title: Real-time functional magnetic resonance imaging neurofeedback for treatment of Parkinson's disease.
abstract: Self-regulation of brain activity in humans based on real-time feedback of functional magnetic resonance imaging (fMRI) signal is emerging as a potentially powerful, new technique. Here, we assessed whether patients with Parkinson's disease (PD) are able to alter local brain activity to improve motor function. Five patients learned to increase activity in the supplementary motor complex over two fMRI sessions using motor imagery. They attained as much activation in this target brain region as during a localizer procedure with overt movements. Concomitantly, they showed an improvement in motor speed (finger tapping) and clinical ratings of motor symptoms (37% improvement of the motor scale of the Unified Parkinson's Disease Rating Scale). Activation during neurofeedback was also observed in other cortical motor areas and the basal ganglia, including the subthalamic nucleus and globus pallidus, which are connected to the supplementary motor area (SMA) and crucial nodes in the pathophysiology of PD. A PD control group of five patients, matched for clinical severity and medication, underwent the same procedure but did not receive feedback about their SMA activity. This group attained no control of SMA activation and showed no motor improvement. These findings demonstrate that self-modulation of cortico-subcortical motor circuits can be achieved by PD patients through neurofeedback and may result in clinical benefits that are not attainable by motor imagery alone.
authors.affiliation: Schools of Psychology and Medical Sciences, Bangor University, Bangor LL572AS, United Kingdom.
authors.forename: Leena
authors.initials: L
authors.lastname: Subramanian
authors.forename: John V
authors.initials: JV
authors.lastname: Hindle
authors.forename: Stephen
authors.initials: S
authors.lastname: Johnston
authors.forename: Mark V
authors.initials: MV
authors.lastname: Roberts
authors.forename: Masud
authors.initials: M
authors.lastname: Husain
authors.forename: Rainer
authors.initials: R
authors.lastname: Goebel
authors.forename: David
authors.initials: D
authors.lastname: Linden
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply*; D001931:Brain Mapping; D004576:Electromyography; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009068:Movement; D058765:Neurofeedback / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010300:Parkinson Disease / Q000473:pathology* / Q000523:psychology / Q000534:rehabilitation*; D010775:Photic Stimulation; D011597:Psychomotor Performance / Q000502:physiology; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
chemical_list: D010100:Oxygen
references.citation: Cogn Affect Behav Neurosci. 2011 Mar;11(1):44-51
references.pmid: 21264651
references.citation: Trends Neurosci. 1990 Jul;13(7):281-5
references.pmid: 1695404
references.citation: Neuroimage. 2004 Jan;21(1):436-43
references.pmid: 14741680
references.citation: J Neurosci Methods. 2007 May 15;162(1-2):8-13
references.pmid: 17254636
references.citation: Brain Res Rev. 2009 May;60(2):306-26
references.pmid: 19167426
references.citation: Neurophysiol Clin. 2006 May-Jun;36(3):125-33
references.pmid: 17046607
references.citation: Neurorehabil Neural Repair. 2012 Jan;26(1):27-35
references.pmid: 21778409
references.citation: J Neurol Neurosurg Psychiatry. 2009 May;80(5):489-92
references.pmid: 19204024
references.citation: Brain. 2001 Mar;124(Pt 3):558-70
references.pmid: 11222456
references.citation: N Engl J Med. 2010 Feb 18;362(7):579-89
references.pmid: 20130250
references.citation: Cleve Clin J Med. 2008 Mar;75 Suppl 2:S59-65
references.pmid: 18540149
references.citation: Biol Psychiatry. 2010 Sep 1;68(5):425-32
references.pmid: 20570245
references.citation: Trends Neurosci. 1989 Oct;12(10):366-75
references.pmid: 2479133
references.citation: Neurosci Biobehav Rev. 2008;32(3):388-407
references.pmid: 17706780
references.citation: Neurology. 2000 Oct 10;55(7):996-1002
references.pmid: 11061258
references.citation: Proc Natl Acad Sci U S A. 2001 Nov 20;98(24):13763-8
references.pmid: 11698650
references.citation: Hum Brain Mapp. 2013 Jan;34(1):200-12
references.pmid: 22021045
references.citation: Nat Rev Neurosci. 2008 Nov;9(11):856-69
references.pmid: 18843271
references.citation: Front Neuroinform. 2009 Jan 15;2:10
references.pmid: 19198666
references.citation: Ann Neurol. 1992 Aug;32(2):151-61
references.pmid: 1510355
references.citation: Acta Physiol Scand. 1998 Aug;163(4):361-8
references.pmid: 9789579
references.citation: Expert Rev Neurother. 2009 Dec;9(12):1755-71
references.pmid: 19951135
references.citation: BMJ. 2008 Sep 29;337:a1655
references.pmid: 18824488
references.citation: Eur Radiol. 2010 Mar;20(3):696-703
references.pmid: 19760238
references.citation: J Neurol Sci. 2009 Dec 15;287(1-2):143-6
references.pmid: 19720383
references.citation: Nat Rev Neurosci. 2008 Sep;9(9):720-9
references.pmid: 18714327
references.citation: Brain Res. 2010 Mar 8;1318:64-76
references.pmid: 20051230
references.citation: Mov Disord. 2008 Aug 15;23(11):1524-31
references.pmid: 18548577
references.citation: Brain. 1995 Aug;118 ( Pt 4):913-33
references.pmid: 7655888
references.citation: Neuroimage. 2010 Jan 1;49(1):1066-72
references.pmid: 19646532
references.citation: J Neurol Sci. 2006 Nov 1;249(1):31-8
references.pmid: 16843494
references.citation: Clin Neuropharmacol. 2007 Sep-Oct;30(5):256-65
references.pmid: 17909303
references.citation: Mov Disord. 2006 Oct;21(10):1693-702
references.pmid: 16817194
references.citation: Brain. 1997 Sep;120 ( Pt 9):1587-602
references.pmid: 9313642
references.citation: Int J Behav Med. 2012 Sep;19(3):372-81
references.pmid: 21633905
references.citation: J Physiol Paris. 2006 Jun;99(4-6):386-95
references.pmid: 16716573
references.citation: Appl Psychophysiol Biofeedback. 2006 Mar;31(1):3-20
references.pmid: 16552626
references.citation: Prog Neurobiol. 1996 Nov;50(4):381-425
references.pmid: 9004351
references.citation: Neuroimage. 2003 Jul;19(3):577-86
references.pmid: 12880789
references.citation: J Neurophysiol. 1995 Sep;74(3):1037-45
references.pmid: 7500130
references.citation: J Neurosci. 2003 Mar 1;23(5):1916-23
references.pmid: 12629196
references.citation: J Neurosci. 1996 Apr 15;16(8):2671-83
references.pmid: 8786443
references.citation: Mov Disord. 2001 Sep;16(5):849-57
references.pmid: 11746614
references.citation: J Neurophysiol. 1980 Jan;43(1):118-36
references.pmid: 7351547
references.citation: Mov Disord. 2008;23 Suppl 3:S548-59
references.pmid: 18781672
references.citation: Proc Natl Acad Sci U S A. 2005 Dec 20;102(51):18626-31
references.pmid: 16352728
references.citation: Annu Rev Psychol. 2009;60:173-96
references.pmid: 19035823
references.citation: J Neurophysiol. 1995 Jan;73(1):373-86
references.pmid: 7714579