This case study investigates how an intervention with ILF-neurofeedback training (ILF-NFT) can affect the symptoms of an eight-year-old patient with Dravet syndrome (DS), a rare and severely debilitating form of epilepsy.

Schmidt, C.; Laugesen, H. (2023): Infra-low frequency training in Dravet Syndrome: a case study. Epilepsy and Behaviour reports. Science Direct; 1-10.

You can read the full study here.

 

Background

Dravet syndrome (DS) is a rare and severe form of epilepsy that occurs in one in 40,000 epilepsy patients (Dhamija et al. 2014). Dravet syndrome is caused by the mutation of a gene responsible for the coding of sodium channels in the central nervous system. This genetic mutation is associated with severe neurological impairments in several areas of the brain (Wheless et al. 2020).  Particularly challenging for DS patients are the frequent epileptic seizures, which are largely resistant to treatment. Sleep disorders are also a significant challenge in DS. In addition, DS is characterized by a high degree of heterogeneity in the EEG. According to the international consensus on the diagnosis and treatment of DS, treatment options are limited. (Bureau/ Bernardina 2011). As a result, seizure remission can only rarely be achieved, which is why persistent developmental disorders and sleep problems are likely (Wheless et al. 2020).

Clinically, the core symptoms in particular are treated as part of a DS disorder. However, despite the numerous pharmacological treatment options, there is still no sufficiently effective treatment for DS patients to reduce neurodevelopmental disorders, sleep disorders and epileptic seizures (Moore 2022; Lyons et al. 2020).

Case Study

This case study presents an 8-year-old DS patient who presented with febrile seizures at the age of 5 months with increasing seizure frequency, up to 3 times per week and a seizure duration of up to 30 minutes. In the course of her illness, the epileptic seizures were increasingly triggered not only by fever, but also by low temperatures, physical activity and sensory stimulation. Until the start of ILF neurofeedback therapy, the patient had increasing sleep problems and was awake for two to four hours a night five nights a week.

During a neuropsychological examination in a Danish epilepsy hospital, the girl's mental development was assessed as delayed by around one year. The girl had tried various pharmacological therapies, which had already caused initial damage to her liver function. The use of benzodiazepines also increased the frequency of lethargic moods.

Methods

ILF neurofeedback training was started in December 2019. Since then, the patient has trained almost daily for approx. 30 minutes per session. The NeuroAmp II and Cygnet software are used for this.

 

Results

The results of the case study consist primarily of the parents' observations, including their records of seizures in the digital app, which they share with the Danish Epilepsy Hospital. After the first three training sessions, there was a clear improvement in sleep, and the waking phases during the night also became significantly shorter. With regard to the epileptic seizures, it was found that they could be reduced both in frequency and intensity. In general, the girl has developed positively since starting ILF-NFT. Her cognitive and motor skills are also developing well, even if they are not age-appropriate.

 

Resources

Dhamija, R.; Erickson, MK.; St. Louis, EK.; Wirrell, E.; Kotagal, S. Sleep abnormalities in children with Dravet syndrome, Pediatr. Neurol 2014; 50(5): 474-478.
Wheless, JW.; Fulton, SP.; Mudigoudar, BD. Dravet syndrome: a review of current management. Pediatr Neurol 2020; 107: 28-40.
Bureau, M.; Bernardina, BD. Electroencophalographic characteristics of Dravet syndrome. Epilepsia 2011; 52: 13-23.
Moore, PT. Infra-low frequency neurofeedback and insomnia as a model of CNS dysregulation. Front Hum Neurosci 2022; 514. 
Lyons, L.; Schoeler, NE.; Langan, D.; Cross, JH. Use of ketogenic diet therapy in infants with epilepsy: a systematic review meta-analysis. Epilepsia 2020; 61(6): 1261-1281. 

Here you will find a selection of current neurofeedback studies

 

ILF-Neurofeedback mechanisms and neurophysiology
Dobrushina, O. et al. (2020). Modulation of Intrinsic Brain Connectivity by Implicit Electroencephalographic Neurofeedback. Frontiers in Human Neuroscience, 14: 192. 
Grin-Yatsenko, V., Kara, O., Evdokimov, S., Gregory, M., Othmer, S. & Kropotov, J. (2020). Infra-Low Frequency Neurofeedback Modulates Infra-Slow Oscillations of Brain Potentials: A Controlled Study. Journal of Biomedical Engineering and Research, 4, 1-11.
Grin-Yatsenko, V. A., Ponomarev, V. A., Kara, O., Wandernoth, B., Gregory, M., Ilyukhina, V. A., & Kropotov, J. D. (2018). Effect of Infra-Low Frequency Neurofeedback on Infra-Slow EEG Fluctuations. In Biofeedback. IntechOpen
Dobrushina, O. R. et al. (2018) Exploring the brain contour of implicit infra-low frequency EEG neurofeedback: a resting state fMRI study. Int. J. Psychophysiol. 131, S76 (2018).
Arina, G., Osina, E., Dobrushina, O. & Aziatskaya, G. (2017). Sham-neurofeedback as an intervention: Placebo or nocebo? European Psychiatry, 41, 253-254. 
Altan, S., Berberoglu, B., Canan, S. & Dane, S. (2016). Effects of neurofeedback therapy in healthy young subjects. Clin invest Med 39, 27–30. 
Dobrushina, O. et al. (2015). The effect of Infra-Low Frequency Neurofeedback on default mode network of the brain. Conference paper at Applied Neuroscience and Social Well being, Moscow. (in Russian).
Othmer S., Othmer S.F., Kaiser D. & Putman J. (2013). Endogenous Neuromodulation at Infra-Low Frequencies. Seminars in Paediatric Neurology, 20(4), 246-257.
Legarda S., McMahon D., Othmer S. & Othmer SF. (2011). Clinical Neurofeedback: Case Studies, Proposed Mechanism and Implication for Paediatric Neurology Practice. Journal of Child Neurology, 26(8), 1045-1051.
Othmer S., Othmer SF. & Legarda S. (2011). Clinical Neurofeedback: Training Brain Behavior. Pediatric Neurology and Psychiatry, 2, 67-73.
Seuß S, Riederle J. Erfahrungen mit Neurofeedback in der therapeutischen Praxis. Prax Ergotherapie. 2021;2:75–81. 
Fleischman, M. J. (2022). Documenting the Impact of Infra Low Frequency Neurofeedback on Underserved Populations With Complex Clinical Presentations. Front. Hum. Neurosci. 16, 1–9.
Bazzana F, Finzi S, Di Fini G and Veglia F (2022) Infra-Low Frequency Neurofeedback: A Systematic Mixed Studies Review. Front. Hum. Neurosci. 16:920659. doi: 10.3389/fnhum.2022.920659.
Kropotov JD (2022) The enigma of infra-slow fluctuations in the human EEG Front. Hum. Neurosci. 16:928410. doi: 10.3389/fnhum.2022.928410.

 

ILF-Neurofeedback in the latest clinical study

 

Addiction
Corominas-Roso, M. et al. (2020). Benefits of EEG-Neurofeedback on the Modulation of Impulsivity in a Sample of Cocaine and Heroin Long-Term Abstinent Inmates: A Pilot Study. International Journal of Offender Therapy and Comparative Criminology, 64(12), 1275-1298.

ADHD
Schneider, H., Riederle, J. & Seuss, S. (2021). Therapeutic Effect of Infra-Low_Frequency Neurofeedback Training on Children and Adolescents with ADHD. In: Brain-Computer Interface, Vahid Asadpour ed., IntechOpen Limited, 2021:13, doi: 10.5772/intechopen.97938
Ahlstrand, P. & Grattbeck, M. Neurofeedback - ett behandlingsalternativ vid ADHD. (2013).
Prinz, W. (2015). Neurofeedbacktherapie als Spezialtherapieangebot. Psychopraxis. Neuropraxis 18, 180–183.
Flatz, T. & Gleußner, M. (2014). Neurofeedbacktherapie bei ADHS und Autismus. Pädiatrie & Pädologie 49, 22–27.

Aging & Parkinson’s
Dobrushina, O. R. et al. (2022). Enhancing Brain Connectivity With Infra-Low Frequency Neurofeedback During Aging : A Pilot Study. Front. Hum. Neurosci. 16, 1–12.
Legarda SB, Michas-Martin PA and McDermott D (2022) Managing Intractable Symptoms of Parkinson's Disease: A Nonsurgical Approach Employing Infralow Frequency Neuromodulation. Front. Hum. Neurosci. 16:894781. doi: 10.3389/fnhum.2022.894781.

Autism-Spectrum-Disorder
Rauter, A., Schneider, H. & Prinz, W. (2022). Effectivity of ILF Neurofeedback on Autism spectrum disorder – a Case Study. Front. Hum. Neurosci. 16.
Prinz, W. (2015). Neurofeedbacktherapie als Spezialtherapieangebot. psychopraxis. neuropraxis 18, 180-183. (in German) 
Flatz, T. & Gleußner, M. (2014). Neurofeedbacktherapie bei ADHS und Autismus. Pädiatrie & Pädologie 49, 22–27.
Othmer S. & Othmer S.F. (2011). Neurofeedback for the Autism Spectrum. In K. Siri and T. Lyons (Eds.), Cutting-Edge Therapies for Autism (262-267). Skyhorse Publishing.
Rauter, A., Schneider, H., Prinz, W. & Study, C. (2022). Effectivity of ILF Neurofeedback on Autism Spectrum Disorder — A Case Study. Front. Hum. Neurosci. 16, 1–6.

