Anil Krithika, Hall Stephen D, Demain Sara, Freeman Jennifer A, Ganis Giorgio, Marsden Jonathan
Peninsula Allied Health Centre, School of Health Professions, University of Plymouth, Derriford Road, Plymouth PL6 8BH, UK.
Brain Research and Imaging Centre, Faculty of Health, University of Plymouth, Research Way, Plymouth PL6 8BU, UK.
Brain Sci. 2021 Sep 29;11(10):1292. doi: 10.3390/brainsci11101292.
Neurofeedback has been proposed as a treatment for Parkinson's disease (PD) motor symptoms by changing the neural network activity directly linked with movement. However, the effectiveness of neurofeedback as a treatment for PD motor symptoms is unclear.
To systematically review the literature to identify the effects of neurofeedback in people with idiopathic PD; as defined by measurement of brain activity; motor function; and performance.
A systematic review. Included Sources and Articles: PubMed; MEDLINE; Cinhal; PsychoInfo; Prospero; Cochrane; ClinicalTrials.gov; EMBASE; Web of Science; PEDro; OpenGrey; Conference Paper Index; Google Scholar; and eThos; searched using the Population-Intervention-Comparison-Outcome (PICO) framework. Primary studies with the following designs were included: randomized controlled trials (RCTs), non-RCTs; quasi-experimental; pre/post studies; and case studies.
This review included 11 studies out of 6197 studies that were identified from the literature search. Neuroimaging methods used were fMRI; scalp EEG; surface brain EEG; and deep brain EEG; where 10-15 Hz and the supplementary motor area were the most commonly targeted signatures for EEG and fMRI, respectively. Success rates for changing one's brain activity ranged from 47% to 100%; however, both sample sizes and success criteria differed considerably between studies. While six studies included a clinical outcome; a lack of consistent assessments prevented a reliable conclusion on neurofeedback's effectiveness. Narratively, fMRI neurofeedback has the greatest potential to improve PD motor symptoms. Two main limitations were found in the studies that contributed to the lack of a confident conclusion: (1) insufficient clinical information and perspectives (e.g., no reporting of adverse events), and (2) limitations in numerical data reporting (e.g., lack of explicit statistics) that prevented a meta-analysis.
While fMRI neurofeedback was narratively the most effective treatment; the omission of clinical outcome measures in studies using other neurofeedback approaches limits comparison. Therefore, no single neurofeedback type can currently be identified as an optimal treatment for PD motor symptoms. This systematic review highlights the need to improve the inclusion of clinical information and more robust reporting of numerical data in future work. Neurofeedback appears to hold great potential as a treatment for PD motor symptoms. However, this field is still in its infancy and needs high quality RCTs to establish its effectiveness. Review Registration: PROSPERO (ID: CRD42020191097).
神经反馈已被提议作为治疗帕金森病（PD）运动症状的一种方法，通过改变与运动直接相关的神经网络活动来实现。然而，神经反馈作为治疗PD运动症状的有效性尚不清楚。
系统回顾文献，以确定神经反馈对特发性PD患者的影响；通过测量大脑活动、运动功能和表现来定义。
系统回顾。纳入的来源和文章：PubMed、MEDLINE、Cinhal、PsychoInfo、Prospero、Cochrane、ClinicalTrials.gov、EMBASE、科学网、PEDro、OpenGrey、会议论文索引、谷歌学术和eThos；使用人群-干预-对照-结果（PICO）框架进行检索。纳入具有以下设计的主要研究：随机对照试验（RCT）、非RCT、准实验、前后研究和案例研究。
本综述纳入了从文献检索中识别出的6197项研究中的11项。使用的神经影像学方法有功能磁共振成像（fMRI）、头皮脑电图（EEG）、表面脑电地形图和深部脑电地形图；其中10 - 15赫兹和辅助运动区分别是EEG和fMRI最常针对的特征。改变大脑活动的成功率在47%至100%之间；然而，不同研究之间的样本量和成功标准差异很大。虽然六项研究纳入了临床结果，但缺乏一致的评估妨碍了对神经反馈有效性得出可靠结论。从叙述角度来看，fMRI神经反馈改善PD运动症状的潜力最大。在这些研究中发现了两个主要局限性，导致无法得出有把握的结论：（1）临床信息和观点不足（例如，未报告不良事件），以及（2）数值数据报告方面的局限性（例如，缺乏明确的统计数据），这妨碍了进行荟萃分析。
虽然从叙述角度来看fMRI神经反馈是最有效的治疗方法，但使用其他神经反馈方法的研究中未纳入临床结果测量，限制了比较。因此，目前无法确定单一的神经反馈类型是治疗PD运动症状的最佳方法。本系统回顾强调了在未来工作中需要改进临床信息的纳入以及更有力地报告数值数据。神经反馈作为治疗PD运动症状的方法似乎具有很大潜力。然而，该领域仍处于起步阶段，需要高质量的RCT来确定其有效性。综述注册号：PROSPERO（ID：CRD42020191097）。
