title: Functional Magnetic Resonance Imaging Neurofeedback-guided Motor Imagery Training and Motor Training for Parkinson's Disease: Randomized Trial.
abstract: OBJECTIVE
  Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback (NF) uses feedback of the patient's own brain activity to self-regulate brain networks which in turn could lead to a change in behavior and clinical symptoms. The objective was to determine the effect of NF and motor training (MOT) alone on motor and non-motor functions in Parkinson's Disease (PD) in a 10-week small Phase I randomized controlled trial.
  
  
  METHODS
  Thirty patients with Parkinson's disease (PD; Hoehn and Yahr I-III) and no significant comorbidity took part in the trial with random allocation to two groups. Group 1 (NF: 15 patients) received rt-fMRI-NF with MOT. Group 2 (MOT: 15 patients) received MOT alone. The primary outcome measure was the Movement Disorder Society-Unified PD Rating Scale-Motor scale (MDS-UPDRS-MS), administered pre- and post-intervention "off-medication". The secondary outcome measures were the "on-medication" MDS-UPDRS, the PD Questionnaire-39, and quantitative motor assessments after 4 and 10 weeks.
  
  
  RESULTS
  Patients in the NF group were able to upregulate activity in the supplementary motor area (SMA) by using motor imagery. They improved by an average of 4.5 points on the MDS-UPDRS-MS in the "off-medication" state (95% confidence interval: -2.5 to -6.6), whereas the MOT group improved only by 1.9 points (95% confidence interval +3.2 to -6.8). The improvement in the intervention group meets the minimal clinically important difference which is also on par with other non-invasive therapies such as repetitive Transcranial Magnetic Stimulation (rTMS). However, the improvement did not differ significantly between the groups. No adverse events were reported in either group.
  
  
  CONCLUSIONS
  This Phase I study suggests that NF combined with MOT is safe and improves motor symptoms immediately after treatment, but larger trials are needed to explore its superiority over active control conditions.
authors.affiliation: MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff UniversityCardiff, UK; Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff UniversityCardiff, UK.
authors.forename: Leena
authors.initials: L
authors.lastname: Subramanian
authors.affiliation: MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University Cardiff, UK.
authors.forename: Monica Busse
authors.initials: MB
authors.lastname: Morris
authors.affiliation: Trinity College Institute of Neuroscience, Trinity CollegeDublin, Ireland; Faculty of Psychology and Neuroscience, Maastricht UniversityMaastricht, Netherlands.
authors.forename: Meadhbh
authors.initials: M
authors.lastname: Brosnan
authors.affiliation: Neurorehabilitation Unit, School of Health, Sport and Bioscience, University of East London London, UK.
authors.forename: Duncan L
authors.initials: DL
authors.lastname: Turner
authors.affiliation: Department of Clinical Neuroscience, Institute of Neurology, University College London London, UK.
authors.forename: Huw R
authors.initials: HR
authors.lastname: Morris
authors.affiliation: MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff UniversityCardiff, UK; Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff UniversityCardiff, UK.
authors.forename: David E J
authors.initials: DE
authors.lastname: Linden
keywords: Parkinson’s disease; WiiFit; motor training; neurofeedback; real-time functional magnetic resonance imaging