Brain injuries
Carlson, J. & Ross, G. (2021). Neurofeedback Impact on Chronic Headache, Sleep and Attention Disorders Experienced by Veterans with Mild Traumatic Brain Injury: A Pilot Study. Biofeedback, 49(1), 2-9. 
Annaheim C, Hug K, Stumm C, Messerli M, Simon Y and Hund-Georgiadis M (2022) Neurofeedback in patients with frontal brain lesions: A randomized, controlled double-blind trial. Front. Hum. Neurosci. 16:979723. doi: 10.3389/fnhum.2022.979723.

Depression
Grin-Yatsenko, V. A. et al. (2018) Infra-low frequency neurofeedback in depression: Three case studies. NeuroRegulation 5, 30–42.
Grin-Yatsenko, V. A., & Kropotov, J. D. (2020). Effect of infra-low frequency neurofeedback on the functional state of the brain in health and depressed individuals. In H. W. Kirk (Ed.), Restoring the brain: Neurofeedback as an integrative approach to health (2nd ed.). Routledge, pp. 244-255.
Tschiesner, R. Infra-Low-Frequency Neurofeedback Treatment in Dysthymia : A Case Study. Behav. Sci. (Basel). 13, (2023).

Eating disorders
Chirita-Emandi, A., & Puiu, M. (2014). Outcomes of neurofeedback training in childhood obesity management: A pilot study. Journal of Alternative and Complementary Medicine, 20(11), 831–837. 
Leong, S. L., Vanneste, S., Lim, J., Smith, M., Manning, P., & De Ridder, D. (2018). A randomised, double-blind, placebo-controlled parallel trial of closed-loop infraslow brain training in food addiction. Scientific reports, 8(1), 1-9.
Winkeler, A., Winkeler, M. & Imgart, H. (2022). Infra-Low Frequency Neurofeedback in the Treatment of Patients With Chronic Eating Disorder and Comorbid Post-Traumatic Stress Disorder. Front. Hum. Neurosci. 16, 1–11.

Fibromyalgia, Multiple sclerosis, Brain injuries
Borchert, N. et al. Learning from Läklabbet : An integrative transdisciplinary eco therapeutic treatment approach designed to promote resource capacity in people recovering from chronic ill health . 1–9 (2023).
Ingvaldsen, S. H. (2019). QEEG and Infra-Low Frequency Neurofeedback Training in Fibromyalgia: A Pilot Study (Master's thesis, NTNU).
Lamprecht, C. E. (2019). The effect of neurofeedback in post-concussion syndrome. Doctoral dissertation, Stellenbosch University. 
Legarda, S. B., Lahti, C. E., Mcdermott, D. & Michas-martin, A. (2022). Use of Novel Concussion Protocol With Infralow Frequency Neuromodulation Demonstrates Significant Treatment Response in Patients With Persistent Postconcussion Symptoms , a Retrospective Study. Front. Hum. Neurosci. 16, 1–16.
Dobrushina, O. R., Varako, N. A., Kovyazina, M. S. & Zinchenko, Y. P. (2016). Combination of Neurofeedback and cognitive training in attention deficit due to multiple sclerosis. Int. J. Psychophysiol. 108, 118. 

Insomnia
Orakpo N, Yuan C, Olukitibi O, Burdette J and Arrington K (2022) Does Virtual Reality Feedback at Infra-Low Frequency Improve Centralized Pain With Comorbid Insomnia While Mitigating Risks for Sedative Use Disorder?: A Case Report. Front. Hum. Neurosci. 16:915376. doi: 10.3389/fnhum.2022.915376
Moore PT (2022) Infra-low frequency neurofeedback and insomnia as a model of CNS dysregulation. Front. Hum. Neurosci. 16:959491. doi: 10.3389/fnhum.2022.959491

Migraine and headaches
Dobrushina, O., Arina, G., Osina, E. & Aziatskaya, G. (2017). Clinical and psychological confirmation of stabilizing effect of neurofeedback in migraine. European Psychiatry, 41.
Arina, G. A. et al. (2022). Infra-Low Frequency Neurofeedback in Tension-Type Headache : A Cross-Over Sham-Controlled Study. Front. Hum. Neurosci. 16, 1–9.
Legarda SB, Michas-Martin PA and McDermott D (2022) Remediating Intractable Headache: An Effective Nonpharmacological Approach Employing Infralow Frequency Neuromodulation. Front. Hum. Neurosci. 16:894856. doi: 10.3389/fnhum.2022.894856

Pain
Orakpo N, Yuan C, Olukitibi O, Burdette J and Arrington K (2022) Does Virtual Reality Feedback at Infra-Low Frequency Improve Centralized Pain With Comorbid Insomnia While Mitigating Risks for Sedative Use Disorder?: A Case Report. Front. Hum. Neurosci. 16:915376. doi: 10.3389/fnhum.2022.915376

Persistent  postural-perceptual dizziness
Sasu R (2022) Infra-low frequency neurofeedback in persistent postural-perceptual dizziness—Case report. Front. Hum. Neurosci. 16:959579. doi: 10.3389/fnhum.2022.959579

PTSD
Gerge, A. (2020). A multifaceted case-vignette integrating neurofeedback and EMDR in the treatment of complex PTSD. European Journal of Trauma & Dissociation, 4(3), 100157.
Nilsson, R. M. & Nilsson, V. (2014). Neurofeedback Treatment for Traumatized Refugees-A Pilot Study. Lund University, Department of Psychology.
Othmer, S., Othmer, S. F. & Legarda, S. B. (2011). Clinical Neurofeedback: Training Brain Behavior. Treat. Strateg. Pediatr. Neurol. Psychiatry 2, 67–73. 
Othmer, S. & Othmer, S. F. (2009). Post Traumatic Stress Disorder—The Neurofeedback Remedy. Biofeedback 37, 24–31.
Dahl, M. G. (2020). Neurofeedback with PTSD and traumatic brain injury. In H. W. Kirk (Ed.), Restoring the brain:Neurofeedback as an integrative approach to health (2nd ed.). New York, NY: Routledge, pp.256-284.
Spreyermann, R. (2022). Case Report : Infra-Low-Frequency Neurofeedback for PTSD : A Therapist ’ s Perspective. Front. Hum. Neurosci. 16.
Winkeler, A., Winkeler, M. & Imgart, H. (2022). Infra-Low Frequency Neurofeedback in the Treatment of Patients With Chronic Eating Disorder and Comorbid Post-Traumatic Stress Disorder. Front. Hum. Neurosci. 16, 1–11.
Kirk HW and Dahl MG (2022) Infra Low Frequency Neurofeedback Training for Trauma Recovery: A Case Report. Front. Hum. Neurosci. 16:905823. doi: 10.3389/fnhum.2022.905823

Refractory neurological disorders (Epilepsy, Cerebral Palsy)
Legarda, S. B., McMahon, D., Othmer, S. S. & Othmer, S. S. (2011). Clinical neurofeedback: Case studies, proposed mechanism, and implications for pediatric neurology practice. J. Child Neurol. 26, 1045–1051. 
Schmidt, C. & Laugesen, H. Infra-low frequency neurofeedback training in Dravet syndrome : a case study. Epilepsy Behav. Reports 100606 (2023). doi:10.1016/j.ebr.2023.100606

Schizophrenia
Nestoros JN and Vallianatou NG (2022) Infra-Low Frequency Neurofeedback rapidly ameliorates schizophrenia symptoms: A case report of the first session. Front. Hum. Neurosci. 16:923695. doi: 10.3389/fnhum.2022.923695

Tinnitus
Güntensperger, D. (2018). Treatment of chronic tinnitus with neurofeedback. (Doctoral Dissertation, University of Zurich). (Attn: they have primarily used frequency band NFB training in their studies and are (just) referring to ILF-NFB) 
Güntensperger, D., Thüring, C., Meyer, M., Neff, P. Kleinjung, T. (2017). Neurofeedback for Tinnitus Treatment - Review and Current Concepts. Frontiers in Aging Neuroscience, 9,386.  (Attn: they have primarily used frequency band NFB training in their studies and are (just) referring to ILF-NFB) 

Tourette
Solberg B and Solberg E (2022) Infra-low frequency neurofeedback in application to Tourette syndrome and other tic disorders: A clinical case series. Front. Hum. Neurosci. 16:891924. doi: 10.3389/fnhum.2022.891924

Virtual Reality NFB in pain treatment
Orakpo, N., Vieux, U. & Castro-Nunez, C. (2021). Case Report: Virtual Reality Neurofeedback Therapy as a Novel Modality for Sustained Analgesia in Centralized Pain Syndromes. Frontiers in Psychiatry, 12, 418. DOI: 10.3389/fpsyt.2021.660105.
Orakpo, N., Yuan, C., Olukitibi, O., Burdette, J. & Arrington, K. (2022).Does Virtual Reality Feedback at Infra-Low Frequency Improve Centralized Pain With Comorbid Insomnia While Mitigating Risks for Sedative Use Disorder ?: A Case Report. Front. Hum. Neurosci. 16, 1–5.

