[Neurofeedback in the Treatment of Anorexia Nervosa: a Case Report]. / Der Einsatz von Neurofeedback bei Anorexia nervosa: ein Fallbeispiel.

Anorexia nervosa has been related to alterations in brain activity in terms of hyperactive EEG patterns. This case report illustrates the principles and results of a five-week neurofeedback treatment in a 29-year-old woman suffering from anorexia nervosa. A neurofeedback protocol to enhance alpha activity (8 - 12 Hz) was developed and conducted additionally to the standardized treatment for eating disorders in training sessions twice a week. Pre- and post-test measurements included resting state EEG measurements and a psychological test battery. The results show improvements from pre- to post-test in eating disorder psychopathology including psychological wellbeing, emotional competence, and eating behavior traits. In addition, a decrease in theta power (4 - 7 Hz), a well-known trait marker of anorexia nervosa, was measured. However, our data should be interpreted with caution because this is a single case study. Nevertheless, this report documents the practicability and method of neurofeedback as treatment adjunct in eating disorders from the clinical perspective. Although the use of neurofeedback in the treatment of anorexia nervosa is recommended in literature, empirical studies are still lacking. Randomized controlled trials to evaluate short- and long-term effects of neurofeedback are needed.

Soul darkness? Dimensions of religious/ spiritual well-being among mood-disordered inpatients compared to healthy controls.

BACKGROUND: Religiosity and spirituality have been found to be substantially associated with a variety of mental health and illness parameters. However, relevant empirical evidence is sparse, and more research is needed in order to further understand what role religiosity/spirituality plays in the development, progression and healing process of a psychiatric disease. Thus, the purpose of this study was to find out more information about the religious/spiritual needs of anxious/depressive inpatients. SAMPLING AND METHODS: A total sample of 200 well-characterized anxious/depressive inpatients was investigated. Results were compared to those from an adjusted group of healthy individuals (n = 200). A newly developed Multidimensional Inventory for Religious/Spiritual Well-Being was applied to both groups, together with established psychiatric measures (e.g. Beck Depression Inventory). RESULTS: Of the dimensions measured, Hope and Forgiveness turned out to be the strongest negative correlates of anxious/depressive symptoms (p < 0.001). Moreover, a lower degree of Hope (p < 0.001) and Experiences of Sense and Meaning (p < 0.01) was found in the patient group compared to healthy controls. In accordance with the literature, religiosity was confirmed to be a substantial suicidal buffer (p < 0.01). CONCLUSIONS: Our results account for a more comprehensive psychiatric evaluation, emphasizing in particular the role that religiosity/spirituality plays in overall well-being. Furthermore, religious/spiritual well-being might be considered an important resource to explore, in particular for affective mentally disordered patients.

HER2 gene amplification and EGFR expression in a large cohort of surgically staged patients with nonendometrioid (type II) endometrial cancer.

Type II endometrial cancers (uterine serous papillary and clear cell histologies) represent rare but highly aggressive variants of endometrial cancer (EC). HER2 and EGFR may be differentially expressed in type II EC. Here, we evaluate the clinical role of HER2 and EGFR in a large cohort of surgically staged patients with type II (nonendometrioid) EC and compare the findings with those seen in a representative cohort of type I (endometrioid) EC. In this study HER2 gene amplification was studied by fluorescence in situ hybridisation (FISH) and EGFR expression by immunohistochemistry. Tissue microarrays were constructed from 279 patients with EC (145 patients with type I and 134 patients with type II EC). All patients were completely surgically staged and long-term clinical follow up was available for 258 patients. The rate of HER2 gene amplification was significantly higher in type II EC compared with type I EC (17 vs 1%, P<0.001). HER2 gene amplification was detected in 17 and 16% of the cases with uterine serous papillary and clear cell type histology, respectively. In contrast, EGFR expression was significantly lower in type II compared with type I EC (34 vs 46%, P=0.041). EGFR expression but not HER2 gene amplification was significantly associated with poor overall survival in patients with type II EC, (EGFR, median survival 20 vs 33 months, P=0.028; HER2, median survival 18 vs 29 months, P=0.113) and EGFR expression retained prognostic independence when adjusting for histology, stage, grade, and age (EGFR, P=0.0197; HER2, P=0.7855). We conclude that assessment of HER2 gene amplification and/or EGFR expression may help to select type II EC patients who could benefit from therapeutic strategies targeting both HER2 and EGFR.

Spatio-temporal differences in brain oxygenation between movement execution and imagery: a multichannel near-infrared spectroscopy study.

