Background: Chronic headache following traumatic brain injury(TBI) sustained in military service, while common, is highly challenging to treat with existing pharmacologic and non-pharmacologic interventions, and it ma...Background: Chronic headache following traumatic brain injury(TBI) sustained in military service, while common, is highly challenging to treat with existing pharmacologic and non-pharmacologic interventions, and it may be complicated by co-morbid posttraumatic stress. Recently, a novel form of brainwave-based intervention known as the Flexyx Neurotherapy System(FNS), which involves minute pulses of electromagnetic energy stimulation of brainwave activity, has been suggested as a means to address symptoms of TBI. This study reports on a clinical series of patients with chronic headache following service-connected TBI treated with FNS.Methods: Nine veterans of the wars in Afghanistan and Iraq with moderate to severe chronic headaches following service-connected TBI complicated by posttraumatic stress symptoms were treated in 20 individual FNS sessions at the Brain Wellness and Biofeedback Center of Washington(in Bethesda, Maryland, USA). They periodically completed measures including the Brief Pain Inventory-Headache(BPI-HA), previous week worst and average pain ratings, the Posttraumatic Stress Disorder Checklist-Military version(PCL-M), and an individual treatment session numerical rating scale(NRS) for the degree of cognitive dysfunction. Data analyses included beginning-to-end of treatment t-test comparisons for the BPI-HA, PCL-M, and cognitive dysfunction NRS. Results: All beginning-to-end of treatment t-test comparisons for the BPI-HA, PCL-M, and cognitive dysfunction NRS indicated statistically significant decreases. All but one participant experienced a reduction in headaches along with reductions in posttraumatic stress and perceived cognitive dysfunction, with a subset experiencing the virtual elimination of headaches. One participant obtained modest headache relief but no improvements in posttraumatic stress or cognitive dysfunction. Conclusions: FNS may be a potentially efficacious treatment for chronic posttraumatic headache sustained in military service. Further research is needed to investigate the efficacy of FNS within a randomized, controlled clinical trial to identify the characteristics of those most likely to respond and to explore underlying mechanisms that may contribute to improvements.展开更多
BACKGROUND Chronic insomnia affects about 6%-13% of the Canadian population.Although treatments already exist,they each have their own issues.Neurofeedback is a neuromodulation technique that specifically targets abno...BACKGROUND Chronic insomnia affects about 6%-13% of the Canadian population.Although treatments already exist,they each have their own issues.Neurofeedback is a neuromodulation technique that specifically targets abnormal brain activity and is gaining attention as a possible insomnia treatment.AIM To review the latest studies pertaining to the use of neurofeedback in the treatment of insomnia.METHODS In this non-systematic review,only experimental studies assessing the effects of neurofeedback on patients with insomnia were targeted across four bibliographic databases.RESULTS A total of 12 studies were retained.All neurofeedback studies included in this study showed a clear improvement of subjective sleep.However,data concerning objective improvement are contradictory.Most studies regarding surface and zscore neurofeedback show that neurofeedback targeting the sensorimotor rhythm in the sensorimotor cortex may help improve subjective sleep.A placebo effect seems also to be present in some studies.Several limitations were present in each study.CONCLUSION While studies concerning neurofeedback as a treatment for insomnia are encouraging,many methodological barriers remain to be resolved to prove its efficacy unequivocally.More studies using robust design parameters,as well as the replication of existing studies,are necessary to support neurofeedback as an effective treatment for insomnia.展开更多
Programmed cell death protein 1(PD-1)is an immune checkpoint modulator and a major target of immunotherapy as anti-PD-1 monoclonal antibodies have demonstrated remarkable efficacy in cancer treatment.Accumulating evid...Programmed cell death protein 1(PD-1)is an immune checkpoint modulator and a major target of immunotherapy as anti-PD-1 monoclonal antibodies have demonstrated remarkable efficacy in cancer treatment.Accumulating evidence suggests an important role of PD-1 in the central nervous system(CNS).PD-1 has been implicated in CNS disorders such as brain tumors,Alzheimer’s disease,ischemic stroke,spinal cord injury,multiple sclerosis,cognitive function,and pain.PD-1 signaling suppresses the CNS immune response via resident microglia and infiltrating peripheral immune cells.Notably,PD-1 is also widely expressed in neurons and suppresses neuronal activity via downstream Src homology 2 domain-containing protein tyrosine phosphatase 1 and modulation of ion channel function.An improved understanding of PD-1 signaling in the cross-talk between glial cells,neurons,and peripheral immune cells in the CNS will shed light on immunomodulation,neuromodulation,and novel strategies for treating brain diseases.展开更多
