Abstract
Novel methods that stimulate neuroplasticity are increasingly being studied to treat neurological and psychiatric conditions. We sought to determine whether real‐time fMRI neurofeedback training is feasible in Huntington's disease (HD), and assess any factors that contribute to its effectiveness. In this proof‐of‐concept study, we used this technique to train 10 patients with HD to volitionally regulate the activity of their supplementary motor area (SMA). We collected detailed behavioral and neuroimaging data before and after training to examine changes of brain function and structure, and cognitive and motor performance. We found that patients overall learned to increase activity of the target region during training with variable effects on cognitive and motor behavior. Improved cognitive and motor performance after training predicted increases in pre‐SMA grey matter volume, fMRI activity in the left putamen, and increased SMA–left putamen functional connectivity. Although we did not directly target the putamen and corticostriatal connectivity during neurofeedback training, our results suggest that training the SMA can lead to regulation of associated networks with beneficial effects in behavior. We conclude that neurofeedback training can induce plasticity in patients with Huntington's disease despite the presence of neurodegeneration, and the effects of training a single region may engage other regions and circuits implicated in disease pathology.
Highlights
We hypothesized that improved performance in the tapping task after training would correlate with ability to upregulate the target region of interest (ROI) activation
Using as seed ROI the left putamen cluster we found that improved performance predicted increase in functional connectivity with the target ROI
We have presented preliminary evidence to suggest that neurofeedback training is feasible in Huntington’s disease (HD), and may induce diseaserelevant neuroplasticity with potentially beneficial effects on cognitive and motor function
Summary
The aim of this study was not to prove efficacy, but feasibility, preliminary evidence was collected on cognitive and motor tasks before and after training using untrained, independently validated biomarkers of HD progression (Tabrizi et al, 2009, 2011, 2012, 2013). The aim of this study was to examine whether HD patients are able to learn to regulate their SMA activity using real-time fMRI neurofeedback training and what effect that would have on their motor and cognitive performance. We did not include a control group, as the main aim of the study was to show proof-of-concept, feasibility, and provide important data to inform future trials
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