MiniQEEG and Neurofeedback in Diagnosis and Treatment of COVID-19-Related Panic Attacks: A Case Report

Abstract

Background: Both the global COVID-19 pandemic situation, as well as the current political situation in Eastern Europe may exacerbate anxiety and contribute to stress-related disorders such as panic disorder. Electroencephalography (EEG)-based neurofeedback provides both assessment of the subject’s brainwave activity as well as the possibility of its therapeutic correction. It is possible that it can be implemented as an auxiliary treatment in panic disorders of different origin. The aim of this feasibility study was to demonstrate (both short- and long-term) effectiveness of neurofeedback therapy in a patient with previously diagnosed panic attacks, related to fear of COVID-19 infection. Methods: We report the case study of a 47-year-old man affected by panic attacks, related to his profound, constant fear of COVID-19 infection and its sequelae. For the initial diagnostic workup, several clinical and research tools were used: 1. Baseline psychological exam; 2. Anxiety—targeted interview performed by miniQEEG therapist; 3. Analysis of previous clinical test results (EEG record/lab blood test); and 4. The miniQEEG exam (central strip recording Cz-C3-C4), The patient was subjected to regular EEG Neurofeedback sessions for two consecutive months. After completing the treatment, follow-up tests, as listed above were repeated immediately after completing the whole treatment program, as well as 1 and 2 years later. MiniQEEG results were compared with healthy control (age-matched male subject not affected with panic attacks) and evaluated over the time that the subject was involved in the study. Results: Initially, the patient was suffering from severe panic attacks accompanied by vegetative symptoms and from destructive and negative thoughts. After 8 consecutive weeks of treatment encompassing sixteen QEEG neurofeedback training sessions (each lasting 30 min), a subjective improvement of his complaints was reported. More importantly, QEEG records of the patient also improved, approximating the pattern of QEEG recorded in the healthy control. Conclusion: In this single case-based feasibility analysis, we demonstrate that systematic application of QEEG-Neurofeedback may result in manifest and durable therapeutic effect. Of note, use of this treatment may be a valuable option for patients with panic attack/panic disorder, especially if related to the psychological burden of the COVID-19/war era. Future studies on a larger patient population, especially with a longitudinal/prospective design, are warranted.

Psycho-neuro-biological Correlates of Beta Activity

“…Though low beta has historically been associated with positive mental state aspects, such as focused energy (Abhang et al, 2016;Díaz et al, 2019;Tarrant et al, 2018), the musing thought capability of this wavelength can become detrimental if too high a relative power is reached (Apazoglou et al, 2019). For instance, abundant high-amplitude low beta wave activity is related to persistent sympathetic hyperactivity that influences mental stress (Kopańska, 2022). Thus, the relative power of low beta appears to be a factor in the modulation between the self-monitoring and internal focus capabilities of beta and more toxic applications of reflective thought, such as rumination (Apazoglou et al, 2019).…”

“…This type of internally focused thinking is associated with increased low beta and can result in more negative thinking types like rumination (Apazoglou et al, 2019) and anxiety in excess. Some of the most recent research has identified that high-amplitude low beta waves are related to a persistent sympathetic hyperactivity state that influences mental stress (Kopańska et al, 2022). These associations of differing aspects of anxiety with different ranges of Beta frequencies show how the neighboring frequency bands can interact with or be impacted by anxiety levels in distinct manners, and relationships must be assessed across the spectra to understand how anxiety manifests in the qEEG and can therefore be addressed therapeutically.…”

The Use of Quantitative Electroencephalography (QEEG) to Assess Post-COVID-19 Concentration Disorders in Professional Pilots: An Initial Concept

“…QEEG involves quantitative analysis of EEG recordings using statistical signal processing [ 13 ]. The use of quantitative electroencephalography instead of the usual EEG allows for an easier analysis of the results due to their better visualization [ 14 ]. It is also worth noting that quantitative electroencephalography is a very sensitive examination and can detect even very small changes in the functioning of the cerebral cortex [ 15 ].…”