Optimizing Real Time fMRI Neurofeedback for Therapeutic Discovery and Development

Abstract

While reducing the burden of brain disorders remains a top priority of organizations like the World Health Organization and National Institutes of Health, the development of novel, safe and effective treatments for brain disorders has been slow. In this paper, we describe the state of the science for an emerging technology, real time functional magnetic resonance imaging (rtfMRI) neurofeedback, in clinical neurotherapeutics. We review the scientific potential of rtfMRI and outline research strategies to optimize the development and application of rtfMRI neurofeedback as a next generation therapeutic tool. We propose that rtfMRI can be used to address a broad range of clinical problems by improving our understanding of brain-behavior relationships in order to develop more specific and effective interventions for individuals with brain disorders. We focus on the use of rtfMRI neurofeedback as a clinical neurotherapeutic tool to drive plasticity in brain function, cognition, and behavior. Our overall goal is for rtfMRI to advance personalized assessment and intervention approaches to enhance resilience and reduce morbidity by correcting maladaptive patterns of brain function in those with brain disorders.

Decreased functional connectivity within a language subnetwork in benign epilepsy with centrotemporal spikes

“…It remains a challenge to demonstrate that decreased functional connectivity contributes to the pathophysiology of coexistent cognitive impairment in BECTS; future studies in children with BECTS should quantify the association between enhancement of connectivity, for example, via an fMRI‐mediated neurofeedback task (for review, Ref. ) or an off‐line training program, and improvement in literacy and language skills.…”

A conceptual framework for the neurobiological study of resilience

“…We may, on the basis of neuroscience findings, be able to characterise individuals in the early aftermath of exposure to stress and adversity and to discriminate those who are likely to be resilient from those likely to succumb to stress (Galatzer-Levy et al 2014a). Neurofeedback methods have been developed that may directly target patterns of brain functions that support resilience (Stoeckel et al 2014). Further strides will be necessary to pave the way for such efforts and to put research findings into practice by developing effective interventions that boost resilience.…”

A network engineering perspective on probing and perturbing cognition with neurofeedback

“…Briefly, a typical neurofeedback study utilizing these tools would implement the following general process: train a statistical model that discriminates patterns of brain activation in response to different stimuli, present the subject with a stimulus, ask the subject to perform a mental operation based on the stimulus, decode the altered pattern of brain activity using the statistical model, adjust the stimulus on the basis of the new brain state, and have the subject repeat the mental operation. The ability to perturb behavioral state based on underlying brain dynamics has immense utility in revealing functional mechanisms underlying changes in behavior . Indeed, recent applications of this technique have yielded critical insights into the mechanisms of attention by altering task complexity during decoded states of attentional lapses …”

“…In addition to functioning as a probe for healthy human cognition, neurofeedback can also be used to identify and potentially treat cognitive disabilities. Particularly in populations with impaired mental health, neurofeedback enables the clinical study of mechanisms of dysfunction in neurologic and psychiatric disorders, and it also has the potential to provide noninvasive therapies to minimize the symptoms of such disorders . Indeed, soon after its introduction in the late 1960s, neurofeedback was popularized in clinical contexts.…”