timed measures and expert ratings from video-recordings by consultant surgeons, together with state/trait anxiety self-reports. SMR training demonstrated advantages absent in the control group, with improvements in surgical skill according to 1) the expert ratings: overall technique (d = 0.6, p < 0.03) and suture task (d = 0.9, p < 0.02) (judges' intraclass correlation coefficient = 0.85); and 2) with overall time on task (d = 0.5, p = 0.02), while everyday anxiety (trait) decreased (d = 0.5, p < 0.02). Importantly the decrease in surgical task time was strongly associated with SMR EEG training changes (p < 0.01), especially with continued reduction of theta (4-7 Hz) power. AT training produced marginal improvements in technique and overall performance time, which were accompanied by a standard error indicative of large individual differences. Notwithstanding, successful within session elevation of the theta-alpha ratio correlated positively with improvements in overall technique (r = 0.64, p = 0.047). CONCLUSION: SMR-Theta neurofeedback training provided significant improvement in surgical technique whilst considerably reducing time on task by 26%. There was also evidence that AT training marginally reduced total surgery time, despite suboptimal training efficacies. Overall, the data set provides encouraging evidence of optimised learning of a complex medical specialty via neurofeedback training.

BMC Neurosci. 2009 Jul 24;10:87. Ros T, Moseley MJ, Bloom PA, Benjamin L, Parkinson LA, Gruzelier JH. Department of Psychology, Goldsmiths, University of London, London, UK. t.ros@gold.ac.uk

Real-time functional magnetic resonance imaging (fMRI) affords the opportunity to explore the feasibility of self-regulation of functional brain networks through neurofeedback. We localised emotion networks individually in thirteen participants using fMRI and trained them to upregulate target areas, including the insula and amygdala. Participants achieved a high degree of control of these networks after a brief training period. We observed activation increases during periods of upregulation of emotion networks in the precuneus and medial prefrontal cortex and, with increasing training success, in the ventral striatum. These findings demonstrate the feasibility of fMRI-based neurofeedback of emotion networks and suggest a possible development into a therapeutic tool.

Neuroimage. 2009 Jul 29. Johnston SJ, Boehm SG, Healy D, Goebel R, Linden DE. Bangor Imaging Unit, Wolfson Centre for Clinical and Cognitive Neuroscience, School of Psychology, Bangor University, Bangor, UK.

Full Title: Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis

Since the first reports of neurofeedback treatment in Attention Deficit Hyperactivity Disorder (ADHD) in 1976, many studies have investigated the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear. In this study selected research on neurofeedback treatment for ADHD was collected and a meta-analysis was performed. Both prospective controlled studies and studies employing a pre- and post-design found large effect sizes (ES) for neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to nonspecific treatment factors. Due to the inclusion of some very recent and sound methodological studies in this meta-analysis, potential confounding factors such as small studies, lack of randomization in previous studies and a lack of adequate control groups have been addressed, and the clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered "Efficacious and Specific" (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.

Clin EEG Neurosci. 2009 Jul;40(3):180-9. Arns M, de Ridder S, Strehl U, Breteler M, Coenen A. Brainclinics Diagnostics, Nijmegen, The Netherlands. martijn@brainclinics.com

Full Title: Distinct EEG effects related to neurofeedback training in children with ADHD: A randomized controlled trial

In a randomized controlled trial, neurofeedback (NF) training was found to be superior to a computerised attention skills training concerning the reduction of ADHD symptomatology (Gevensleben et al., 2009). The aims of this investigation were to assess the impact of different NF protocols (theta / beta and slow cortical potentials (SCP) training) on the resting EEG and the association between distinct EEG measures and behavioral improvements. In 72 (of initially 102) children with ADHD, aged 8-12, EEG changes after either a NF training (n=46) or the control training (n=26) could be studied. The combined NF training consisted of one block of theta / beta training and one block of SCP training, each block comprising 18 units of 50 minutes (balanced order). Spontaneous EEG was recorded in a two-minutes resting condition before the start of the training, between the two training blocks and after the end of the training. Activity in the different EEG frequency bands was analysed. In contrast to the control condition, the combined NF training was accompanied by a reduction of theta activity. Protocol-specific EEG changes (theta/beta training: decrease of posterior-midline theta activity; SCP training: increase of central-midline alpha activity) were associated with a decrease of the hyperactivity/impulsivity subscale of the German ADHD rating scale. Related EEG-based predictors were obtained. Thus, differential EEG patterns for theta / beta and SCP training provide further evidence that distinct neuronal mechanisms may contribute to similar behavioral improvements in children with ADHD.