Near-infrared spectroscopy (NIRS) was used to assess human motor-cortex oxygenation changes in response to self-paced movements as well as movement imagery. We used a 24 channel NIRS-system which allows non-invasive monitoring of cerebral oxygenation changes in the human brain induced by cortical activity. From previous studies it is known that motor imagery activates sensorimotor areas similar to those activated during execution of the same movement. Sixteen healthy subjects were recruited and the changes in concentration of oxygenated hemoglobin (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) were examined during a simple right and left hand tapping task and during kinesthetic movement imagery. All subjects showed significant increases in oxy-Hb during both tasks compared to the resting period, but with different onset latencies of oxygenation. During left and right movement imagery, the oxy-Hb concentration increased about 2 s later compared to real movement execution. Furthermore, the oxygenation found was bilaterally represented for both tasks but with temporal differences. The present study reported new results concerning timing and topographical distribution of the hemodynamic response during motor imagery measured by near-infrared spectroscopy.

15 years of BCI research at Graz University of Technology: current projects.

Over the last 15 years, the Graz Brain-Computer Interface (BCI) has been developed and all components such as feature extraction and classification, mode of operation, mental strategy, and type of feedback have been investigated. Recent projects deal with the development of asynchronous BCIs, the presentation of feedback and applications for communication and control.

EEG alpha band dissociation with increasing task demands.

In assuming functional differences between different EEG alpha frequency bands, recent studies emphasize the importance of using narrow (8-10 Hz or 10-12 Hz) instead of broad alpha frequency ranges (8-12 Hz). Due to individual differences in alpha activity, it has also been suggested to adjust alpha frequency bands individually for each participant. The present paper highlights the dissociating role of different task demands on the extent of event-related desynchronization (ERD) in different alpha frequency bands. In analyzing the data of four large-scale EEG studies (with sample sizes of 51, 58, 55, and 66, respectively) employing a wide range of cognitive tasks, we found evidence that the correlations between lower and upper alpha band ERD systematically decline as task demands increase.

Beta rebound after different types of motor imagery in man.

We investigated the behavior of short-lasting beta bursts (beta rebound, beta ERS) induced after imagination of hand, foot or tongue movement. Nine able-bodied subjects were asked to imagine one type of movement following the presentation of a visual cue stimulus. EEG was recorded from 60 closely spaced electrodes placed over frontal, central and parietal areas. Spatiotemporal ERD/ERS patterns were evaluated in form of time-frequency maps. Seven out of nine subjects displayed a significant short-lasting beta power increase (beta rebound) after termination of imagery of movement of both feet in the frequency range of 23-29Hz with a clear maximum at the vertex. In contrast, only two subjects displayed a clear beta rebound at the vertex after imagery of one of the hands, although five exhibited a significant beta rebound at the contralateral side of the head. None showed a beta rebound after tongue motor imagery. The midcentrally located beta rebound is interpreted as an electrophysiological correlate of a simultaneous "resetting" of overlapping neural networks in the foot representation areas and the SMA.

Extraversion and cortical activation during memory performance.

In this study we analyzed the influence of the personality dimension extraversion-introversion (E) on the level and topographical distribution of cortical activation. In 62 participants (32 introverts and 30 extraverts), we measured the extent of Event-Related Desynchronization (ERD) in the EEG during performance of a short-term memory (i.e., temporary maintenance of information) and a more complex working memory task (i.e., temporary maintenance and active manipulation of information). The results indicate that during performance of both tasks, introverts display a larger amount of ERD than extraverted individuals. Moreover, the present E effects largely match previous studies as to the restriction of these effects to lower EEG frequency ranges (approx. 4-8 Hz). Topographical analyses show that the E effects are primarily present over (right-hemispheric) frontal and parietal regions of the cerebral cortex.

Propagation of EEG activity in the beta and gamma band during movement imagery in humans.

OBJECTIVES: The objective of the paper was the determination of electrical brain activity propagation in sensorimotor areas during hand movement imagery. METHODS: Right-hand and left-hand movement imagination was studied in three subjects. The 10-channel Multivariate Autoregressive Model (MVAR) was fitted to EEG signals recorded from subsets of electrodes overlying central and related brain areas. By means of the Short-time Directed Transfer Function (SDTF) the propagation of brain activity as a function of frequency and time was found. RESULTS: During imagery the relation between propagations in gamma and beta bands changed significantly for electrodes overlying sensorimotor areas, namely the increase in gamma was accompanied by the decrease in the beta band. CONCLUSIONS: The hypothesis was put forward that these kinds of changes in flow of electrical brain activity are connected with the specific information processing.

Brain volumetry and self-regulation of brain activity relevant for neurofeedback.

