Strehl Ute, Leins Ulrike, Goth Gabriella, Klinger Christoph, Hinterberger Thilo, Birbaumer Niels
Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Gartenstrasse 29, 72074 Tübingen, Germany.
Pediatrics. 2006 Nov;118(5):e1530-40. doi: 10.1542/peds.2005-2478. Epub 2006 Oct 23.
We investigated the effects of self-regulation of slow cortical potentials for children with attention-deficit/hyperactivity disorder. Slow cortical potentials are slow event-related direct-current shifts of the electroencephalogram. Slow cortical potential shifts in the electrical negative direction reflect the depolarization of large cortical cell assemblies, reducing their excitation threshold. This training aims at regulation of cortical excitation thresholds considered to be impaired in children with attention-deficit/hyperactivity disorder. Electroencephalographic data from the training and the 6-month follow-up are reported, as are changes in behavior and cognition.
Twenty-three children with attention-deficit/hyperactivity disorder aged between 8 and 13 years received 30 sessions of self-regulation training of slow cortical potentials in 3 phases of 10 sessions each. Increasing and decreasing slow cortical potentials at central brain regions was fed back visually and auditorily. Transfer trials without feedback were intermixed with feedback trials to allow generalization to everyday-life situations. In addition to the neurofeedback sessions, children exercised during the third training phase to apply the self-regulation strategy while doing their homework.
For the first time, electroencephalographic data during the course of slow cortical potential neurofeedback are reported. Measurement before and after the trials showed that children with attention-deficit/hyperactivity disorder learn to regulate negative slow cortical potentials. After training, significant improvement in behavior, attention, and IQ score was observed. The behavior ratings included Diagnostic and Statistical Manual of Mental Disorders criteria, number of problems, and social behavior at school and were conducted by parents and teachers. The cognitive variables were assessed with the Wechsler Intelligence Scale for Children and with a computerized test battery that measures several components of attention. All changes proved to be stable at 6 months' follow-up after the end of training. Clinical outcome was predicted by the ability to produce negative potential shifts in transfer sessions without feedback.
According to the guidelines of the efficacy of treatments, the evidence of the efficacy of slow cortical potential feedback found in this study reaches level 2: "possibly efficacious." In the absence of a control group, no causal relationship between observed improvements and the ability to regulate brain activity can be made. However, it could be shown for the first time that good performance in self-regulation predicts clinical outcome. "Good performance" was defined as the ability to produce negative potential shifts in trials without feedback, because it is known that the ability to self-regulate without feedback is impaired in children and adults with attention problems. Additional research should focus on the control of unspecific effects, medication, and subtypes to confirm the assumption that slow cortical potential feedback is a viable treatment option for attention-deficit/hyperactivity disorder. Regulation of slow cortical potentials may involve similar neurobiological pathways as medical treatment. It is suggested that regulation of frontocentral negative slow cortical potentials affects the cholinergic-dopaminergic balance and allows children to adapt to task requirements more flexibly.
我们研究了慢皮层电位自我调节对注意力缺陷多动障碍儿童的影响。慢皮层电位是脑电图中与事件相关的缓慢直流偏移。慢皮层电位向电负性方向的偏移反映了大皮层细胞集合的去极化，降低了它们的兴奋阈值。这种训练旨在调节被认为在注意力缺陷多动障碍儿童中受损的皮层兴奋阈值。报告了训练和6个月随访时的脑电图数据，以及行为和认知方面的变化。
23名年龄在8至13岁之间的注意力缺陷多动障碍儿童接受了30次慢皮层电位自我调节训练，分3个阶段，每个阶段10次。在中央脑区增加和降低慢皮层电位的情况通过视觉和听觉进行反馈。无反馈的转移试验与反馈试验混合进行，以促进向日常生活情境的泛化。除了神经反馈训练外，儿童在第三个训练阶段进行练习，以便在做作业时应用自我调节策略。
首次报告了慢皮层电位神经反馈过程中的脑电图数据。试验前后的测量结果表明，注意力缺陷多动障碍儿童学会了调节负向慢皮层电位。训练后，行为、注意力和智商得分有显著改善。行为评分包括《精神障碍诊断与统计手册》标准、问题数量以及在学校的社会行为，由家长和教师进行。认知变量通过韦氏儿童智力量表和一个测量注意力多个成分的计算机化测试组合进行评估。所有变化在训练结束后的6个月随访中被证明是稳定的。在无反馈的转移训练中产生负电位偏移的能力可预测临床结果。
根据治疗效果指南，本研究中发现的慢皮层电位反馈疗效证据达到2级：“可能有效”。由于没有对照组，无法确定观察到的改善与调节大脑活动能力之间的因果关系。然而，首次表明自我调节方面的良好表现可预测临床结果。“良好表现”被定义为在无反馈试验中产生负电位偏移的能力，因为已知有注意力问题的儿童和成人在无反馈情况下的自我调节能力受损。进一步的研究应聚焦于非特异性效应、药物治疗和亚型的控制，以证实慢皮层电位反馈是注意力缺陷多动障碍一种可行治疗选择的假设。慢皮层电位的调节可能涉及与药物治疗相似的神经生物学途径。有人提出，额中央负向慢皮层电位的调节会影响胆碱能 - 多巴胺能平衡，并使儿童能够更灵活地适应任务要求。
