Abstract
ObjectiveNeurofeedback training may improve cognitive function in patients with neurological disorders. However, the underlying cerebral mechanisms of such improvements are poorly understood. Therefore, we aimed to investigate MRI correlates of cognitive improvement after EEG-based neurofeedback training in patients with MS (pwMS).MethodsFourteen pwMS underwent ten neurofeedback training sessions within 3–4 weeks at home using a tele-rehabilitation system. Half of the pwMS (N = 7, responders) learned to self-regulate sensorimotor rhythm (SMR, 12–15 Hz) by visual feedback and improved cognitively after training, whereas the remainder (non-responders, n = 7) did not. Diffusion-tensor imaging and resting-state fMRI of the brain was performed before and after training. We analyzed fractional anisotropy (FA) and functional connectivity (FC) of the default-mode, sensorimotor (SMN) and salience network (SAL).ResultsAt baseline, responders and non-responders were comparable regarding sex, age, education, disease duration, physical and cognitive impairment, and MRI parameters. After training, compared to non-responders, responders showed increased FA and FC within the SAL and SMN. Cognitive improvement correlated with increased FC in SAL and a correlation trend with increased FA was observed.ConclusionsThis exploratory study suggests that successful neurofeedback training may not only lead to cognitive improvement, but also to increases in brain microstructure and functional connectivity.
Highlights
Cognitive impairment (CI) is present in 40–70% of patients with MS and viewed as one of the most disabling symptoms [1, 2]
We focused on three networks: the default mode network (DMN), the sensorimotor network (SMN), and the salience network (SAL), which were objectified by an overlap of the network identified by MELODIC with the Smith 10 templates [22]
Changes in white matter integrity associated with cognitive improvement or SMR increase Across the entire group, voxel-wise analysis revealed a trend for the positive correlation between increased fractional anisotropy (FA) and improved overall cognitive function in the left corticospinal tract (CST) and anterior thalamic radiation (ATR) (p = 0.08; Fig. 3)
Summary
Cognitive impairment (CI) is present in 40–70% of patients with MS (pwMS) and viewed as one of the most disabling symptoms [1, 2]. Journal of Neurology (2021) 268:3808–3816 enables voluntary modulation of one’s own brain activity, which might lead to cognitive, motor, affective, or behavioral improvements [10]. Notwithstanding these aspects, to date, only a few studies have investigated the efficacy of NF training on cognition, depression and fatigue in MS so far [8, 11, 12]. In a recent pilot study, we found that pwMS who successfully learned to self-regulate sensorimotor rhythm (SMR, 12–15 Hz) showed cognitive improvements after training [12]. We here aim to investigate MRI correlates of such cognitive improvement after EEG-based NF training in pwMS
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