Brain mapping inflammatory-arthritis-related fatigue in the pursuit of novel therapeutics.

Despite developments in pharmacological treatments, chronic fatigue is an unresolved issue for most people with inflammatory arthritis that severely disrupts their personal and working lives. Fatigue in these patients is not strongly linked with peripheral disease activity but is associated with CNS-derived symptoms such as chronic pain, sleep disturbance, and depression. Therefore, a neurobiological basis should be considered when pursuing novel fatigue-specific therapeutics. In this Review, we focus on clinical imaging biomarkers that map candidate brain regions and are crucial in fatigue pathophysiology. We then evaluate neuromodulation techniques that could affect these candidate brain regions and are potential treatment strategies for fatigue in patients with inflammatory arthritis. We delineate work that is still required for neuroimaging and neuromodulation to eventually become part of a clinical pathway to treat and manage fatigue.

Using Real-Time fMRI Neurofeedback to Modulate M1-Cerebellum Connectivity.

Objective: The potential of neurofeedback to alter the M1-cerebellum connectivity was explored using motor imagery-based rt-fMRI. These regions were chosen due to their importance in motor performance and motor rehabilitation. Methods: Four right-handed individuals were recruited to examine the potential to change the M1-cerebellum neurofeedback link. The University of Glasgow Cognitive Neuroimaging Centre used a 3T MRI scanner from January 2019 to January 2020 to conduct this prospective study. Everyone participated in each fMRI session, which included six NF training runs. Participants were instructed to imagine complicated hand motions during the NF training to raise a thermometer bar's height. To contrast the correlation coefficients between the initial and last NF runs, a t-test was performed post hoc. Results: The neurofeedback connection between M1 and the cerebellum was strengthened in each participant. Motor imagery strategy was a significant task in training M1-cerebellum connectivity as participants used it successfully to enhance the activation level between these regions during M1-cerebellum modulation using real-time fMRI. The t-test and linear regression, on the other hand, showed this increase to be insignificant. Conclusion: A novel technique to manipulate M1-cerebellum connectivity was discovered using real-time fMRI NF. This study showed that each participant's neurofeedback connectivity between M1 and cerebellum was enhanced. This increase, on the other hand, was insignificant statistically. The results showed that the connectivity between both areas increased positively. Through the integration of fMRI and neurofeedback, M1-cerebellum connectivity can be positively affected.

Upregulation of Supplementary Motor Area Activation with fMRI Neurofeedback during Motor Imagery.

Functional magnetic resonance imaging (fMRI) neurofeedback (NF) is a promising tool to study the relationship between behavior and brain activity. It enables people to self-regulate their brain signal. Here, we applied fMRI NF to train healthy participants to increase activity in their supplementary motor area (SMA) during a motor imagery (MI) task of complex body movements while they received a continuous visual feedback signal. This signal represented the activity of participants' localized SMA regions in the NF group and a prerecorded signal in the control group (sham feedback). In the NF group only, results showed a gradual increase in SMA-related activity across runs. This upregulation was largely restricted to the SMA, while other regions of the motor network showed no, or only marginal NF effects. In addition, we found behavioral changes, i.e., shorter reaction times in a Go/No-go task after the NF training only. These results suggest that NF can assist participants to develop greater control over a specifically targeted motor region involved in motor skill learning. The results contribute to a better understanding of the underlying mechanisms of SMA NF based on MI with a direct implication for rehabilitation of motor dysfunctions.

Empathy to emotional voices and the use of real-time fMRI to enhance activation of the anterior insula.

The right anterior insula (AI), known to have a key role in the processing and understanding of social emotions, is activated during tasks that involve the act of empathising. Neurofeedback provides individuals with a visualisation of their own brain activity, enabling them to regulate and modify this activity. Following previous research investigating the ability of individuals to up-regulate right AI activity levels through neurofeedback, we investigated whether this could be similarly accomplished during an empathy task involving auditory stimuli of human positive and negative emotional expressions. Twenty participants, ten with feedback from right anterior insula and ten with feedback from a sham brain region, participated in two sessions that included sixteen neurofeedback runs and four transfer runs. Results showed that for the second session participants in the right AI neurofeedback group demonstrated better ability to up-regulate their right AI compared to the control group who received sham feedback. Examination of the relationship between individual participants' empathic traits and their ability to up-regulate right AI activity showed that participants low on empathic traits produced a greater increase in activation of right AI by the end of training. Moreover, the response to positively valenced audio stimuli was greater than for negatively valenced stimuli. These results have implications for therapeutic training of empathy in populations with limited empathic response.