 

 

Book and book chapter on ILF Neurofeedback

Othmer S. (2019). Protocol Guide for Neurofeedback Clinicians, 7th Edition. EEG Info
Kirk H. (2015) Restoring the Brain: Neurofeedback as an Integrative Approach to Health. CRC Press, Taylor and Francis Group.
Othmer, S. & Othmer, S. F. (2011). Performance Enhancement Applications of Neurofeedback. In Case Studies in Applied Psychophysiology: Neurofeedback and Biofeedback Treatments for Advances in Human Performance 17–30. Wiley-Blackwell.
Kirk, H. W. (2020) Restoring the Brain: Neurofeedback as an Integrative Approach to Health. Second Edition, Routledge, Taylor and Francis Group.  

 

Dr. Dawn Harris, founder and CEO of Kedras Clinics, has been working successfully with Neurofeedback for years. In an article, she shares how neurofeedback can also be used in dealing with symptoms of menopause. The article appeared in the British journal Menopause in June 2023.

 

The hormonal changes that accompany menopause can be a not insignificant burden for some women, which can be associated with a number of challenges for the women affected. Dr. Dawn Harris explains how Neurofeedback can help patients regain a better quality of life. The perimenopausal changes in a woman's body begin on average at age 47 and last about four to five years (Krug 2022:93). This hormonal reprogramming can be accompanied by a number of physical, neurological as well as psychological changes. In particular, these changes can manifest themselves in hot flashes, sleep disturbances, forgetfulness, mood swings, changes in weight, development of anxiety, skin changes, and relationship problems, to name just a few of the possible symptoms. Since both the intensity of perimenopausal symptoms and the coping strategies associated with them vary, some women may find it challenging to find a therapy that suits them and is associated with as few undesirable side effects as possible.

According to a study from 2021, menopause causes dynamic neurological transformations that have a significant impact on the structure of the brain. Against this background, it is obvious to use therapy components that address these neurological dysregulations. This is where Neurofeedback comes in - with the help of the non-invasive and at the same time safe and fast technology, the brain and the body can learn to regenerate from the neurological changes.

 

What benefits can Neurofeedback have in the context of symptomatic menopause?

Neurofeedback can work on the regulation of subcortical areas of the brain, including the amygdala, the control center of emotions. In addition, neurofeedback can also work on the regulation of the hypothalamus, which can affect the patient's body temperature. The hippocampus, which is primarily associated with memory, can also be trained through neurofeedback. In addition to the brain areas already mentioned, neurofeedback training also focuses on the regulation of the prefrontal cortex, so that, for example, the ability to concentrate can be trained. Neurofeedback can thus address many of the symptoms associated with menopause by acting on these parts of the brain.

 

Read the full article in the June issue of Menopause Life magazine.
https://menopauseexperts.com/product/menopause-life-june-2023/

We would also like to advance the knowledge in this area. We are therefore looking for interested therapists who would like to be part of a study investigating case studies on this topic. If you are interested, please let us know here:
https://docs.google.com/forms/d/e/1FAIpQLScoACLdNJnqX8g4We7BVTKfHoVrzD8ix-g4oj7WYlpT_p3RAw/viewform?usp=sf_link

 

 

Additional sources:

Krug, M. (2022): Menopause - ein Organ verabschiedet sich. EHK; 71: 89-96. a-1718-1360.pdf (thieme-connect.com)

The study "Case Report: Infra-Low-Frequency Neurofeedback for PTSD: A Therapist's Perspective"
by Spreyermann (2022) shows how a combined therapy of trauma psychotherapy and Neurofeedback, specifically ILF Neurofeedback and alpha-theta training, can be used with patients diagnosed with complex post-traumatic stress disorder (C-PTSD). Two case studies are presented as well as an overall assessment of clinical outcomes over the past 7 years.

The study appeared in Frontiers in Human Neuroscience, May 2022.

Citation: Spreyermann R (2022) Case Report: Infra-Low-Frequency Neurofeedback for PTSD: A Therapist's Perspective. Front. Hum. Neurosci. 16:893830. doi: 10.3389/fnhum.2022.893830 PDF 

 

Neurofeedback and complex post-traumatic stress disorder.

 

One speaks of a complex post-traumatic stress disorder if the persistent PTSD symptoms, such as hyperarousal, sleep disorders, panic attacks, nightmares, flashbacks, muscle tension, fatigue, lack of concentration, emotional instability and depressive symptoms have additionally led to personality changes and emotional dysregulation according to the criteria of the International Classification of Diseases 11th Revision (World Health Organization, 2022). Patients may receive Neurofeedback as an additive to their regular psychotherapeutic therapy if psychotherapeutic treatment has resulted in insufficient improvements in trauma-specific symptoms (van der Kolk et al., 2016). According to the guidelines of the German Society for Psychotraumatology, the indications for combined therapy include the symptomatic persistence of an overstimulated state, which can manifest itself, for example, in the form of anxiety and sleep disorders, despite trauma-focused psychotherapy and supportive medication. Another indication, which suggests a therapy with Neurofeedback, is the persistence of dissociative symptoms, in which the patients have an impaired perception of themselves as well as of their environment. 
 

Case reports

The process of combined therapy is described and illustrated in this study using two representative case reports. Case 1 is about a 40-year-old woman suffering from complex post-traumatic stress disorder. Neurofeedback therapy was recommended due to residual symptoms after approximately 10 years of psychotrauma therapy. Over the course of 47 neurofeedback sessions, a decrease in symptom severity to below 30% of baseline was noted.

Case 2 discusses the history of a 35-year-old woman with complex post-traumatic stress disorder. Over the 4.5 years she was treated with Neurofeedback in combination with psychotherapy, a steady and very positive progression was noted. Among other things, she was able to reduce her extensive psychiatric medication as well as significantly improve her sleep quality.

 

Overall assessment of clinical outcomes

According to a qualitative assessment in the present study, the combination of trauma-based psychotherapy and ILF neurofeedback over the past 7 years has led to surprising and motivating results. In only 2 of the 80 patients with complex post-traumatic stress disorder, no improvement was observed with combined therapy and neurofeedback. 15% of the patients dropped out of the study prematurely, so that no valid statements can be made in this regard. In the remaining patients, an improvement in symptom burden of 60-90% on average was observed.

The study results suggest promising findings for patients with complex post-traumatic stress disorder. As you can see from the full text, the case reports cited show that people who have suffered greatly and have not been able to lead a regular life have been able to get back to their lives with the help of combined neurofeedback therapy. 

Read the entire study here.

 

 

References

Spreyermann, R. (2022): Case report: infra-low frequency neurofeedback for PTSD: A therapist's perspective. Frontiers in Human Neuroscience 16: 893830. doi: 10.3389/fnhum.2022.893830.

van der Kolk, B. A., Hodgon, H., Gapen, M., Musicaro, R., Suvak, M. K., Hamlin, E., et al., (2016). A randomizes controlled study of neurofeedback for chronic PTSD. Randomized Controlled Trial>PLoS. 11, e01166752. doi: 10.1371/journal.pone.0166752

We all know of the importance of sleep, which we notice in particular when we have problems with it: Difficulties falling asleep and sleeping through the night, constantly waking up and having trouble getting back to sleep - sleep disorders are multifaceted, and so are their causes. In this blog post we want to explain why sleep is so important, what the consequences of poor sleep can be and how Neurofeedback can help with sleep problems.

 

If you sleep a lot, you sleep well, right?

Of course, it's not quite that simple. The need for sleep differs according to age and gender. Generally, women need more sleep than men and children more than adults. But also other factors influence our need for sleep such as season, habit, health or life circumstances (Hirshkowitz et al., 2015). In Central Europe, the average sleep duration is seven hours per day, varying between five and nine hours. However, the duration of sleep does not necessarily say anything about the quality of sleep and the feeling of being refreshed (Crönlein et al., 2017). Whether we feel refreshed and fit throughout the day depends primarily on our subjective perception.

 

What are the different sleep types?  

Science distinguishes between three chronotypes: Evening, morning and normal type. These differ in their time of peak performance, alertness and sleep preference (Crönlein et al., 2017). As the word already suggests, the morning type is particularly efficient in the morning hours and has difficulty staying awake for a long time in the evening. The evening type on the other side can achieve high performance especially at a later hour and finds the morning hours torturous. However, these two extreme types are rather rare (Crönlein et al., 2017). The normal type is most often found in society. These people wake up neither particularly early nor late, so they are a mixed type of the "lark" (morning type) and "owl" (evening type).

 

How do we know when we need to sleep?