文摘Background: Chronic headache following traumatic brain injury(TBI) sustained in military service, while common, is highly challenging to treat with existing pharmacologic and non-pharmacologic interventions, and it may be complicated by co-morbid posttraumatic stress. Recently, a novel form of brainwave-based intervention known as the Flexyx Neurotherapy System(FNS), which involves minute pulses of electromagnetic energy stimulation of brainwave activity, has been suggested as a means to address symptoms of TBI. This study reports on a clinical series of patients with chronic headache following service-connected TBI treated with FNS.Methods: Nine veterans of the wars in Afghanistan and Iraq with moderate to severe chronic headaches following service-connected TBI complicated by posttraumatic stress symptoms were treated in 20 individual FNS sessions at the Brain Wellness and Biofeedback Center of Washington(in Bethesda, Maryland, USA). They periodically completed measures including the Brief Pain Inventory-Headache(BPI-HA), previous week worst and average pain ratings, the Posttraumatic Stress Disorder Checklist-Military version(PCL-M), and an individual treatment session numerical rating scale(NRS) for the degree of cognitive dysfunction. Data analyses included beginning-to-end of treatment t-test comparisons for the BPI-HA, PCL-M, and cognitive dysfunction NRS. Results: All beginning-to-end of treatment t-test comparisons for the BPI-HA, PCL-M, and cognitive dysfunction NRS indicated statistically significant decreases. All but one participant experienced a reduction in headaches along with reductions in posttraumatic stress and perceived cognitive dysfunction, with a subset experiencing the virtual elimination of headaches. One participant obtained modest headache relief but no improvements in posttraumatic stress or cognitive dysfunction. Conclusions: FNS may be a potentially efficacious treatment for chronic posttraumatic headache sustained in military service. Further research is needed to investigate the efficacy of FNS within a randomized, controlled clinical trial to identify the characteristics of those most likely to respond and to explore underlying mechanisms that may contribute to improvements.
文摘BACKGROUND Chronic insomnia affects about 6%-13% of the Canadian population.Although treatments already exist,they each have their own issues.Neurofeedback is a neuromodulation technique that specifically targets abnormal brain activity and is gaining attention as a possible insomnia treatment.AIM To review the latest studies pertaining to the use of neurofeedback in the treatment of insomnia.METHODS In this non-systematic review,only experimental studies assessing the effects of neurofeedback on patients with insomnia were targeted across four bibliographic databases.RESULTS A total of 12 studies were retained.All neurofeedback studies included in this study showed a clear improvement of subjective sleep.However,data concerning objective improvement are contradictory.Most studies regarding surface and zscore neurofeedback show that neurofeedback targeting the sensorimotor rhythm in the sensorimotor cortex may help improve subjective sleep.A placebo effect seems also to be present in some studies.Several limitations were present in each study.CONCLUSION While studies concerning neurofeedback as a treatment for insomnia are encouraging,many methodological barriers remain to be resolved to prove its efficacy unequivocally.More studies using robust design parameters,as well as the replication of existing studies,are necessary to support neurofeedback as an effective treatment for insomnia.
基金The work related to this review was partially supported by Duke University Fund.
文摘Programmed cell death protein 1(PD-1)is an immune checkpoint modulator and a major target of immunotherapy as anti-PD-1 monoclonal antibodies have demonstrated remarkable efficacy in cancer treatment.Accumulating evidence suggests an important role of PD-1 in the central nervous system(CNS).PD-1 has been implicated in CNS disorders such as brain tumors,Alzheimer’s disease,ischemic stroke,spinal cord injury,multiple sclerosis,cognitive function,and pain.PD-1 signaling suppresses the CNS immune response via resident microglia and infiltrating peripheral immune cells.Notably,PD-1 is also widely expressed in neurons and suppresses neuronal activity via downstream Src homology 2 domain-containing protein tyrosine phosphatase 1 and modulation of ion channel function.An improved understanding of PD-1 signaling in the cross-talk between glial cells,neurons,and peripheral immune cells in the CNS will shed light on immunomodulation,neuromodulation,and novel strategies for treating brain diseases.
