Design and Preliminary Study of a Neurofeedback Protocol to reduce Drowsiness

International audienceNeuroFeedback (NF) consists in using electroencephalographic (EEG) measurements to guide users to perform a cognitive learning using information coming from their own brain activity, by means of a real-time sensory feedback (e.g., visual or auditory)[4]. Many NF approaches have been studied to improve attentional abilities, notably for Attention Deficit Hy-peractivity Disorder [1, 2]. However, to our knowledge, no NF solution has been proposed to specifically reduce drowsiness. Thus, we propose a complete EEG-NF solution to train users to self-regulate an EEG marker of drowsiness. This marker is based on a ratio of beta over theta/alpha power in Cz electrode. In addition to this EEG marker of drowsiness, we also carefully selected and designed the duration, the sequencing, the objective evaluation metrics and the visual and audio feedback to use in for each NF session. Preliminary study with five healthy subjects showed that three of them could learn to self-regulate this EEG marker with a relatively short number of NF sessions (up to 8 sessions of 40 min). Clinical trials with sleep-deprived subjects are expected to begin in 2019 to study possible cognitive and clinical benefits of this self-regulation. The implementation of this NF solution is available for free 1 , with the OpenViBE platform [3], under the AGPL-3.0 license

Conception et étude préliminaire d'un protocole de neurofeedback visant à autoréguler un marqueur EEG de la somnolence

International audienceNeurofeedback (NF) consists in using electroencephalographic (EEG) measurements to guide users to perform a cognitive learning using information coming from their own brain activity, by means of a real-time sensory feedback (e.g., visual or auditory). Many NF approaches have been studied to improve atten-tional abilities, notably for attention deficit hyper activity disorder. However, to our knowledge, no NF solution has been proposed to specifically reduce drowsiness. Thus, we propose an EEG-NF solution to train users to self-regulate an EEG marker of drowsiness, and evaluate it with a preliminary study. Results with five healthy subjects showed that three of them could learn to self-regulate this EEG marker with a relatively short number of NF sessions (up to 8 sessions of 40 min). Clinical trials with sleep-deprived subjects should begin in 2019 to study possible cognitive and clinical benefits of this self-regulation. This NF solution implementation is available for free, with the OpenViBE platform, under the AGPL-3.0 license.Le neurofeedback (NF) consiste à utiliser des mesures électroencéphalographiques (EEG) pour aider les utilisateurs à effectuer un apprentissage cognitif en utilisant des informations provenant de leur propre activité cérébrale, au moyen d'un retour sensoriel en temps réel (visuel ou auditif, par exemple). De nombreuses approches du NF ont été étudiées pour améliorer les capacités d'attention, notamment pour le trouble d'hyperactivité avec déficit de l'attention. Cependant, à notre connaissance, aucune solution de NF n'a été proposée pour réduire spécifiquement la somnolence. Ainsi, nous proposons une solution de NF-EEG pour former les utilisateurs à l’autorégulation d’un marqueur EEG de la somnolence et l’évaluer avec une étude préliminaire. Les résultats, avec cinq sujets sains, ont montré que trois d'entre eux pourraient apprendre à autoréguler ce marqueur EEG avec un nombre relativement court de séances de NF (jusqu'à 8 séances de 40 min). Les essais cliniques sur des sujets privés de sommeil devraient commencer en 2019 pour étudier les avantages cognitifs et cliniques possibles de cette autorégulation. Cette mise en œuvre de la solution de NF est disponible gratuitement, avec la plateforme OpenViBE, sous la licence AGPL-3.0

Involvement of Basal Ganglia Network in Motor Disabilities Induced by Typical Antipsychotics

