González Méndez Pamela P, Rodino Climent Julio, Stanley Jeffrey A, Sitaram Ranganatha
Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile.
Brain Dynamics Laboratory, School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso 2362905, Chile.
J Clin Med. 2022 Nov 23;11(23):6909. doi: 10.3390/jcm11236909.
Real-time functional magnetic resonance imaging neurofeedback (rt-fMRI-nf) training is an emerging intervention for neurorehabilitation. However, its translation into clinical use on participants with clinical depression is unclear, the effect estimates from randomized control trials and the certainty of the supporting evidence on the effect estimates are unknown. As the number of studies on neurofeedback increases every year, and better quality evidence becomes available, we evaluate the evidence of all randomized control trials available on the clinical application of rt-fMRI-nf training on participants with clinical depression. We performed electronic searches in Pubmed, Embase, CENTRAL, rtFIN database, Epistemonikos, trial registers, reference lists, other systematic reviews, conference abstracts, and cross-citation in Google Scholar. Reviewers independently selected studies, extracted data and evaluated the risk of bias. The certainty of the evidence was judged using the GRADE framework. This review complies with PRISMA guidelines and was submitted to PROSPERO registration. We found 435 results. After the selection process, we included 11 reports corresponding to four RCTs. The effect of rt-fMRI-nf on improving the severity of clinical depression scores demonstrated a tendency to favor the intervention; however, the general effect was not significant. At end of treatment, SMD (standardized mean difference): -0.32 (95% CI -0.73 to 0.10). At follow-up, SMD: -0.33 (95% CI -0.91, 1.25). All the studies showed changes in BOLD fMRI activation after training; however, only one study confirmed regulation success during a transfer run. Whole-brain analyses suggests that rt-fMRI nf may alter activity patterns in brain networks. More studies are needed to evaluate quality of life, acceptability, adverse effects, cognitive tasks, and physiology measures. We conclude that the current evidence on the effect of rt-fMRI-nf training for decision-making outcomes in patients with clinical depression is still based on low certainty of the evidence.
实时功能磁共振成像神经反馈（rt-fMRI-nf）训练是一种新兴的神经康复干预方法。然而，其在临床抑郁症患者中的临床应用尚不清楚，随机对照试验的效果估计以及支持这些效果估计的证据的确定性也未知。随着每年关于神经反馈的研究数量增加，以及可获得质量更好的证据，我们评估了所有关于rt-fMRI-nf训练在临床抑郁症患者中临床应用的随机对照试验的证据。我们在PubMed、Embase、CENTRAL、rtFIN数据库、Epistemonikos、试验注册库、参考文献列表、其他系统评价、会议摘要以及谷歌学术中的交叉引用中进行了电子检索。评审人员独立选择研究、提取数据并评估偏倚风险。使用GRADE框架判断证据的确定性。本综述符合PRISMA指南，并已提交至PROSPERO注册。我们找到了435个结果。经过筛选过程，我们纳入了对应四项随机对照试验的11份报告。rt-fMRI-nf对改善临床抑郁评分严重程度的效果显示出有利于干预的趋势；然而，总体效果并不显著。治疗结束时，标准化均差（SMD）：-0.32（95%置信区间-0.73至0.10）。随访时，SMD：-0.33（95%置信区间-0.91，1.25）。所有研究均显示训练后BOLD fMRI激活有变化；然而，只有一项研究在转移运行期间证实了调节成功。全脑分析表明，rt-fMRI nf可能会改变脑网络中的活动模式。需要更多研究来评估生活质量、可接受性、不良反应、认知任务和生理测量。我们得出结论，目前关于rt-fMRI-nf训练对临床抑郁症患者决策结果影响的证据仍然基于证据的低确定性。
