WFA Neuromodulation 2021

D, although virtually I will tell you about neuromodulation and

HD. So I will tell you about the last the

bio markets we and others found over the last three

decades. And if my which have then been used as

targets for neuromodulation in the form of neurofeedback or brain

simulation, these are my disclosures in terms of brain function

deficits. We know that we have done several meta analysis,

especially it's three of cognitive control, where we have replicated

the key finding that the right in front frontal cortex

is reduced in a.

D. C.

Compared with the basal ganglia and the last meta analysis,

we have more than 1000 HD patients.

We also find that doing attention functions that right there

was a lot of prefrontal cortex reduced inactivation compared to

controls, and this is also seen bilaterally doing working memory.

And we see that from the cerebral A regions are

reduced on activation during timing functions.

Now, if you focus on the blue regions here, this

is the posterior part of the default mode network.

There is evidence that a D C.

Patients have enhanced activation and the default mode network, which

reflects mind wandering, and there is evidence for more mind

wandering at the behavior level at the cognitive level, which

leads to attention lapses in cognitive performance.

And there is evidence for reduced antique relation between towns,

relevant networks in this lateral regions and the midline, the

formal network.

And this has been shown to be an expression of

delayed moderation.

So the brain abnormalities and HD the functional levels are

complex and evolve networks, not just regions like several domain

specific from the tribal networks and abnormally enhanced activation of

the default mode network.

However, for neuromodulation a day have focused more on the

frontal parts of those networks, which are the easiest to

modulate, especially with stimulation like the infra frontal cortex that

those are a lot of prefrontal cortex and the total

interest single it so that there's a lot of prefrontal

cortex just to reiterate has been found especially to be

under activated in meta analysis of tension and of working

memory. Uh, the infant frontal politics already said, is the

most replicated finding.

We found it in three meta analysis, the last one

in more than 1000 patients.

But we also found this area that we disorder specifically

reduced in 18 patients compared to people with autism and

Old City.

Furthermore, this is a cognitive control hub region.

This region is under activated.

Uh, this region is responsible not just for inhibition but

also for sustained attention.

It's part of the eventual attention network.

It's also important for timing this evidence that timing and

cognitive control overlap in the in the in that immediate

by the right and the frontal cortex.

Furthermore, if you found that stimulant medication significantly enhances the

activity of the right and prefrontal cortex, both of the

single doors and after chronic administration.

And of course, if you target this area, we could

potentially argue that we would mimic the stimulant effects, but

without the side effects.

Now the stimulus medication is, of course, one of the

best drugs we have in psychiatry.

70% of patients respond to stimulants, but their limitations and

that they have side effects and long term efficacy has

not been demonstrated.

An observational studies and meta analysis, and this may be

due to the fact that the brain adapts to stimulants,

which is what we found in a pet meta analysis.

Now, narrow therapies could have a potential in that they're

more targeted.

They're based on the last three decades of brain imaging

research. They have minimal and transient side effects, and they

have longer term nor a plastic effects which drugs don't

have. So the three, um, ways we can modify this

area. We can teach people to self regulate certain regions

in the brain, and we can also do that in

the cortical areas with FM on your feedback or in

cortical errors with near zero feedback.

A more passive way is to stimulate these areas with

TMS, for example, of T.

D. C s and it's it's more passive.

But if you combine it with cognitive training, it could

be half active, half passive and a recent methods at

TNS Triggerman and our stimulation has shown to indirectly lead

to increase of activation in the brain stem, which leads

to from total atomic increase, Um, which is more like

a bottom up indirect increase of front thalamic regions.

So it was FMI Nora feedback with your feedback.

In general, there are several imaging methods which could be

used each in your feedback has been used for 45

years near Sonora.

Feedback has been shown so far in one study and

FM mine of feedback and two studies and no studies

have used energy, although that could also potentially be used.

Non fmr enough, he begged.

The child is asked to enhance activity with brain, and

he does it in there, um, with trial and error.

So every time he enhances activity of this region, Um,

this is directly translated in real time to a computer

game when something happens on the computer games.

So he gets direct visual feedback of his activation in

the brain, and he learns by basically opera and conditioning

that's called the neural feedback loop.

So every time he enhances activities region and something happens

on the video game, the child would do it again.

Um, now, EG.

Nor fitting, as I said, has been around for about

45 years.

The latest meta analysis show very small effects, though, compared

to non active control groups and inferior effect compared to

stimulants now.

Mm. I know feedback has the advantage that it has

a better special resolution.

And the, uh, learning is faster.

It seems that have a dynamic.

Feedback is faster than electrical.

If he did from electrical activity and it can, of

course, also target deeper areas with in the case of

fMRI, Or you could look at whole brain effects of

neurofeedback. There's one pilot study which has been used as

we used the listener feedback of bilateral.

There's a lot of prefrontal cortex in a D.

C. Children was very small, but they found no significant

effect, um, not differential effect of nears over E g

or E M.

G Nora feedback.

But there was some indication that the nearest group improved

in symptoms where the other groups only improved at the

trend level.

Um, there is a larger study currently underway to see

whether this can be replicated in a larger number.

The first FMI nor feedback study was done by the

group of young, beautiful and adults with a PhD, and

they tested, um, again 12 rounds of across four scans.

People had to enhance, uh, to do a mental calculation

task with them without neural feedback of the total into

a single eight, and there was no goodbye time interaction

effect. But the Nurofen group showed better cognition and sustained

attention and working memory, so there was some indication of

better cognitive effects, please.

Now we did the proof of concept study of FM,

mine and feedback and other lessons with the A d

h d, which was done by an loc Alegria.

And, uh, we tested 31 HD other lessons who had

to aid enhance the writing prefrontal cortex of the left

para hippocampal gyrus.

And then we looked at a series of outcomes.

Uh, we used the rocketeer a rocket in the original

study, but I show you the current study where we

use the rocketeer, which is a bit more interesting.

So every time the Children enhance activity or the right

frontal cortex, um, the rocket take us out.

So we found that H D um mhm.

WFA Neuromodulation 2021

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