personalized medicine
Research Papers
Resting state functional connectivity predicts neurofeedback response
Tailoring treatments to the specific needs and biology of individual patients—personalized medicine—requires delineation of reliable predictors of response. Unfortunately, these have been slow to emerge, especially in neuropsychiatric disorders. We have recently described a real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback protocol that can reduce contamination-related anxiety, a prominent symptom of many cases of obsessive-compulsive disorder (OCD). Individual response to this intervention is variable. Here we used patterns of brain functional connectivity, as measured by baseline resting-state fMRI (rs-fMRI), to predict improvements in contamination anxiety after neurofeedback training. Activity of a region of the orbitofrontal cortex (OFC) and anterior prefrontal cortex, Brodmann area (BA) 10, associated with contamination anxiety in each subject was measured in real time and presented as a neurofeedback signal, permitting subjects to learn to modulate this target brain region. We have previously reported both enhanced OFC/BA 10 control and improved anxiety in a group of subclinically anxious subjects after neurofeedback. Five individuals with contamination-related OCD who underwent the same protocol also showed improved clinical symptomatology. In both groups, these behavioral improvements were strongly correlated with baseline whole-brain connectivity in the OFC/BA 10, computed from rs-fMRI collected several days prior to neurofeedback training. These pilot data suggest that rs-fMRI can be used to identify individuals likely to benefit from rt-fMRI neurofeedback training to control contamination anxiety
View Full Paper →EEG-Based Personalized Medicine in ADHD: Individual Alpha Peak Frequency as an Endophenotype Associated with Nonresponse
This review article summarizes some recent developments in psychiatry such as personalized medicine, employing biomarkers and endophenotypes, and developments collectively referred to as neuromodulation with a focus on ADHD. Several neurophysiological subtypes in ADHD and their relation to treatment outcome are reviewed. In older research the existence of an "abnormal EEG" or "paroxysmal EEG" was often reported, most likely explained by the high occurrence of this EEG subtype in autism, as the diagnosis of autism was not coined until 1980. This subgroup might respond best to anticonvulsant treatments, which requires more specific research. A second subgroup is a beta-excess or beta-spindling subgroup. This group responds well to stimulant medication, albeit several studies suggesting that neurophysiologically this might represent a different subgroup. The third subgroup consists of the "impaired vigilance" subgroup with the often-reported excess frontal theta or excess frontal alpha. This subgroup responds well to stimulant medication. Finally, it is proposed that a slow individual alpha peak frequency is an endophenotype related to treatment resistance in ADHD. Future studies should incorporate this endophenotype in clinical trials to further investigate new treatments for this substantial subgroup of patients, such as NIRS-biofeedback, transcranial Doppler sonography biofeedback, hyperbaric oxygen therapy, or medications such as nicotine and piracetam
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