Revisiting the Potential of EEG Neurofeedback for Patients With Schizophrenia.
Revisiting the Potential of EEG Neurofeedback for Patients With Schizophrenia.
复制标题
重新审视脑电图神经反馈对精神分裂症患者的潜力。
DOI：
10.1093/schbul/sbaa033
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发表时间：
2020
影响因子：
6.6
通讯作者：
Pineda,JaimeA
中科院分区：
文献类型：
--
作者：
Singh,Fiza;Shu,I-Wei;Granholm,Eric;Pineda,JaimeA
精神分裂症（SCZ）是一种神经发育障碍，早在青春期后期就可出现幻觉、妄想、社交退缩、快感缺乏以及注意力和记忆力缺陷等症状。治疗通常包括多巴胺拮抗剂的药物治疗，这是非常有效的减少阳性症状，特别是在急性发作的精神病。然而，阴性症状（例如，社交退缩，快感缺乏）和认知缺陷往往持续存在，并与严重的功能下降有关。鉴于这些现实，需要新的方法来开发精神分裂症患者的新治疗方法，特别是那些针对未满足的治疗需求的方法。最近的发展表明，在神经调节的新兴领域存在一个潜在的有前途的旧的，但新的方法。神经调节是指直接针对神经或大脑信号的治疗。例如，直流电和交流电刺激、深部脑刺激、迷走神经刺激、经颅磁刺激、电休克治疗和神经反馈（NFB）是神经调节干预的示例。在这类治疗中，包括新的和旧的模式，NFB占据了独特的地位。NFB，或对大脑目标的生物反馈，于20世纪60年代由Joseph Kamiya 1和巴里斯特曼（Barry Sterman）首次引入（单独）。[2]神谷发现，受试者可以调整他们的大脑活动（通过脑电图或EEG测量），以回应简单的奖励。斯特曼最初训练猫控制它们的脑电波，2随后继续使用NFB训练癫痫患者降低癫痫发作活动。[3]在此后的几年里，许多不同的，主要是脑电图引导的协议已经开发出来，以解决几种疾病，包括注意缺陷多动障碍（ADHD），抑郁症，创伤后应激障碍和精神分裂症等。[4]简而言之，这些NFB协议通常使个人能够通过有意识地操纵他们的EEG活动的视觉或听觉表征来练习调节他们自己的大脑活动。5 NFB的独特之处在于，每个人都使用自己的策略来取得成功，这本身就允许个体差异和灵活的个性化治疗方法。此外，NFB与大脑组成的结构变化有关，例如目标区域的灰质体积增加，6表明治疗效果可能涉及皮质生长和可塑性。因此，鉴于NFB以个性化方式解锁大脑神经可塑性的独特能力，我们的团队正在开发基于NFB的SCZ认知症状治疗方法。作为该项目的一部分，我们对精神分裂症患者NFB研究的文献进行了系统综述，详细信息见我们在《精神分裂症公报》上发表的随附论文。迄今为止，很少有NFB研究已进行精神分裂症谱系障碍。尽管如此，作为一个整体，现有的研究表明，NFB影响大脑中的神经处理，连接和代谢，并且这种影响远远超过了治疗期。这种影响似乎也可以推广到相关的行为、生物和临床结果，甚至在要求受试者重现他们在正式反馈之外学到的神经调节技能时也可以观察到。最后，对于具有复杂治疗要求的患者特别重要的是，NFB通常耐受性良好，并且具有良好的安全性。
Schizophrenia (SCZ) is a neurodevelopmental disorder that can present as early as late adolescence with symptoms such as hallucinations, delusions, social withdrawal, anhedonia, and deficits in attention and memory. Treatment generally consists of pharmacotherapy with dopamine antagonists, which are highly effective in reducing positive symptoms, especially during acute episodes of psychosis. However, negative symptoms (eg, social withdrawal, anhedonia) and cognitive deficits tend to persist and are associated with profound functional decline. Given these realities, novel approaches are required to develop new treatments for patients with schizophrenia, especially those targeting unmet therapeutic needs. Recent developments suggest that within the emerging field of neuromodulation exists a potentially promising old, yet new, approach. Neuromodulation refers to treatments that directly target neural or brain signals. For instance, direct and alternating current stimulation, deep brain stimulation, vagal nerve stimulation, transcranial magnetic stimulation, electroconvulsive therapy, and neurofeedback (NFB) are examples of neuromodulatory interventions. In this category of treatments that include both newer and older modalities, NFB occupies a unique position. NFB, or biofeedback to brain targets, was first introduced (separately) in the 1960s by Joseph Kamiya 1 and Barry Sterman. 2 Kamiya discovered that subjects could modulate their brain activity (as measured by electroencephalography, or EEG) in response to simple rewards. Sterman initially trained cats to control their brainwaves, 2 and subsequently went on to use NFB to train patients with epilepsy to lower seizure activity. 3 In the years since, many different, primarily EEG-guided, protocols have been developed to address several disorders, including attention deficit hyperactivity disorder (ADHD), depression, post-traumatic stress disorder, and schizophrenia, among others. 4 In brief, these NFB protocols generally enable individuals to practice modulating their own brain activity, by consciously manipulating visual or auditory representations of their EEG activity. 5 NFB is unique in that an individual uses his or her own strategy to achieve success, which inherently allows for individual differences and a flexible, personalized treatment approach. Furthermore, NFB is associated with structural changes in brain composition, such as increase in grey matter volume of the target area, 6 suggesting that treatment effects likely involve cortical growth and plasticity. Thus, in light of NFB’s unique ability to unlock the brain’s neuroplasticity in an individualized manner, our group is developing NFB based treatments for cognitive symptoms in SCZ. As part of this project, we conducted a systematic review of the literature for studies of NFB in patients with schizophrenia, the details of which are presented in our accompanying paper in Schizophrenia Bulletin Open. To date, few NFB studies have been conducted in schizophrenia spectrum disorders. Nonetheless, as a whole, available studies suggest that NFB influences neural processing, connectivity, and metabolism in the brain and that the effects last well beyond the treatment period. The effects also appear to generalize to related behavioral, biological, and clinical outcomes and are observed even during periods when subjects are asked to reproduce the neuromodulatory skills they have learned outside of formal feedback. Finally, of special importance for patients with complex treatment requirements, NFB is generally well tolerated and has a good safety profile.