Clearly, when we are tired. But why do we get tired? Regardless of whether we are evening, morning or normal type, our tiredness and the urge to sleep is caused by two factors: the circadian rhythm and the hormone adenosine. The circadian rhythm is, so to speak, the "inner clock" that our organism and all our cells follow. It lasts about 24 hours (hence the term circadian, which is derived from the Latin word circa, roughly meaning day). Among other things, this circadian rhythm influences hormone release and metabolic processes, including the sleep-wake rhythm. By releasing the hormone melatonin this rhythm signals the body to sleep. But melatonin is not the only thing that makes us tired. Our cells work at full speed all day and need energy. This produces adenosine. The longer the day, the more adenosine accumulates in the body. And the more adenosine accumulates  in the body, the higher the sleep pressure becomes and we get tired. During sleep, the adenosine is broken down again and the sleep pressure decreases over night. When we wake up, the process starts all over again (Birbaumer & Schmidt, 2010).

 

What happens in case of a lack of sleep - sleep as a symptom

Different types of sleep disorders can be distinguished: Insomnias, hypersomnias, parasomnias, sleep-wake rhythm disorders or motor disorders such as restless leg syndrome (Spiegelhalder, Backhaus & Riemann, 2011). Between 2010 and 2017, the number of sleep disorders among working people increased by 66%, with about one in ten people suffering from insomniac complaints (DAK, 2017). These include problems falling asleep, sleeping through the night and not getting restful sleep.

Who can’t relate? Stress at work, bad sleep at night which causes low performance at work the next day - a vicious circle. It seems logical that this is not good for our organism, but what exactly are the consequences of sleep disorders? If we do not sleep well, increased risk of falling asleep, a lack of energy and motivation, tension, headaches, moods and concentration problems can be the consequence (DAK, 2017). And mental disorders can also worsen as a result of lack of sleep (Crönlein et al., 2017). Sleep quality and an exact assessment of sleep problems are therefore an important part of the assessment before Neurofeedback therapy.

Sleep as a symptom - How neurofeedback can help 

Because sleep problems often occur as a symptom of other diseases, Neurofeedback can be used for various sleep problems. Especially at the beginning of Neurofeedback therapy, sleep is an important indicator to determine suitable starting positions for ILF Neurofeedback. It makes a difference whether patients have difficulties falling asleep or problems sleeping through the night, which means they need better regulation of the sleep phases. A combination of both can also be present. It influences which electrode positions one starts with in ILF Neurofeedback. 

Furthermore, sleep disorders are a well-describable symptom that causes a high level of suffering for many of those affected. The effects are noticeable in everyday life. Sleep is therefore often a symptom where the first treatment successes with ILF Neurofeedback can become visible quickly. For many patients, being able to fall asleep or sleep through the night "at last" brings a significant improvement to everyday life.

Studies also support the positive effects of Neurofeedback on sleep disorders. For example, study participants reported a subjective improvement in their sleep quality and better performance during the day (Hammer et al., 2011; Schabus et al., 2013). Neurofeedback can also minimise sleep latency, i.e. the time needed from going to bed to actually falling asleep (Wu et al., 2021). Another study shows that sleep problems in burnout patients could be improved (Kratzke et al., 2020). 

ADHD patients in particular report sleep problems repeatedly. An improvement of these problems was observed through SMR Neurofeedback training (Arns, Feddema & Kenemans, 2014). An explanation for this is given in a review article by Arns & Kenemans (2014), in which the effects of Neurofeedback on the so-called sleep spindle circuit are discussed. Increased sleep spindle density leads to a normalisation of insomnia, which in turn reduces ADHD symptoms. "In a [...] randomised controlled trial, 27 healthy adults were trained with SMR conditioning to improve sleep and declarative learning. After 10 sessions, positive changes were observed in sleep parameters such as sleep spindles and latency to fall asleep" (author's translation, Hoedlmoser et al., 2008).

Sleep problems were also improved in a patient treated with ILF Neurofeedback in a virtual reality setting. These improvements persisted after a one-year follow-up. (Orakpo et al., 2021). In another case study, treatment with ILF Neurofeedback in the virtual reality setting improved a patient's pain-related insomnia. Again, the sustained improvement was confirmed after one year (Orakpo et al., 2022).

Based on current research and clinical experience, Neurofeedback can be a useful therapeutic component in the treatment of insomnia or symptoms of disturbed sleep. We are currently working with other researchers to support further Neurofeedback studies. 

For more detailed information on Neurofeedback and scientific work, please contact us.

 

 

 

Sources:

Arns, M., Feddema, I. & Kenemans, J. L. (2014) Differential effects of theta/beta and SMR neurofeedback in ADHD on sleep onset latency. Front. Hum. Neurosci. 8, 1–10.

Birbaumer, N., Schmidt, R. (2010) Wach-Schlaf-Rhythmus und Aufmerksamkeit, in: Schmidt, R. F.,Lang, F.,Heckmann, M. (Hrsg.), Physiologie des Menschen, 31., überarbeitete und aktualisierte Auflage, Heidelberg, Springer Medizin-Verlag, 181–200.

Crönlein T, Galetke W, Young P. (2017) Schlaf und Schlafmedizin – Grundlagen. In: Crönlein T, Galetke W, Young P, Hrsg. Schlafmedizin 1×1. Berlin, Heidelberg: Springer Berlin, Heidelberg.

Hammer, B. U., Colbert, A. P., Brown, K. A. & Ilioi, E. C. (2011). Neurofeedback for insomnia: A pilot study of Z-score SMR and individualized protocols. Appl. Psychophysiol. Biofeedback 36, 251–264.

Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J.,

Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O'Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J. C., Adams Hillard, P. J. (2015) National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep health 1, 1, 40–43.

Hoedlmoser, K., Pecherstorfer, T., Gruber,G., Anderer, P., Doppelmayr, M., Klimesch, W., Schabus, M. (2008) Instrumental Conditioning of Human Sensorimotor Rhythm (12-15 Hz) and Its Impact on Sleep as Well as Declarative Learning. SLEEP 31, 1401–1408.

Kratzke, I. M., Campbell, A., Yefimov, M. N., Mosaly, P. R., Adapa, K., Meltzer-Brody, S., Farrell, T. M., Mazur, L. M. (2020) Pilot Study Using Neurofeedback as a Tool to Reduce Surgical Resident Burnout. Journal of the American College of Surgeons 232, 74-80.

Marschall, J., Hildebrandt, S., Sydow, H., Nolting, H.-D. (2017) Gesundheitsreport 2017. Analyse der Arbeitsunfähigkeitsdaten. Update: Schlafstörungen, 1. Auflage, Heidelberg, Neckar, medhochzwei Verlag.

Orakpo, N., Vieux, U. & Castro-nuñez, C. (2021) Case Report : Virtual Reality Neurofeedback Therapy as a Novel Modality for Sustained Analgesia in Centralized Pain Syndromes. Front. Hum. Neurosci 12, 3–7.

Orakpo, N., Yuan, C., Olukitibi, O., Burdette, J., Arrington, K. (2022) Does Virtual Reality Feedback at Infra-Low Frequency Improve Centralized Pain With Comorbid Insomnia While Mitigating Risks for Sedative Use Disorder?: A Case Report. Front. Hum. Neurosci 16, 1-5.

Schabus, M., Heib, D. P. J., Lechinger, J., Griessenberger, H., Klimesch, W., Pawlizki, A., Kunz, A. B., Sterma, B. M., Hoedlmoser, K. (2013) Enhancing sleep quality and memory in insomnia using instrumental sensorimotor rhythm conditioning. Biol. Psychol. 95, 126–134.

Spiegelhalder, K., Backhaus, J. & Riemann, D. (2011) Schlafstörungen (2. Aufl.). Hogrefe eLibrary: Band 7. Hogrefe.

Wu, Y., Fang, S., Chen, S., Tai, C. & Tsai, P. (2021) Effects of Neurofeedback on Fibromyalgia : A Randomized Controlled Trial. Pain Manag. Nurs. 21, 755-763.
 

Please find here a selection of current neurofeedback studies:

 

ILF Neurofeedback Mechanisms and Neurophysiology 

Dobrushina, O. et al. (2020). Modulation of Intrinsic Brain Connectivity by Implicit Electroencephalographic Neurofeedback. Frontiers in Human Neuroscience, 14: 192. 

Grin-Yatsenko, V., Kara, O., Evdokimov, S., Gregory, M., Othmer, S. & Kropotov, J. (2020). Infra-Low Frequency Neurofeedback Modulates Infra-Slow Oscillations of Brain Potentials: A Controlled Study. Journal of Biomedical Engineering and Research, 4, 1-11.

Grin-Yatsenko, V. A., Ponomarev, V. A., Kara, O., Wandernoth, B., Gregory, M., Ilyukhina, V. A., & Kropotov, J. D. (2018). Effect of Infra-Low Frequency Neurofeedback on Infra-Slow EEG Fluctuations. In Biofeedback. IntechOpen

Dobrushina, O. R. et al. (2018) Exploring the brain contour of implicit infra-low frequency EEG neurofeedback: a resting state fMRI study. Int. J. Psychophysiol. 131, S76 (2018).