Int J Psychophysiol. 2009 Aug 24. Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Wangler S, Rothenberger A, Moll GH, Heinrich H. Child & Adolescent Psychiatry, University of Göttingen, v.Siebold-Str. 5, D-37075 Göttingen, Germany.

Full Title: Improvements in Spelling after QEEG-based Neurofeedback in Dyslexia: A Randomized Controlled Treatment Study

Phonological theories of dyslexia assume a specific deficit in representation, storage and recall of phonemes. Various brain imaging techniques, including qEEG, point to the importance of a range of areas, predominantly the left hemispheric temporal areas. This study attempted to reduce reading and spelling deficits in children who are dyslexic by means of neurofeedback training based on neurophysiological differences between the participants and gender and age matched controls. Nineteen children were randomized into an experimental group receiving qEEG based neurofeedback (n = 10) and a control group (n = 9). Both groups also received remedial teaching. The experimental group improved considerably in spelling (Cohen's d = 3). No improvement was found in reading. An indepth study of the changes in the qEEG power and coherence protocols evidenced no fronto-central changes, which is in line with the absence of reading improvements. A significant increase of alpha coherence was found, which may be an indication that attentional processes account for the improvement in spelling. Consideration of subtypes of dyslexia may refine the results of future studies.

Appl Psychophysiol Biofeedback. 2009 Aug 27. Breteler MH, Arns M, Peters S, Giepmans I, Verhoeven L. EEG Resource Institute, P.O. Box 31070, 6503 CB, Nijmegen, The Netherlands, r.breteler@eegbiofeedback.nl.

BACKGROUND: For children with attention deficit/hyperactivity disorder (ADHD), a reduction of inattention, impulsivity and hyperactivity by neurofeedback (NF) has been reported in several studies. But so far, unspecific training effects have not been adequately controlled for and/or studies do not provide sufficient statistical power. To overcome these methodological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite randomised controlled study using a computerised attention skills training as a control condition. METHODS: 102 children with ADHD, aged 8 to 12 years, participated in the study. Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each (randomised group assignment). The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training. Pre-training, intermediate and post-training assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents and teachers. Evaluation ('placebo') scales were applied to control for parental expectations and satisfaction with the treatment. RESULTS: For parent and teacher ratings, improvements in the NF group were superior to those of the control group. For the parent-rated FBB-HKS total score (primary outcome measure), the effect size was .60. Comparable effects were obtained for the two NF protocols (theta/beta training, SCP training). Parental attitude towards the treatment did not differ between NF and control group. CONCLUSIONS: Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD. Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD.

J Child Psychol Psychiatry. 2009 Jul;50(7):780-9. Epub 2009 Jan 12. Gevensleben H, Holl B, Albrecht B, Vogel C, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H. Child & Adolescent Psychiatry, University of Göttingen, Germany.

In the present study, we propose a neurofeedback-based motor imagery training system for EEG-based brain-computer interface (BCI). The proposed system can help individuals get the feel of motor imagery by presenting them with real-time brain activation maps on their cortex. Ten healthy participants took part in our experiment, half of whom were trained by the suggested training system and the others did not use any training. All participants in the trained group succeeded in performing motor imagery after a series of trials to activate their motor cortex without any physical movements of their limbs. To confirm the effect of the suggested system, we recorded EEG signals for the trained group around sensorimotor cortex while they were imagining either left or right hand movements according to our experimental design, before and after the motor imagery training. For the control group, we also recorded EEG signals twice without any training sessions. The participants' intentions were then classified using a time-frequency analysis technique, and the results of the trained group showed significant differences in the sensorimotor rhythms between the signals recorded before and after training. Classification accuracy was also enhanced considerably in all participants after motor imagery training, compared to the accuracy before training. On the other hand, the analysis results for the control EEG data set did not show consistent increment in both the number of meaningful time-frequency combinations and the classification accuracy, demonstrating that the suggested system can be used as a tool for training motor imagery tasks in BCI applications. Further, we expect that the motor imagery training system will be useful not only for BCI applications, but for functional brain mapping studies that utilize motor imagery tasks as well.

J Neurosci Methods. 2009 Apr 30;179(1):150-6. Epub 2009 Jan 29. Hwang HJ, Kwon K, Im CH. Department of Biomedical Engineering, Yonsei University, Wonju-si, Kangwon-do, Republic of Korea.