Can Neurofeedback Training Be Effective in Huntington's Disease?

New data conducted by British researchers at University College London concludes that neurofeedback training could potentially increase brain connectivity in patients with Huntington’s disease (HD).

Results from the study, “Stimulating neural plasticity with real-time fMRI neurofeedback in Huntington’s disease: A proof of concept study” were published in the journal Human Brain Mapping, and provides evidence that behavior and movement abnormalities could be improved with the process. Neurofeedback allows patients to experience activity in a specific region of the brain while thinking of cues. In this way, a patient deciphers which cues trigger the most activity, and can therefore trigger the development of more connections.

HD is a neurodegenerative disease resulting from an unbalanced CAG (cytosine-adenine-guanine) repeat expansion in the Huntingtin gene that eventually produces of a mutant form of the huntingtin protein. While how the mutant huntingtin protein leads to neurotoxicity and the observed motor, behavioral and psychological features that afflict adults with HD has not yet been determined, there is strong evidence that the immune system does not factor in the pathophysiology of the condition.

Eleven adults were recruited to the study, one of whom withdrew after 2 visits for reasons unrelated to the study. All had undergone genetic testing for HD with a positive result, and each had to have a Unified Huntington’s Disease Rating Scale Total Motor Score (TMS) of <20 and a chorea subscore of <5. Researchers evaluated the supplementary motor area in all patients, and each was individually placed in a scanner that measured brain activity and instructed to imagine motor tasks.

As part of the study, participants were asked to complete 3-4 of these neurofeedback training sessions. Each visit was between 3 and 14 days apart. Overall improvement in the ability to perform motor tasks did not improve among the group, however, it was noted that patients who succeeded in voluntarily activating their SMA brain region performed better, suggesting that the training may improve motor performance.

In the trainings, patients were coached to consciously increase functional MRI (fMRI) signals from the supplementary motor area by receiving near real-time visual feedback in the form of a thermometer bar whose height represented the signal recorded from the area. To do so, patients were placed in a brain scanner capable of measuring brain activity, and commanded to visualize motor tasks while looking at a bar representative of activity in the SMA region.

At completion of the training, patients were instructed to perform a simple motor task while using the cues they had learned had the strongest activating effect on their SMA region. It was concluded that patients who succeeded in voluntarily activating their SMA brain region performed better, despite no overall improvement in the group as it pertained to performing motor tasks.

Lead researcher Marina Papoutsi concluded: “We have shown that HD patients can learn to regulate their own brain activity using neurofeedback training. Importantly, we were able to identify the functional and structural changes that occurred during neurofeedback training and which correlated with cognitive and motor improvement in a set of (untrained) measures sensitive to disease progression.”

The non-invasive method can be used alongside other forms of treatment, assuming researchers believe it is effective. Larger studies are still required to confirm that these findings can be applied to patients with HD.

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