Arina, G., Osina, E., Dobrushina, O. & Aziatskaya, G. (2017). Sham-neurofeedback as an intervention: Placebo or nocebo? European Psychiatry, 41, 253-254. 

Altan, S., Berberoglu, B., Canan, S. & Dane, S. (2016). Effects of neurofeedback therapy in healthy young subjects. Clin invest Med 39, 27–30. 

Dobrushina, O. et al. (2015). The effect of Infra-Low Frequency Neurofeedback on default mode network of the brain. Conference paper at Applied Neuroscience and Social Well being, Moscow. (in Russian).

Othmer S., Othmer S.F., Kaiser D. & Putman J. (2013). Endogenous Neuromodulation at Infra-Low Frequencies. Seminars in Paediatric Neurology, 20(4), 246-257.

Legarda S., McMahon D., Othmer S. & Othmer SF. (2011). Clinical Neurofeedback: Case Studies, Proposed Mechanism and Implication for Paediatric Neurology Practice. Journal of Child Neurology, 26(8), 1045-1051.

Othmer S., Othmer SF. & Legarda S. (2011). Clinical Neurofeedback: Training Brain Behavior. Pediatric Neurology and Psychiatry, 2, 67-73.

Seuß S, Riederle J. Erfahrungen mit Neurofeedback in der therapeutischen Praxis. Prax Ergotherapie. 2021;2:75–81. 

Fleischman, M. J. (2022). Documenting the Impact of Infra Low Frequency Neurofeedback on Underserved Populations With Complex Clinical Presentations. Front. Hum. Neurosci. 16, 1–9.

Bazzana F, Finzi S, Di Fini G and Veglia F (2022) Infra-Low Frequency Neurofeedback: A Systematic Mixed Studies Review. Front. Hum. Neurosci. 16:920659. doi: 10.3389/fnhum.2022.920659

Kropotov JD (2022) The enigma of infra-slow fluctuations in the human EEG Front. Hum. Neurosci. 16:928410. doi: 10.3389/fnhum.2022.928410

ILF Neurofeedback in latest clinical application

Addiction 

Corominas-Roso, M. et al. (2020). Benefits of EEG-Neurofeedback on the Modulation of Impulsivity in a Sample of Cocaine and Heroin Long-Term Abstinent Inmates: A Pilot Study. International Journal of Offender Therapy and Comparative Criminology, 64(12), 1275-1298.

ADHD 

Schneider, H., Riederle, J. & Seuss, S. (2021). Therapeutic Effect of Infra-Low_Frequency Neurofeedback Training on Children and Adolescents with ADHD. In: Brain-Computer Interface, Vahid Asadpour ed., IntechOpen Limited, 2021:13, doi: 10.5772/intechopen.97938

Ahlstrand, P. & Grattbeck, M. Neurofeedback - ett behandlingsalternativ vid ADHD. (2013).

Prinz, W. (2015). Neurofeedbacktherapie als Spezialtherapieangebot. Psychopraxis. Neuropraxis 18, 180–183.

Flatz, T. & Gleußner, M. (2014). Neurofeedbacktherapie bei ADHS und Autismus. Pädiatrie & Pädologie 49, 22–27.

Aging & Parkinson’s

Dobrushina, O. R. et al. (2022). Enhancing Brain Connectivity With Infra-Low Frequency Neurofeedback During Aging : A Pilot Study. Front. Hum. Neurosci. 16, 1–12.

Legarda SB, Michas-Martin PA and McDermott D (2022) Managing Intractable Symptoms of Parkinson's Disease: A Nonsurgical Approach Employing Infralow Frequency Neuromodulation. Front. Hum. Neurosci. 16:894781. doi: 10.3389/fnhum.2022.894781

Autism 

Rauter, A., Schneider, H. & Prinz, W. (2022). Effectivity of ILF Neurofeedback on Autism spectrum disorder – a Case Study. Front. Hum. Neurosci. 16.

Prinz, W. (2015). Neurofeedbacktherapie als Spezialtherapieangebot. psychopraxis. neuropraxis 18, 180-183. (in German) 

Flatz, T. & Gleußner, M. (2014). Neurofeedbacktherapie bei ADHS und Autismus. Pädiatrie & Pädologie 49, 22–27.

Othmer S. & Othmer S.F. (2011). Neurofeedback for the Autism Spectrum. In K. Siri and T. Lyons (Eds.), Cutting-Edge Therapies for Autism (262-267). Skyhorse Publishing.

Rauter, A., Schneider, H., Prinz, W. & Study, C. (2022). Effectivity of ILF Neurofeedback on Autism Spectrum Disorder — A Case Study. Front. Hum. Neurosci. 16, 1–6.

Brain Injury

Carlson, J. & Ross, G. (2021). Neurofeedback Impact on Chronic Headache, Sleep and Attention Disorders Experienced by Veterans with Mild Traumatic Brain Injury: A Pilot Study. Biofeedback, 49(1), 2-9. 

Annaheim C, Hug K, Stumm C, Messerli M, Simon Y and Hund-Georgiadis M (2022) Neurofeedback in patients with frontal brain lesions: A randomized, controlled double-blind trial. Front. Hum. Neurosci. 16:979723. doi: 10.3389/fnhum.2022.979723

Depression 

Grin-Yatsenko, V. A. et al. (2018) Infra-low frequency neurofeedback in depression: Three case studies. NeuroRegulation 5, 30–42.

Grin-Yatsenko, V. A., & Kropotov, J. D. (2020). Effect of infra-low frequency neurofeedback on the functional state of the brain in health and depressed individuals. In H. W. Kirk (Ed.), Restoring the brain: Neurofeedback as an integrative approach to health (2nd ed.). Routledge, pp. 244-255.

Eating disorders

Chirita-Emandi, A., & Puiu, M. (2014). Outcomes of neurofeedback training in childhood obesity management: A pilot study. Journal of Alternative and Complementary Medicine, 20(11), 831–837. 

Leong, S. L., Vanneste, S., Lim, J., Smith, M., Manning, P., & De Ridder, D. (2018). A randomised, double-blind, placebo-controlled parallel trial of closed-loop infraslow brain training in food addiction. Scientific reports, 8(1), 1-9.

Winkeler, A., Winkeler, M. & Imgart, H. (2022). Infra-Low Frequency Neurofeedback in the Treatment of Patients With Chronic Eating Disorder and Comorbid Post-Traumatic Stress Disorder. Front. Hum. Neurosci. 16, 1–11..

Fibromyalgia, Multiple Sclerosis, Concussion 

Ingvaldsen, S. H. (2019). QEEG and Infra-Low Frequency Neurofeedback Training in Fibromyalgia: A Pilot Study (Master's thesis, NTNU).

Lamprecht, C. E. (2019). The effect of neurofeedback in post-concussion syndrome. Doctoral dissertation, Stellenbosch University. 

Legarda, S. B., Lahti, C. E., Mcdermott, D. & Michas-martin, A. (2022). Use of Novel Concussion Protocol With Infralow Frequency Neuromodulation Demonstrates Significant Treatment Response in Patients With Persistent Postconcussion Symptoms , a Retrospective Study. Front. Hum. Neurosci. 16, 1–16.

Dobrushina, O. R., Varako, N. A., Kovyazina, M. S. & Zinchenko, Y. P. (2016). Combination of Neurofeedback and cognitive training in attention deficit due to multiple sclerosis. Int. J. Psychophysiol. 108, 118. 

Insomnia

Orakpo N, Yuan C, Olukitibi O, Burdette J and Arrington K (2022) Does Virtual Reality Feedback at Infra-Low Frequency Improve Centralized Pain With Comorbid Insomnia While Mitigating Risks for Sedative Use Disorder?: A Case Report. Front. Hum. Neurosci. 16:915376. doi: 10.3389/fnhum.2022.915376

Moore PT (2022) Infra-low frequency neurofeedback and insomnia as a model of CNS dysregulation. Front. Hum. Neurosci. 16:959491. doi: 10.3389/fnhum.2022.959491

Migraine & Tension Headache

Dobrushina, O., Arina, G., Osina, E. & Aziatskaya, G. (2017). Clinical and psychological confirmation of stabilizing effect of neurofeedback in migraine. European Psychiatry, 41.

Arina, G. A. et al. (2022). Infra-Low Frequency Neurofeedback in Tension-Type Headache : A Cross-Over Sham-Controlled Study. Front. Hum. Neurosci. 16, 1–9.