BACKGROUND:Clinical treatments with typical antipsychotic drugs (APDs) are accompanied by extrapyramidal motor side-effects (EPS) such as hypokinesia and catalepsy. As little is known about electrophysiological substrates of such motor disturbances, we investigated the effects of a typical APD, alpha-flupentixol, on the motor behavior and the neuronal activity of the whole basal ganglia nuclei in the rat. METHODS AND FINDINGS:The motor behavior was examined by the open field actimeter and the neuronal activity of basal ganglia nuclei was investigated using extracellular single unit recordings on urethane anesthetized rats. We show that alpha-flupentixol induced EPS paralleled by a decrease in the firing rate and a disorganization of the firing pattern in both substantia nigra pars reticulata (SNr) and subthalamic nucleus (STN). Furthermore, alpha-flupentixol induced an increase in the firing rate of globus pallidus (GP) neurons. In the striatum, we recorded two populations of medium spiny neurons (MSNs) after their antidromic identification. At basal level, both striato-pallidal and striato-nigral MSNs were found to be unaffected by alpha-flupentixol. However, during electrical cortico-striatal activation only striato-pallidal, but not striato-nigral, MSNs were found to be inhibited by alpha-flupentixol. Together, our results suggest that the changes in STN and SNr neuronal activity are a consequence of increased neuronal activity of globus pallidus (GP). Indeed, after selective GP lesion, alpha-flupentixol failed to induce EPS and to alter STN neuronal activity. CONCLUSION:Our study reports strong evidence to show that hypokinesia and catalepsy induced by alpha-flupentixol are triggered by dramatic changes occurring in basal ganglia network. We provide new insight into the key role of GP in the pathophysiology of APD-induced EPS suggesting that the GP can be considered as a potential target for the treatment of EPS

Mise en place d’une solution de Neurofeedback pour lutter contre la somnolence diurne excessive.

International audienc

J Med Internet Res

Background: The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. Objective: Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. Methods: The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score >14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. Results: Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score >14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; P21) did not respond to either intervention. Conclusions: These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia.Bordeaux Region Aquitaine Initiative for NeurosciencePhénotypage humain et réalité virtuell

Smartphone-Based Virtual Agents Can Help the General Population Concerned by Sleep Complaints: A Proof-of-Concept Study During COVID-19 Confinement

Background: The COVID-19 crisis induces psychosocial stress and sleep complaints that require early management. KANOPEE is a smartphone-based application, providing an interaction with a virtual agent dedicated to screen and deliver behavioral interventions to fight sleep disorders. This paper describes the feasibility study of this application, during the context of COVID-19 confinement in France. Method: 2,069 users of aged 18 years and over downloaded the app during the inclusion period (between 22 April and 5 May 2020). Users first answered a screening interview based on the insomnia severity index (ISI) that was conducted by the virtual agent. If participants were positive for insomniac complaints (ISI > 14), they could join a two-stage intervention program: a) complete an electronic sleep diary for one week, and b) follow personalized sleep recommendations for 10 days. Measures collected included socio-demographic information, ISI and sleep/wake schedules; and acceptance and trust of the agent.Bordeaux Region Aquitaine Initiative for NeurosciencePhénotypage humain et réalité virtuell

Limited usefulness of neurocognitive functioning indices as predictive markers for treatment response to methylphenidate or neurofeedback@home in children and adolescents with ADHD

