Connectivity based Real-Time fMRI Neurofeedback Training in Youth with a History of Major Depressive Disorder.

BACKGROUND: Real-time functional magnetic resonance imaging neurofeedback (rtfMRI-nf) has proven to be a powerful technique to help subjects to gauge and enhance emotional control. Traditionally, rtfMRI-nf has focused on emotional regulation through self-regulation of amygdala. Recently, rtfMRI studies have observed that regulation of a target brain region is accompanied by connectivity changes beyond the target region. Therefore, the aim of present study is to investigate the use of connectivity between amygdala and prefrontal regions as the target of neurofeedback training in healthy individuals and subjects with a life-time history of major depressive disorder (MDD) performing an emotion regulation task. METHOD: Ten remitted MDD subjects and twelve healthy controls (HC) performed an emotion regulation task in 4 runs of rtfMRI-nf training followed by one transfer run without neurofeedback conducted in a single session. The functional connectivity between amygdala and prefrontal cortex was presented as a feedback bar concurrent with the emotion regulation task. Participants' emotional state was measured by the Positive and Negative Affect Schedule (PANAS) prior to and following the rtfMRI-nf. Psychological assessments were used to determine subjects' history of depression. RESULTS: Participants with a history of MDD showed a trend of decreasing functional connectivity across the four rtfMRI-nf runs, and there was a marginally significant interaction between the MDD history and number of training runs. The HC group showed a significant increase of frontal cortex activation between the second and third neurofeedback runs. Comparing PANAS scores before and after connectivity-based rtfMRI-nf, we observed a significant decrease in negative PANAS score in the whole group overall, and a significant decrease in positive PANAS score in the MDD group alone.

Parental Occupational Exposure is Associated With Their Children's Psychopathology: A Study of Families of Israeli First Responders.

OBJECTIVE: To examine the association between parental occupational exposure to traumatic events and their children's mental health in families of First Responders (FRs), a neglected area of research. METHODS: In 208 families of Israeli FRs, children's symptoms and comorbidity patterns of seven psychiatric disorders were regressed on parental work-related variables, controlling for relevant covariates. RESULTS: Having a father working as a FR and higher paternal exposure were associated with a greater number of separation anxiety and posttraumatic stress symptoms, respectively. Maternal exposure was associated with a greater number of symptoms of generalized anxiety, panic disorder, depression, and oppositional defiant disorder, and with increased odds of comorbid internalizing symptomatology. CONCLUSIONS: Additional research on children of FRs is encouraged. An adaption to this understudied population of family-centered interventions available for military families could inform targeted prevention efforts.

A case of locked-in syndrome complicated by central deafness.

BACKGROUND: A 53-year-old male with a history of hypertension, diabetes mellitus, and factor V deficiency presented to an emergency room with progressively increasing headache, slurred speech, and left upper extremity weakness. Over the previous 3 months, he had been receiving warfarin for prophylaxis of deep venous thrombosis following knee surgery. After presentation and an initial period of coma, he became tetraplegic and anarthric, requiring intubation and ventilatory assistance. INVESTIGATIONS: Neurological examination, CT scan, electroencephalogram, brainstem auditory and visual evoked potential studies, neuropsychological assessment and functional MRI studies. DIAGNOSIS: Locked-in syndrome following ventral pontine hemorrhage, complicated by central deafness secondary to extension of the lesion to the inferior colliculus. MANAGEMENT: Development of an augmentative communication system designed to exploit the patient's preserved cognitive and motor functions.

Residual cerebral activity and behavioural fragments can remain in the persistently vegetative brain.

This report identifies evidence of partially functional cerebral regions in catastrophically injured brains. To study five patients in a persistent vegetative state (PVS) with different behavioural features, we employed [(18)F]fluorodeoxyglucose-positron emission tomography (FDG-PET), MRI and magnetoencephalographic (MEG) responses to sensory stimulation. Each patient's brain expressed a unique metabolic pattern. In three of the five patients, co-registered PET/MRI correlate islands of relatively preserved brain metabolism with isolated fragments of behaviour. Two patients had suffered anoxic injuries and demonstrated marked decreases in overall cerebral metabolism to 30-40% of normal. Two other patients with non-anoxic, multifocal brain injuries demonstrated several isolated brain regions with relatively higher metabolic rates, that ranged up to 50-80% of normal. Nevertheless, their global metabolic rates remained <50% of normal. MEG recordings from three PVS patients provide clear evidence for the absence, abnormality or reduction of evoked responses. Despite major abnormalities, however, these data also provide evidence for localized residual activity at the cortical level. Each patient partially preserved restricted sensory representations, as evidenced by slow evoked magnetic fields and gamma band activity. In two patients, these activations correlate with isolated behavioural patterns and metabolic activity. Remaining active regions identified in the three PVS patients with behavioural fragments appear to consist of segregated corticothalamic networks that retain connectivity and partial functional integrity. A single patient who suffered severe injury to the tegmental mesencephalon and paramedian thalamus showed widely preserved cortical metabolism, and a global average metabolic rate of 65% of normal. The relatively high preservation of cortical metabolism in this patient defines the first functional correlate of clinical- pathological reports associating permanent unconsciousness with structural damage to these regions. The specific patterns of preserved metabolic activity identified in these patients do not appear to represent random survivals of a few neuronal islands; rather they reflect novel evidence of the modular nature of individual functional networks that underlie conscious brain function. The variations in cerebral metabolism in chronic PVS patients indicate that some cerebral regions can retain partial function in catastrophically injured brains.