Legarda SB, Michas-Martin PA and McDermott D (2022) Remediating Intractable Headache: An Effective Nonpharmacological Approach Employing Infralow Frequency Neuromodulation. Front. Hum. Neurosci. 16:894856. doi: 10.3389/fnhum.2022.894856

Pain

Orakpo N, Yuan C, Olukitibi O, Burdette J and Arrington K (2022) Does Virtual Reality Feedback at Infra-Low Frequency Improve Centralized Pain With Comorbid Insomnia While Mitigating Risks for Sedative Use Disorder?: A Case Report. Front. Hum. Neurosci. 16:915376. doi: 10.3389/fnhum.2022.915376

Persistent  postural-perceptual dizziness

Sasu R (2022) Infra-low frequency neurofeedback in persistent postural-perceptual dizziness—Case report. Front. Hum. Neurosci. 16:959579. doi: 10.3389/fnhum.2022.959579

PTSD

Gerge, A. (2020). A multifaceted case-vignette integrating neurofeedback and EMDR in the treatment of complex PTSD. European Journal of Trauma & Dissociation, 4(3), 100157.

Nilsson, R. M. & Nilsson, V. (2014). Neurofeedback Treatment for Traumatized Refugees-A Pilot Study. Lund University, Department of Psychology.

Othmer, S., Othmer, S. F. & Legarda, S. B. (2011). Clinical Neurofeedback: Training Brain Behavior. Treat. Strateg. Pediatr. Neurol. Psychiatry 2, 67–73. 

Othmer, S. & Othmer, S. F. (2009). Post Traumatic Stress Disorder—The Neurofeedback Remedy. Biofeedback 37, 24–31.

Dahl, M. G. (2020). Neurofeedback with PTSD and traumatic brain injury. In H. W. Kirk (Ed.), Restoring the brain:Neurofeedback as an integrative approach to health (2nd ed.). New York, NY: Routledge, pp.256-284.

Spreyermann, R. (2022). Case Report : Infra-Low-Frequency Neurofeedback for PTSD : A Therapist ’ s Perspective. Front. Hum. Neurosci. 16.

Winkeler, A., Winkeler, M. & Imgart, H. (2022). Infra-Low Frequency Neurofeedback in the Treatment of Patients With Chronic Eating Disorder and Comorbid Post-Traumatic Stress Disorder. Front. Hum. Neurosci. 16, 1–11.

Kirk HW and Dahl MG (2022) Infra Low Frequency Neurofeedback Training for Trauma Recovery: A Case Report. Front. Hum. Neurosci. 16:905823. doi: 10.3389/fnhum.2022.905823

Refractory neurological disorders (Epilepsy, Cerebral Palsy)

Legarda, S. B., McMahon, D., Othmer, S. S. & Othmer, S. S. (2011). Clinical neurofeedback: Case studies, proposed mechanism, and implications for pediatric neurology practice. J. Child Neurol. 26, 1045–1051. 

Schizophrenia

Nestoros JN and Vallianatou NG (2022) Infra-Low Frequency Neurofeedback rapidly ameliorates schizophrenia symptoms: A case report of the first session. Front. Hum. Neurosci. 16:923695. doi: 10.3389/fnhum.2022.923695

Tinnitus

Güntensperger, D. (2018). Treatment of chronic tinnitus with neurofeedback. (Doctoral Dissertation, University of Zurich). (Attn: they have primarily used frequency band NFB training in their studies and are (just) referring to ILF-NFB) 

Güntensperger, D., Thüring, C., Meyer, M., Neff, P. Kleinjung, T. (2017). Neurofeedback for Tinnitus Treatment - Review and Current Concepts. Frontiers in Aging Neuroscience, 9,386.  (Attn: they have primarily used frequency band NFB training in their studies and are (just) referring to ILF-NFB) 

Tourette

Solberg B and Solberg E (2022) Infra-low frequency neurofeedback in application to Tourette syndrome and other tic disorders: A clinical case series. Front. Hum. Neurosci. 16:891924. doi: 10.3389/fnhum.2022.891924

Virtual Reality NFB in Pain Treatment 

Orakpo, N., Vieux, U. & Castro-Nunez, C. (2021). Case Report: Virtual Reality Neurofeedback Therapy as a Novel Modality for Sustained Analgesia in Centralized Pain Syndromes. Frontiers in Psychiatry, 12, 418. DOI: 10.3389/fpsyt.2021.660105 

Orakpo, N., Yuan, C., Olukitibi, O., Burdette, J. & Arrington, K. (2022).Does Virtual Reality Feedback at Infra-Low Frequency Improve Centralized Pain With Comorbid Insomnia While Mitigating Risks for Sedative Use Disorder ?: A Case Report. Front. Hum. Neurosci. 16, 1–5.

Books and book chapters on ILF Neurofeedback

Othmer S. (2019). Protocol Guide for Neurofeedback Clinicians, 7th Edition. EEG Info

Kirk H. (2015) Restoring the Brain: Neurofeedback as an Integrative Approach to Health. CRC Press, Taylor and Francis Group.

Othmer, S. & Othmer, S. F. (2011). Performance Enhancement Applications of Neurofeedback. In Case Studies in Applied Psychophysiology: Neurofeedback and Biofeedback Treatments for Advances in Human Performance 17–30. Wiley-Blackwell.

Kirk, H. W. (2020) Restoring the Brain: Neurofeedback as an Integrative Approach to Health. Second Edition, Routledge, Taylor and Francis Group.  

 

 

Eight patients with tension headache received 10 sessions of ILF neurofeedback and 10 sessions of sham neurofeedback in random order. The intervention was in addition to a baseline psychotherapeutic intervention. Results of the study titled "Infra-Low Frequency Neurofeedback in Tension-Type Headache: A Cross-Over Sham-Controlled Study" from Arina et al. showed that compared to sham treatment, the frequency of headaches after treatment with ILF neurofeedback, was significantly lower.

 

Neurofeedback and headache

Although neurofeedback is increasingly used for chronic pain, its effectiveness for headaches has been little studied. Yet headaches are among the most common conditions; 38% of the adult population actively suffers from tension headaches (Jensen and Stovner, 2008). In treatment, non-drug treatments, including biofeedback and neuromodulation, are promising alternatives to medication (Nestoriuc et al., 2008; Bendtsen et al., 2010; Ailani et al., 2021).

Neurofeedback uses brain signals and aims to therapeutically modulate a dysfunctional brain state, such as an imbalance in electroencephalographic (EEG) activity or altered intrinsic connectivity patterns (Ros et al., 2013; Marzbani et al., 2016; Nicholson et al., 2016; Dobrushina et al., 2020). In the present study, infra-low frequency (ILF) neurofeedback was applied, which targets the slow brain fluctuations. In practice, neurofeedback is already widely used in the treatment of headache (Othmer, 2017). However, a sham-controlled study in patients with tension headache has not yet been conducted.

 

Study and methods

The aim of the present study was therefore to evaluate the effects of low-frequency EEG neurofeedback in patients with tension headache using a sham-controlled cross-over study. 8 patients, aged between 18 and 45 years, diagnosed with tension headache, received 10 sessions of neurofeedback treatment and 10 sessions of sham neurofeedback treatment in two intervention phases. The order (neurofeedback first or sham neurofeedback first) was randomized. In addition, the mechanisms of tension headache, including the benign nature of the headache and the risk of medication overdose, and progressive muscle relaxation training were explained to all participating subjects. Patients received an audio recording of the relaxation technique and were asked to use it three times per week. During the study period, participating subjects were required to keep a headache diary that included information on the duration and intensity of headaches and medication use. 
Neurofeedback sessions were conducted according to the Othmer protocol. Furthermore, the NeuroAmp as well as the Cygnet software of the BEE Medic company were used.

Results and implications

 

Results of the study showed a significant effect of neurofeedback and no effect of sham sessions. Treatment with neurofeedback reduced the frequency of tension headaches. Sham sessions, on the other hand, resulted in a placebo effect in one participant and a nocebo effect in two others. Furthermore, it was found that beliefs about neurofeedback and behavior during the sessions did not influence the effectiveness of neurofeedback.

In conclusion, the results of the study support the use of low-frequency neurofeedback in the integrative treatment of patients with tension headaches.

Read the entire study here.

References

Ailani, J., Burch, R. C., and Robbins, M. S. (2021). The American Headache Society Consensus Statement: update on integrating new migraine treatments into clinical practice. Headache J. Head Face Pain 61, 1021–1039. doi: 10.1111/head.14153

Bendtsen, L., Evers, S., Linde, M., Mitsikostas, D. D., Sandrini, G., and Schoenen, J. (2010). EFNS guideline on the treatment of tension-type headache - Report of an EFNS task force. Eur. J. Neurol. 17, 1318–1325. doi: 10.1111/j.1468-1331.2010.03070.x

Dobrushina, O. R., Vlasova, R. M., Rumshiskaya, A. D., Litvinova, L. D., Mershina, E. A., Sinitsyn, V. E., et al. (2020). Modulation of intrinsic brain connectivity by implicit electroencephalographic neurofeedback. Front. Hum. Neurosci. 14:192. doi: 10.3389/fnhum.2020.00192

Jensen, R., and Stovner, L. J. (2008). Epidemiology and comorbidity of headache. Lancet Neurol. 7, 354–361. doi: 10.1016/S1474-4422(08)70062-0

Marzbani, H., Marateb, H. R., and Mansourian, M. (2016). Neurofeedback: a comprehensive review on system design, methodology and clinical applications. Basic Clin. Neurosci. 7, 143–158. doi: 10.15412/J.BCN.03070208

Nestoriuc, Y., Rief, W., and Martin, A. (2008). Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators. J. Consult. Clin. Psychol. 76, 379–396. doi: 10.1037/0022-006X.76.3.379
 

 

As part of the study—which was conducted in cooperation with the Neurofeedback Network and a group of child and adolescent psychiatric practices in Munich—251 patients with AD(H)D received neurofeedback treatment. Attention was assessed before the start and after completion of the therapy. A comparison of the test results showed significant improvements in attention and impulse control; patients also reported an improvement in AD(H)D symptoms.