Neurofeedback is a technique to learn to control brain signals by means of real time feedback. In the present study, the individual ability to learn two EEG neurofeedback protocols - sensorimotor rhythm and gamma rhythm - was related to structural properties of the brain. The volumes in the anterior insula bilaterally, left thalamus, right frontal operculum, right putamen, right middle frontal gyrus, and right lingual gyrus predicted the outcomes of sensorimotor rhythm training. Gray matter volumes in the supplementary motor area and left middle frontal gyrus predicted the outcomes of gamma rhythm training. These findings combined with further evidence from the literature are compatible with the existence of a more general self-control network, which through self-referential and self-control processes regulates neurofeedback learning.

Intelligence and working memory systems: evidence of neural efficiency in alpha band ERD.

Starting from the well-established finding that brighter individuals display a more efficient brain function when performing cognitive tasks (i.e., neural efficiency), we investigated the relationship between intelligence and cortical activation in the context of working memory (WM) tasks. Fifty-five male (n=28) and female (n=27) participants worked on (1) a classical forward digit span task demanding only short-term memory (STM), (2) an attention-switching task drawing on the central executive (CE) of WM and (3) a WM task involving both STM storage and CE processes. During performance of these three types of tasks, cortical activation was quantified by the extent of Event-Related Desynchronization (ERD) in the alpha band of the human EEG. Correlational analyses revealed associations between the amount of ERD in the upper alpha band and intelligence in several brain regions. In all tasks, the males were more likely to display the negative intelligence-cortical activation relationship. Furthermore, stronger associations between ERD and intelligence were found for fluid rather than crystallized intelligence. Analyses also point to topographical differences in neural efficiency depending on sex, task type and the associated cognitive subsystems engaged during task performance.

Simultaneous EEG 10 Hz desynchronization and 40 Hz synchronization during finger movements.

Nineteen-channel EEG was recorded with closely spaced electrodes overlaying the left sensorimotor cortex during self-paced, voluntary right finger movements. Three right-handed people served as subjects. The EEG was analysed in the 10 Hz band (10-12 Hz) and in four 40 Hz bands (34-36, 36-38, 38-40, 40-42) by calculation of ERD time courses and ERD maps, whereby a ERD is characterized by a movement-related band power decrease. In all three subjects a close to C3 localized 10 Hz ERD was found, starting about 2 s prior to movement onset and continuing during movement. Along with this 10 Hz ERD a localized and short-lasting (about 0.5 s) burst of 40 Hz oscillations was embedded around movement onset. This can be interpreted as indicating that planning of movement is accompanied by a desynchronization of central mu rhythm and a generation of 40 Hz oscillations.

Evidence for distinct beta resonance frequencies in human EEG related to specific sensorimotor cortical areas.

OBJECTIVE: We studied event-related synchronization (ERS) of beta rhythms related to voluntary movement vs. stimulation of upper and lower limbs. The aim of this study was to investigate whether the frequency of the beta response is related to specific regions within the sensorimotor strip. METHODS: Self-paced movement and electrical stimulation of the dominant hand and foot/leg was investigated in 10 right-handed volunteers. The electroencephalogram was recorded from closely spaced electrodes over central areas and processed time-locked to movement-offset or stimulation. In order to identify the dominant frequency of the induced beta oscillations, time-frequency maps were calculated using the continuous wavelet transformation. For the specific beta frequency bands, the band power time courses were analyzed by quantifying the event-related (de-)synchronization (ERD/ERS). RESULTS: Both limb movement and somatosensory stimulation induced bursts of beta oscillations appearing within 1 s after movement/stimulation with a clear focus close to the corresponding sensorimotor representation area. The peak frequency was significantly lower over the hand area (below approximately 20 Hz) than at mid-central sites overlying the foot representation area (above approximately 20 Hz). But no difference was found between movement and stimulation of the respective limb. CONCLUSIONS: Analyzing the frequency of induced beta activity revealed concomitant oscillations at slightly different frequencies over neighboring cortical areas. These oscillations might be indicative for a resonance-like behavior of connected sub-networks in sensorimotor areas.

Functional dissociation of lower and upper frequency mu rhythms in relation to voluntary limb movement.

OBJECTIVE: The goal of this study is to investigate the reactivity of central rhythms in the alpha band during self-paced voluntary finger and foot movement and to give an answer to the question, whether different types of mu rhythms exist. METHODS: The effect of self-paced, voluntary finger and foot movement was studied in a group of 12 right-handed healthy volunteers. The EEG was recorded from a grid of 34 electrodes placed over sensorimotor areas with inter-electrode distances of approximately 2.5 cm. The event-related desynchronization (ERD) was quantified in the 8-10 and 10-12 Hz bands. RESULTS: Both frequency components are blocked prior to and during movement and therefore, they have to be considered as mu rhythms. The lower frequency component results in a widespread movement-type non-specific ERD pattern, whereas the upper frequency component shows a more focused and movement-type specific pattern, clearly different with finger and foot movement. CONCLUSIONS: The distinct reactivity patterns provide evidence for the existence of two types of mu rhythms, a somatotopically non-specific lower frequency mu rhythm and a somatotopically specific mu rhythm characteristically found in the upper alpha frequency band.

