A Single Case Feasibility Study of Sensorimotor Rhythm Neurofeedback in Parkinson’s Disease

Abstract

Electroencephalographic activity over the sensorimotor cortex has been one of the best studied targets for neurofeedback therapy. Parkinson’s disease patients display abnormal brain rhythms in the motor cortex caused by increased synchrony in the basal ganglia-cortical pathway. Few studies have examined the effects of sensorimotor-based neurofeedback therapy in humans with PD. In this pilot study, one patient, diagnosed with Parkinson’s disease 10 years prior, participated in two consecutive days of EEG neurofeedback training to increase sensorimotor rhythm (SMR) power over the motor cortex. Using a visual display connected to ongoing EEG, the patient voluntarily manipulated SMR power, and he/she was awarded with points to positively reinforce successful increases over a predefined threshold. Recorded EEG data were source localized and analyzed for the occurrence of high amplitude bursts of SMR activity as well as bursts in the beta frequency band in the precentral cortex. The rate of SMR bursts increased with each subsequent training session, while the rate of beta bursts only increased on the final session. Relative power in the beta band, a marker of PD symptom severity, decreased over the motor cortex in the later session. These results provide first evidence for the feasibility of SMR neurofeedback training as a non-invasive therapy for reducing Parkinson’s disease related activity and upregulating SMR in the human motor cortex.

The New Field of Network Physiology: Building the Human Physiolome

“…Utilizing this new perspective, recent studies have focused on 1) investigating brain-brain network interactions across distinct brain rhythms and locations, and their relation to new aspects of neural plasticity in response to changes in physiologic state; 2) characterizing dynamical features of brain-organ communications as a new signature of neuroautonomic control; 3) establishing basic principles underlying coordinated organ-organ communications, and 4) constructing first dynamic maps of physiological systems and organ interactions across distinct physiologic states (Bashan et al, 2012;Bartsch et al, 2012;Ivanov and Bartsch, 2014;Liu et al, 2015a;Liu et al, 2015b;Bartsch et al, 2015;Lin et al, 2016;Ivanov et al, 2017Ivanov et al, , 2021bDvir et al, 2018;dos Santos Lima et al, 2019;Lin et al, 2020;Rizzo et al, 2020;Ivanov et al, 2021a;Balagué et al, 2020). Pioneering investigations have made first insights into structural and functional connectivity of physiologic networks underlying individual organ systems and their sub-systems (Tass et al, 1998;Bullmore and Sporns, 2009;Gallos et al, 2012;Liu et al, 2015a;Neufang and Akhrif, 2020;Cohen et al, 2021;Cook et al, 2021), and how global behaviors at the organism level, different physiologic states and functions arise out of networked interactions among organ systems to generate health or disease (Bashan et al, 2012;Ivanov and Bartsch, 2014;Karavaev et al, 2020;Pernice et al, 2020;Tecchio et al, 2020;Wood et al, 2020;Zavala et al, 2020;Angelova et al, 2021;Guillet et al, 2021;…”

Changes in non-oscillatory features of the cortical sensorimotor rhythm in Parkinson’s disease across age

“…Understanding how features in the neural time series are related to motor symptoms in PD will also help develop non-invasive neural stimulation that can potentially relieve motor symptoms. 35,59 4 Methods…”

“…The Levodopa equivalent daily dose (LEDD) was calculated according to Tomlinson et al 62 Motor symptoms in the PD group were assessed using the Movement-Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III). 59 Global cognition was assessed with the Montreal Cognitive Assessment battery (MoCA). 64 We recorded three minutes of resting-state MEG while the participants sat with their eyes closed.…”

Volitional Control of Brain Motor Activity and Its Therapeutic Potential

“…Across two consecutive days of training, a PD participant learned to volitionally increase SMR power over the motor cortex with visual feedback and positive rewards. The rate of SMR bursts increased with each subsequence training session, while relative power in the beta band decreased in the later session 38 . These results correlated with improvements in both rigidity and gait on the second day of training.…”