A detailed article on the study was published in May 2020 in neue AKZENTE, issue no. 115 (ADHS Deutschland e.V.).

Citation:
Mackert, J. (2020). Neurofeedback in AD(H)D – Improving attention with ILF neurofeedback. neue AKZENTE, 115(1), 8–12.
PDF version available via ResearchGate.

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The Diagnosis of AD(H)D

Approximately five percent of children of school age are affected by AD(H)D. They exhibit cross-situational symptoms of inattention, impulsivity, and, in some cases, hyperactivity, which can cause considerable distress. The disorder is generally associated with functional impairments, and problems frequently arise, particularly in the areas of school and education. Affected individuals and their parents are therefore seeking effective treatment methods—especially those that can achieve lasting therapeutic effects without the use of psychopharmaceuticals.

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AD(H)D and Neurofeedback

As neurological and psychiatric disorders are associated with specific alterations in brain activity (Hammond, 2019), neurofeedback— a non-invasive, EEG-based, computer-assisted therapeutic method—can represent a meaningful treatment option. Neurofeedback allows certain components of a patient’s own brain activity to be visualized in real time. These visual stimuli serve as feedback signals that can be decoded by the visual processing centers of the brain. Based on this visualization of brain activity, different training modules can be applied depending on the therapeutic goal.

Infra-Low-Frequency Neurofeedback

In this study, Infra-Low-Frequency (ILF) neurofeedback was applied. This approach confronts the brain with components of its own activity that lie within an extremely low frequency range. By placing electrodes on the scalp above specific associative brain areas, up to 15 different activity parameters can be fed back to the brain in order to reflect changes in its internal states and to initiate adaptive processes at an unconscious level (Wiedemann, 2015).

Clinical studies involving patients with AD(H)D have demonstrated since the 1980s that neurofeedback can lead to significant improvements in various parameters of attention, impulse control, and academic performance (Lubar & Lubar, 1985; Kaiser & Othmer, 2000; Sasu & Othmer, 2015). Follow-up studies have further confirmed sustained improvements in attention and academic performance six and 24 months after completion of neurofeedback therapy (Gani, Birbaumer & Strehl, 2008; Van Doren et al., 2018). More recent studies have shown that neurofeedback treatment can produce lasting effects comparable to those achieved with stimulant medication such as methylphenidate (Ritalin) (Fuchs et al., 2003; Monastra et al., 2002; Rossiter, 2004).

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The Study

The aim of this multicenter observational study was to investigate whether ILF neurofeedback represents a therapeutically relevant treatment option for children, adolescents, and young adults with AD(H)D. Between January 2015 and September 2017, 251 children, adolescents, and young adults (aged 7–21 years) diagnosed with AD(H)D were observed. Over a period of 15 weeks, participants received approximately 30 neurofeedback sessions, corresponding to the recommended frequency of two sessions per week.

Participants completed a specific assessment of various parameters of attention and impulse control both before and after the neurofeedback therapy and also rated the severity of their symptoms.

ILF neurofeedback was delivered using EEG NeuroAmp® systems manufactured by BEE Medic. The applied treatment protocol followed the evidence-based method developed by Othmer, in which electrode placement and training frequencies (<0.1 Hz) are individually determined (Othmer, 2017). Attention and impulse control were assessed using the Continuous Performance Test (QIKtest), which measures attention across four variables: reaction time, variability of reaction time, omission errors, and commission errors.

Pre- and post-treatment data from n = 196 participants were included in the analysis (21% female, 79% male; mean age = 12.06 years). Table 1 presents the measured pre–post values for the four attention variables as well as the (significant) differences observed.

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Results

Analysis of the attention test revealed significant improvements across all four parameters following neurofeedback therapy. This suggests that neurofeedback contributes to improved self-regulation of brain activity. On average, participants responded more quickly, showed reduced variability in reaction times, and made significantly fewer errors.

This effect was particularly pronounced for commission errors, indicating that participants exhibited significantly less impulsive response behavior after completing neurofeedback therapy.

In addition, 97% of participants subjectively reported an improvement in symptoms following neurofeedback treatment. Only 3% indicated no perceived improvement when comparing pre- and post-treatment symptom ratings.

The strongest changes in symptom ratings were observed for hyperactivity and inattention, both of which were rated as markedly less severe by participants after neurofeedback therapy.

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Study Results and Implications

The results suggest that after approximately 30 neurofeedback sessions, patients showed significant improvements in attention, sustained attention, and impulse control. Furthermore, the perceived severity of symptoms was substantially reduced. Based on these findings, the therapeutic benefit of ILF neurofeedback can be rated as very good.

These results support the conclusion that ILF neurofeedback may represent a valuable therapeutic component for children, adolescents, and young adults with AD(H)D. Feedback from patients and their parents was consistently positive, and treating therapists also rated both the treatment method and patient outcomes very positively.

These promising findings encourage further research into ILF neurofeedback for the treatment of AD(H)D—particularly studies that address the limitations of this observational design by employing interventional approaches, control groups, and additional validated assessment instruments for attention, impulse control, and related parameters, including validity criteria. Comparative studies examining neurofeedback relative to other treatment approaches and investigations into the long-term effects of neurofeedback therapy would also be of interest.

Although the results of this observational study are only partially generalizable, the relatively large sample size demonstrates that both subjective and behavioral improvements in symptoms are achievable through ILF neurofeedback therapy in children and adolescents with AD(H)D. ILF neurofeedback thus represents a non-pharmacological, non-invasive, and pain-free treatment option that can meaningfully expand therapeutic approaches for AD(H)D.

 

Sources 

Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J. H. & Kaiser, J. (2003). Neurofeedback Treatment for AttentionDeficit/Hyperactivity Disorder in Children: A Comparison with Methylphenidate. Applied Psychophysiology and Biofeedback, 28 (1), 1-12.
Gani, C., Birbaumer, N. & Strehl, U. (2008). Long term effects after feedback of slow cortical potentials and of theta-betaamplitudes in chindren with attention-deficit/hyperactivy disorder (ADHD). International Journal of Bioelectromagnetism, 10 (4), 209-232. 
Hammond, D. C. (2019). Integrating Clinical Hypnosis and Neurofeedback. American Journal of Clinical Hypnosis, 61(4), 302- 321. 
Kaiser, D.A. & Othmer, S. (2000). Effect of Neurofeedback on Variables of Attention in a Large Multi-Center Trial. Journal of Neurotherapy, 4 (1), 5-15. 
Lubar, J.O. & Lubar, J.F. (1984). Electroencephalographic Biofeedback of SMR and Beta for Treatment of Attention Deficit Disorders in a Clinical Setting. Biofeedback and Self-Regulation, 9 (1), 1-23. 
Monastra, V. J., Monastra, D. M. & George, S. (2002). The Effects of Stimulant Therapy, EEG Biofeedback and Parenting Style on the Primary Symptoms of Attention-Deficit/Hyperactivity Disorder. Applied Psychophysiology and Biofeedback, 27 (4), 231-249. 
Othmer, S. (2017) Protocol guide ILF HD-module 6th Edition. Woodland Hills CA: EEG Institute.
Rossiter, T. (2004). The Effectiveness of Neurofeedback and Stimulant Drugs in Treating AD/HD. Applied Psychophysiology and Biofeedback, 29 (4), 233-243. 
Sasu, R. & Othmer, S. (2015). Neurofeedback in Application to the ADHD spectrum. In Hanno W. Kirk (Hsg.) Restoring the Brain: Neurofeedback as an Integrative Approach to Health. (S.231-260). Boca Raton, Florida: CRC Press.
Van Doren, J., Arns, M., Heinriich, H., Vollebregt, M. A., Strehl, U. & Loo, S. K. (2018). Sustained Effects of Neurofeedback in ADHD: a Systematic Review and Meta-Analysis. European Child & Adolescent Psychiatry, doi: 10.1007/s00787-018- 1121-4. 
Wiedemann, M. (2015). Infra Low Frequency (ILF-) Neurofeedback. In K.-M. Haus, C. Held, A. Kowalski, A. Krobholz, M. Nowak, E. Schneider, G. Strauß & M. Wiedemann, Praxisbuch für Biofeedback und Neurofeedback (2. Auflage), 91- 115. Berlin, Heidelberg: Springer. 

 

This blog post is about... um... oh… let me think... yeah! Memory and forgetting. We all have been in such situations: forgetting the appointment at the dentist, having to search for our car in the parking lot and not remembering birthdays. In this blog post, we explain why we forget things and how neurofeedback can improve memory. We are also discussing a study by the Saarland University in which the memory of test subjects could be improved in the long term through neurofeedback training.