Clinical application of an EEG-based brain-computer interface: a case study in a patient with severe motor impairment.

OBJECTIVE: This case study describes how a completely paralyzed patient, diagnosed with severe cerebral palsy, was trained over a period of several months to use an electroencephalography (EEG)-based brain-computer interface (BCI) for verbal communication. METHODS: EEG feedback training was performed in the patient's home (clinic), supervised from a distant laboratory with the help of a 'telemonitoring system'. Online feedback computation was based on single-trial analysis and classification of specific band power features of the spontaneous EEG. Task-related changes in brain oscillations over the course of training steps was investigated by quantifying time-frequency maps of event-related (de-)synchronization (ERD/ERS). RESULTS: The patient learned to 'produce' two distinct EEG patterns, beta band ERD during movement imagery vs. no ERD during relaxing, and to use this for BCI-controlled spelling. Significant learning progress was found as a function of training session, resulting in an average accuracy level of 70% (correct responses) for letter selection. 'Copy spelling' was performed with a rate of approximately one letter per min. CONCLUSIONS: The proposed BCI training procedure, based on electroencephalogram (EEG) biofeedback and concomitant adaptation of feature extraction and classification, may improve actual levels of communication ability in locked-in patients. 'Telemonitoring-assisted' BCI training facilitates clinical application in a larger number of patients.

Event-related synchronization of mu rhythm in the EEG over the cortical hand area in man.

Spontaneous EEG activity was recorded at 56 electrodes in 3 healthy subjects. All subjects displayed event-related desynchronization (ERD) of mu rhythms over the cortical hand area during discrete finger movement. In contrast to this, foot movement resulted in an enhancement or event-related synchronization (ERS) of mu rhythms over the hand area. This phasic synchronization of mu waves was circumscribed and found at electrodes overlying both cortical hand areas. It is speculated, that this ERS represents a short lasting 'idling state' of hand area neurons when other body parts are moved.

Post-movement synchronization of beta rhythms in the EEG over the cortical foot area in man.

Post-movement synchronization of the electroencephalogram (EEG) was studied in nine right-handed subjects who performed voluntary self-paced dorsal flexions with the right and left foot. The findings revealed that foot movement results in enhanced beta oscillations after movement. These beta bursts showed subject-specific resonance frequencies in the range between 12 and 32 Hz and were localized to electrode Cz and to one electrode 2.5 cm more anterior. Comparison of left and right foot movement revealed a larger post-movement beta synchronization (PMBS) with left foot movement, but no differences concerning the topographical distribution of the PMBS.

Motor imagery activates primary sensorimotor area in humans.

The spatiotemporal patterns of Rolandic mu and beta rhythms were studied during motor imagery with a dense array of EEG electrodes. The subjects were instructed to imagine movements of either the right or the left hand, corresponding to visual stimuli on a computer screen. It was found that unilateral motor imagery results in a short-lasting and localized EEG change over the primary sensorimotor area. The Rolandic rhythms displayed an event-related desynchronization (ERD) only over the contralateral hemisphere. In two of the three investigated subjects, an enhanced Rolandic rhythm was found over the ipsilateral side. The pattern of EEG desynchronization related to imagination of a movement was similar to the pattern during planning of a voluntary movement.

40-Hz oscillations during motor behavior in man.

40-Hz oscillations were measured during finger, toe and tongue movement using an electrode array of 56 electrodes over the pre and post central areas. Each movement was made 150 times in intervals of 12 s. The average power increase in narrow frequency bands between 8 and 40 Hz was then calculated and the topographical distribution studied. 40-Hz oscillations were only found contralateral over the hand area for finger movements, close to the vertex for toe movements and bilateral symmetrical for tongue movements. The maxima of the 40-Hz oscillations occurred before movement onset.

Visualization of sensorimotor areas involved in preparation for hand movement based on classification of mu and central beta rhythms in single EEG trials in man.

It is well known that mu and central beta rhythms start to desynchronize > 1 s before active hand or finger movement. To investigate whether the same cortical areas are involved in desynchronization of mu and central beta rhythms, 56-channel EEG recordings were made during right- and left-finger flexions in three normal subjects. The event-related desynchronization (ERD) was quantified in single EEG trials and classified by the Distinction Sensitive Learning Vector Quantization (DSLVQ) algorithm. This DSLVQ selects the most relevant features (electrode positions) for discrimination between the preparatory state for left- and right-finger movements. It was found that the most important electrode positions were close to the primary hand area. However, in all three subjects the focus of the central beta ERD was slightly anterior to the focus of mu desynchronization. This can be interpreted that different neural networks are involved in the generation of mu and central beta rhythms.