Pindi Pamela, Houenou Josselin, Piguet Camille, Favre Pauline
Paris Est Créteil University (UPEC), INSERM U955, IMRB, Translational Neuro-psychiatry Team, AP-HP, DMU IMPACT, Mondor University Hospitals, FondaMental Foundation, F-94010 Créteil, France; Paris-Saclay University, Neurospin, CEA, UNIACT Lab, PsyBrain Team, F-91191 Gif-sur-Yvette, France.
Paris Est Créteil University (UPEC), INSERM U955, IMRB, Translational Neuro-psychiatry Team, AP-HP, DMU IMPACT, Mondor University Hospitals, FondaMental Foundation, F-94010 Créteil, France; Paris-Saclay University, Neurospin, CEA, UNIACT Lab, PsyBrain Team, F-91191 Gif-sur-Yvette, France.
Prog Neuropsychopharmacol Biol Psychiatry. 2022 Dec 20;119:110605. doi: 10.1016/j.pnpbp.2022.110605. Epub 2022 Jul 16.
Neurofeedback using real-time functional MRI (RT-fMRI-NF) is an innovative technique that allows to voluntarily modulate a targeted brain response and its associated behavior. Despite promising results in the current literature, its effectiveness on symptoms management in psychiatric disorders is not yet clearly demonstrated. Here, we provide 1) a state-of-art qualitative review of RT-fMRI-NF studies aiming at alleviating clinical symptoms in a psychiatric population; 2) a quantitative evaluation (meta-analysis) of RT-fMRI-NF effectiveness on various psychiatric disorders and 3) methodological suggestions for future studies. Thirty-one clinical trials focusing on psychiatric disorders were included and categorized according to standard diagnostic categories. Among the 31 identified studies, 22 consisted of controlled trials, of which only eight showed significant clinical improvement in the experimental vs. control group after the training. Nine studies found an effect at follow-up on ADHD symptoms, emotion dysregulation, facial emotion processing, depressive symptoms, hallucinations, psychotic symptoms, and specific phobia. Within-group meta-analysis revealed large effects of the NF training on depressive symptoms right after the training (g = 0.81, p < 0.01) and at follow-up (g = 1.19, p < 0.01), as well as medium effects on anxiety (g = 0.44, p = 0.01) and emotion regulation (g = 0.48, p < 0.01). Between-group meta-analysis showed a medium effect on depressive symptoms (g = 0.49, p < 0.01) and a large effect on anxiety (g = 0.77, p = 0.01). However, the between-studies heterogeneity is very high. The use of RT-fMRI-NF as a treatment for psychiatric symptoms is promising, however, further double-blind, multicentric, randomized-controlled trials are warranted.
使用实时功能磁共振成像的神经反馈（RT-fMRI-NF）是一种创新技术，它能够让人们自主调节目标大脑反应及其相关行为。尽管当前文献报道了一些有前景的结果，但其对精神疾病症状管理的有效性尚未得到明确证实。在此，我们提供：1）针对旨在缓解精神疾病患者临床症状的RT-fMRI-NF研究的最新定性综述；2）对RT-fMRI-NF对各种精神疾病有效性的定量评估（荟萃分析）；以及3）对未来研究的方法学建议。我们纳入了31项关注精神疾病的临床试验，并根据标准诊断类别进行了分类。在这31项已确定的研究中，22项为对照试验，其中只有8项显示训练后试验组与对照组相比有显著的临床改善。9项研究发现随访时对注意力缺陷多动障碍（ADHD）症状、情绪失调、面部情绪处理、抑郁症状、幻觉、精神病症状和特定恐惧症有效果。组内荟萃分析显示，神经反馈训练在训练后即刻（g = 0.81，p < 0.01）和随访时（g = 1.19，p < 0.01）对抑郁症状有较大影响，对焦虑（g = 0.44，p = 0.01）和情绪调节（g = 0.48，p < 0.01）有中等影响。组间荟萃分析显示对抑郁症状有中等影响（g = 0.49，p < 0.01），对焦虑有较大影响（g = 0.77，p = 0.01）。然而，研究间的异质性非常高。将RT-fMRI-NF用作精神症状的治疗方法是有前景的，不过，有必要进一步开展双盲、多中心、随机对照试验。
