Clinical Neurofeedback using fMRI Principles Results & Future Developments
Since its invention over 25 years ago, functional magnetic resonance imaging (fMRI) has become one of the most widely used and publicly visible non-invasive technique to measure brain activation. FMRI-based neurofeedback (fMRI-NF) has the potential to open up new paths to translation. During fMRI-NF training, participants receive feedback on their brain activity in real-time and are instructed to change this activation, for example by engaging in specific mental imagery. One attractive feature of neurofeedback is that it enables patients to control their own brain activity and thus contributes to their experience of self-efficacy, which is an important therapeutic factor in many neuropsychiatric disorders. In the first interventional application of fMRI-NF to a mental disorder, we demonstrated feasibility of upregulation of areas responsive to positive affective cues in patients with depression (Linden et al., 2012). We have also piloted fMRI-NF in Parkinson’s disease (PD), guided by models of neuroplasticity and functional compensation implicating the supplementary motor area (Subramanian et al., 2011). I will report results of our recent trial comparing a combined fMRI-NF and exercise intervention with exercise alone in early PD(Subramanian et al., 2016) and of our fMRI-NF trial in depression (NCT01544205). Central challenges for future clinical studies are identifying the symptoms and disorders that will respond to fMRI-NF; adapting fMRI-NF treatment protocols to the neural networks involved in each disorder; evaluating underlying neurophysiological mechanisms and lastly devising training strategies that enable sustainable long-term effects of fMRI-NF. BRAINTRAIN, a European consortium involving several academic and industrial partners, is developing and evaluating fMRI-NF procedures for a range of mental and behavioural disorders. fMRI-NF could become an attractive add-on therapy for some psychiatric and neurological diseases but only if appropriately combined with other (psychological, pharmacological and/or physiological) approaches, for example through an integration in neuro-psychotherapy or neurorehabilitation programmes.