J12 HD brain-train: enhancing neural plasticity using real-time FMRI neurofeedback training

Abstract

Background and aims Methods that can normalize neuronal function, such as neurofeedback (NF) training, could support symptom management in HD as primary or adjunct treatments to other disease-modifying therapies. During NF training, participants receive feedback on the activity of a target brain region and learn by trial and error to regulate it. The aim of the present study was to test whether HD patients can learn to regulate their brain activity using NF training and to compare two different NF training protocols to establish which one is more effective. Methods Thirty-two HD patients completed a real-time fMRI NF training paradigm consisting of 4 training visits (4–14 days apart). Half of the participants received feedback derived from their own brain activity measured using BOLD contrast fMRI (treatment group), while the other half received sham feedback derived from unrelated participants in the treatment group (control group). Participants were further divided in two subgroups, one receiving neurofeedback derived from the Supplementary Motor Area (SMA), and another receiving neurofeedback based on the cross-correlation of SMA and left striatum activity (a measure of connectivity). Participants were blinded to group allocation. Results To evaluate successful learning, we tested for a linear increase in participants’ ability to enhance fMRI activity/connectivity voluntarily across visits. Participants in the SMA-activity NF group were the only group that showed a linear increase across visits. We also evaluated participants’ capacity to upregulate their brain activity after the end of training in the absence of explicit feedback (transfer effects). The SMA-activity NF group was again the only group that showed successful upregulation. Conclusions Our results suggest that SMA-activity NF training is a more promising approach than connectivity-based NF training. Future larger trials focusing only on activity-based NF training, are now needed to enable us to gather more evidence on the efficacy of the method in symptom-management in HD.