IntroductionEarlier studies exploring the value of executive functioning (EF) indices for assessing treatment effectiveness and predicting treatment response in attention-deficit/hyperactivity disorder (ADHD) mainly focused on pharmacological treatment options and revealed rather heterogeneous results. Envisioning the long-term goal of personalized treatment selection and intervention planning, this study comparing methylphenidate treatment (MPH) and a home-based neurofeedback intervention (NF@Home) aimed to expand previous findings by assessing objective as well as subjectively reported EF indices and by analyzing their value as treatment and predictive markers.MethodsChildren and adolescents (n = 146 in the per protocol sample) aged 7–13 years with a formal diagnosis of an inattentive or combined presentation of ADHD were examined. We explored the EF performance profile using the Conners Continuous Performance Task (CPT) and the BRIEF self-report questionnaire within our prospective, multicenter, randomized, reference drug-controlled NEWROFEED study with sites in five European countries (France, Spain, Switzerland, Germany, and Belgium). As primary outcome for treatment response, the clinician-rated ADHD Rating Scale-IV was used. Patients participating in this non-inferiority trial were randomized to either NF@home (34–40 sessions of TBR or SMR NF depending on the pre-assessed individual alpha peak frequency) or MPH treatment (ratio: 3:2). Within a mixed-effects model framework, analyses of change were calculated to explore the predictive value of neurocognitive indices for ADHD symptom-related treatment response.ResultsFor a variety of neurocognitive indices, we found a significant pre-post change during treatment, mainly in the MPH group. However, the results of the current study reveal a rather limited prognostic value of neurocognitive indices for treatment response to either NF@Home or MPH treatment. Some significant effects emerged for parent-ratings only.DiscussionCurrent findings indicate a potential value of self-report (BRIEF global score) and some objectively measured neurocognitive indices (CPT commission errors and hit reaction time variability) as treatment markers (of change) for MPH. However, we found a rather limited prognostic value with regard to predicting treatment response not (yet) allowing recommendation for clinical use. Baseline symptom severity was revealed as the most relevant predictor, replicating robust findings from previous studies

Neurofeedback en psychiatrie : une technique du présent ? [Neurofeedback: one of today's techniques in psychiatry?]

International audienceObjectivesNeurofeedback is a technique that aims to teach a subject to regulate a brain parameter measured by a technical interface to modulate his/her related brain and cognitive activities. However, the use of neurofeedback as a therapeutic tool for psychiatric disorders remains controversial. The aim of this review is to summarize and to comment the level of evidence of electroencephalogram (EEG) neurofeedback and real-time functional magnetic resonance imaging (fMRI) neurofeedback for therapeutic application in psychiatry.MethodLiterature on neurofeedback and mental disorders but also on Brain Computer Interfaces (BCI) used in the field of neurocognitive science has been considered by the group of expert of the NExT (Neurofeedback Evaluation & Training) section of the French Association of Biological Psychiatry and Neuropsychopharmacology (AFPBN).ResultsResults show a potential efficacy of EEG-neurofeedback in the treatment of attentional-deficit/hyperactivity disorder (ADHD) in children, even if this is still debated. For other mental disorders, there is too limited research to warrant the use of EEG-neurofeedback in clinical practice. Regarding fMRI-neurofeedback, the level of evidence remains too weak, for now, to justify clinical use. The literature review highlights various unclear points, such as indications (psychiatric disorders, pathophysiologic rationale), protocols (brain signals targeted, learning characteristics), and techniques (EEG, fMRI, signal processing). ConclusionThe field of neurofeedback involves psychiatrists, neurophysiologists and researchers in the field of brain-computer-interfaces. Future studies should determine the criteria for optimizing neurofeedback sessions. A better understanding of the learning processes underpinning neurofeedback could be a key element to develop the use of this technique in clinical practice

International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders

Introduction: Insomnia and circadian rhythm disorders, such as the delayed sleep phase syndrome, are frequent in psychiatric disorders and their evaluation and management in early stages should be a priority. The aim of this paper was to express recommendations on the use of exogenous melatonin, which exhibits both chronobiotic and sleep-promoting actions, for the treatment of these sleep disturbances in psychiatric disorders.Methods: To this aim, we conducted a systematic review according to PRISMA on the use of melatonin for the treatment of insomnia and circadian sleep disorders in neuropsychiatry. We expressed recommendations for the use of melatonin in psychiatric clinical practice for each disorder using the RAND/UCLA appropriateness method.Results: We selected 41 studies, which included mood disorders, schizophrenia, substance use disorders, attention deficit hyperactivity disorders, autism spectrum disorders, neurocognitive disorders, and delirium; no studies were found for both anxiety and eating disorders.Conclusion: The administration of prolonged release melatonin at 2–10 mg, 1–2 h before bedtime, might be used in the treatment of insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, in adults with autism spectrum disorders, neurocognitive disorders and during sedative-hypnotics discontinuation. Immediate release melatonin at <1 mg might be useful in the treatment of circadian sleep disturbances of neuropsychiatric disorders