Why do we forget things? 
 

The question seems trivial, but the answer is not. Forgetting is often perceived as a counterpart to memory and malfunction of the brain, but in fact it is an elementary brain function. In order to adapt to changing environmental conditions, we must learn new things, but also forget or relearn old things. Through the mechanism of forgetting, we learn to separate the unimportant from the important. 

By the way, we not only forget declarative facts and episodic contents of our memory – such as knowledge from school or memories of our first birthday – especially when it comes to sensory perception, the deletion of impressions is important in order to ensure a functioning perception in the presence.There would be small benefit to save an old sensory impression in our sensory system forever – rather, the storage takes only about 0.25 seconds until the information reaches the brain, then the old sensory impression must be overwritten by a new one in order to ensure timely perception of the environment and possible dangers.

 

Forgetting as spam filter

Forgetting is an active process that - like a spam filter - scrolls over our perceptions and helps us to perceive the impression or to call up the memory we need. Forgetting suppresses the “spam” in the respective situation, i.e. related impressions or irrelevant knowledge. But we also forget things that are important, such as the dentist appointment. That’s because in the process of forgetting, as well as in learning (keyword – maladaptive behavior, addiction), our spam filter may be mistaken and important information is not properly classified – perhaps because while we made the dentist appointment, at the same time another important sensory impression (door bells) disturbed our system and thus upset the storage and separation of important and unimportant. 

 

Synaptogenesis in teenage years

There is also a clear correlation for the importance of forgetting: The so-called synaptogenesis during puberty: An adult has significantly fewer synapses – neuronal connections between nerve cells – than a child. The brain ‘forgets’ things - or in this case eliminates synapses- through its development in order to make processing more efficient. What should not be neglected: The human brain and its executive functions are not infinite, but limited in capacity – so the existing structures and storage capacities must be used in the most efficient way to learn, repeat and remind those things which are adaptive to the prevailing environmental conditions.

However, researchers still discuss whether by forgetting we really lose memory content or it simply becomes more difficult to access these content.. It is also exciting that we can change memories on every retrieval – and that there are memories where this is not possible. Patients suffering from post-traumatic stress disorder, for example, cannot change the traumatic memory stored in their memory.Even the spam filter can not surpress those kind of memories - a trigger or an association can lead to flashbacks. This is also because the memory of the trauma – not least because of the involvement of Amygdala– is saved very deeply in the brain. The amygdala also reacts to stimuli that are just somehow associated with the traumatic situation. So how well you remember depends on how well you forget. 

 

Neurofeedback and memory - theta activity can be trained individually

A team of Experimental Neuropsychologists from the University of Saarland investigated in a study with 17 subjects how memory could be improved by a specific neurofeedback training. Using a specially developed neurofeedback protocol, the subjects trained to increase Theta waves (4-8 Hz) in brain activity. Those are known to be associated with relaxed waking states or flow experiences through previous research. If the subjects showed high theta activity, took the speed of a roller coaster that they saw on the screen in front of them; A small proportion of Theta Waves caused the roller coaster to stand still. Subjects trained with neurofeedback in a total of seven sessions for 30 min within almost two weeks. 18 subjects in the control group received sham feedback and were presented randomly selected frequencies of their EEG during the same amount of sessions. 

While the training group showed significantly more theta activity from the third session onwards (theta increase of 10-15 % per subject), there was no increase in the theta activity in the control group. The authors concluded that subjects could learn to upregulate the theta waves.Thus, theta activity can be trained individually through neurofeedback training.
 

Increased theta activity shows improvement in memory performance

The researchers then examined the impact of increased theta activity on long-term memory. Subjects from both groups solved a memory task on three different dates – one day after the first NFB training, one day after the last NFB session and 13 days after the last session. In the task, memory capacity and memory context were considered. The participants were presented with 200 words (for each of the 3 test times new words were chosen here). They should indicate whether these words describe living objects or if they seem pleasant to them. In a subsequent memory test, the previously learned words were presented together with some new words. If the subjects assessed a word as seen before, they were asked in which context (i.e. with the question of alive or pleasant) it had been presented before. 

Subjects who previously received neurofeedback training and thus increased their theta waves, showed a clear improvement in their memory performance. After neurofeedback training, they were able to recognise more words and assign them to the right context. This improvement was not only of a short-term nature: Even if the test was repeated 13 days after the last neurofeedback session, a long-term improvement in memory and memory context could be registered. The individual improvement in the memory test was related to the individual increase of the theta activity in neurofeedback training.

At both test times after neurofeedback training, but especially during testing 13 days after the last session, subjects in the training group achieved absolutely better results than subjects in the control group, while the results in the pretest were comparable. 

This research was carried out with young and healthy subjects, but forms the basis for investigating the improvement of memory through neurofeedback in the future – possibly using other protocols then theta frequency training – with patients suffering from pathological memory problems. In any case, the results suggest to further investigate the possibilities of neurofeedback training to improve memory. Even in current treatments – with corresponding symptoms – the improvement of memory can be considered as a treatment goal.

 

Study:  Eschmann, K. C., Bader, R., & Mecklinger, A. (2020). Improving episodic memory: Frontal-midline theta neurofeedback training increases source memory performance. NeuroImage, 222, 117219. 

For the first time a randomized, controlled study has shown effects of Infra Low Frequency Neurofeedback (ILF Neurofeedback for short and also known as the Othmer method), on connectivity and brain activity - and this after only a single session. The study by Dobrushina et al. entitled "Modulation of Intrinsic Brain Connectivity by Implicit Electroencephalographic Neurofeedback" thus makes an important contribution to a better understanding of the mechanisms and processes of ILF Neurofeedback. “This confirms what we see in daily practice and what patients telling us: that ILF Neurofeedback has effects even after only one session,” says Dr. Bernhard Wandernoth, Founder of BEE Medic GmbH.

Dobrushina et al. (2020). Modulation of Intrinsic Brain Connectivity by Implicit Electroencephalographic Neurofeedback. Frontiers in Human Neuroscience, 14:192

 

Detection of a change in brain connectivity by 30 minutes ILF Neurofeedback

The human brain consists of about 100 billion nerve cells, which form extremely complex networks via so-called synaptic connections. neuronal compounds (connective) develop and change dynamically. Every functional change in the brain is accompanied by changes in the connectivity of nerve cells. Using functional magnetic resonance imaging (fMRI), Dobrushina and colleagues have now been able to show for the first time that ILF Neurofeedback modulates significant changes in brain connectivity.

 

Investigation on 52 probands

The 52 healthy probands completed a 30-minute ILF Neurofeedback session (electrode position: T4/P4) in a double-blind, controlled experimental design. Half of the test persons (control group) received sham Neurofeedback, in which the animations were generated randomly and were not the result of brain waves. Before and after the Neurofeedback session, the activity of neuronal networks in the brain was recorded in all subjects using functional magnetic resonance imaging (fMRI) at rest.

 

Special feature of ILF Neurofeedback: Implicit processing of the feedback signal modulates neuronal networks and increases connectivity

A special feature of ILF Neurofeedback is that the feedback signal is not consciously altered but implicitly processed, which is assumed to modulate neuronal networks involved in the self-regulation of the brain. A comparison of the fMRI images before and after ILF Neurofeedback shows the activation of a network of several regions in the brain, which is associated with the implicit Neurofeedback process and is formed immediately after the ILF Neurofeedback session. Some of the regions involved in the network have key functions in processes of control, visual perception and implicit learning. In addition, post Neurofeedback recordings show increased connectivity between brain regions associated with stimulus perception (salience), speech and visual networks, i.e. multi-sensory information processing and integration. This increased connectivity is only seen in the experimental group but not in the control group, suggesting that the increased connectivity is an effect of Neurofeedback.

 

An important milestone in the understanding of Neurofeedback

"The work of Olga Dobrushina is an important basis for further studies. The result is significant, is being appreciatively discussed by high-ranking neuroscientists and a follow-up study has already started", says Dr. Bernhard Wandernoth and continues: "Of course, I am especially pleased about the confirmation of what drives us every day, what we have been observing for years and what we get back from therapists and patients. After all, it has always been our goal to develop Neurofeedback procedures and technologies in a way that we achieve the greatest possible effects, so that patients and therapists are enthusiastic. The study now makes an important contribution to further research into the mode of action of Neurofeedback and the development of explanatory models. Above all, the study also shows the role of ILF Neurofeedback and the potential of this individual and effective Neurofeedback approach. We will continue to push the development of modern neurofeedback. Most importantly, the study also shows what role ILF Neurofeedback is playing and the potential of this individual and effective Neurofeedback approach. The fact that we can look back to 35 years of intensive cooperation between clinicians, scientists and developers and which has resulted in empirical clinical work of hundreds of thousands and more Neurofeedback sessions, have now succeeded in gaining a first impression of what Neurofeedback actually does in the brain. And this is definitely a milestone for a better understanding of Neurofeedback in general.”