Anton Coenen

Efficacy of Neurofeedback Treatment in ADHD: the Effects on Inattention, Impulsivity and Hyperactivity: a Meta-Analysis

Since the first reports of neurofeedback treatment in Attention Deficit Hyperactivity Disorder (ADHD) in 1976, many studies have investigated the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear. In this study selected research on neurofeedback treatment for ADHD was collected and a meta-analysis was performed. Both prospective controlled studies and studies employing a pre-and post-design found large effect sizes (ES) for neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to nonspecific treatment factors. Due to the inclusion of some very recent and sound methodological studies in this meta-analysis, potential confounding factors such as small studies, lack of randomization in previous studies and a lack of adequate control groups have been addressed, and the clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered “Efficacious and Specific” (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.

Melatonin for chronic sleep onset insomnia in children: a randomized placebo-controlled trial.

To establish the efficacy of melatonin treatment in childhood sleep onset insomnia, 40 elementary school children, 6 to 12 years of age, who suffered more than 1 year from chronic sleep onset insomnia, were studied in a double-blind, placebo-controlled study. The children were randomly assigned to receive either 5-mg melatonin or placebo. The study consisted of a 1-week baseline, consecutively followed by a 4-week treatment period. After that period, treatment was continued if the parents wished so. The studys impact was assessed by measurements of lights-off time, sleep onset, and wake-up time, recorded in a diary (n = 33). Sleep onset was also recorded with an actigraph (n = 25). Endogenous dim light melatonin onset was measured in saliva (n = 27). Sustained attention was evaluated with the Bourdon-Vos reaction time test (n = 36). In the melatonin group, mean (95% CI) lights-off time advanced 34 (6-63) minutes, diary sleep onset 63 (32-94) minutes, actigraphic sleep onset 75 (36-114) minutes, and melatonin onset 57 (24 to 89) minutes; total sleep time increased 41 (19-62) minutes. In the placebo group, these parameters did not shift significantly. The change during the 4-week treatment period differed between the treatment groups significantly as to lights-off time, diary and actigraphic sleep onset, sleep duration, and melatonin onset. There were no significant differences between the treatment groups in the change of sleep latency, wake-up time, and sustained attention reaction times. Mild headache occurred in 2 children during the first 2 days of the melatonin treatment. Eighteen months after the start of the trial, in 13 of the 38 children who could be followed up, melatonin treatment was stopped because their sleep problem was solved and in 1 child because sleep was not improved. Twelve children used melatonin 5 mg, the other 1.0 to 2.5 mg. One child developed mild generalized epilepsy 4 months after the start of the trial. The results show that melatonin, 5 mg at 6 PM, was relatively safe to take in the short term and significantly more effective than placebo in advancing sleep onset and dim light melatonin onset and increasing sleep duration in elementary school children with chronic sleep onset insomnia. Sustained attention was not affected. (J Child Neurol 2001;16:86-92).

Thalamic multiple-unit activity underlying spike-wave discharges in anesthetized rats

In epilept WAG/Rij rats, multiple unit activity coinciding with the occurrence of spike-wave discharges was recorded under neurolept anesthesia. Recordings were made in the frontal cortex and in various nuclei of the thalamus, in specific nuclei such as the ventroposterolateral, the ventroposteromedial and the ventrolateral nuclei, as well as in non-specific nuclei such as the mediodorsal nucleus, the reticular thalamic nucleus, the interanteromedial nucleus and the intralaminar nuclei (the central medial nucleus, the centrolateral nucleus and the paracentral nucleus). Rhythmic unit firing concurrent with the spike component of the cortical spike-wave discharge was observed in deep layers of the cortex and in the following thalamic nuclei: in specific nuclei, the mediodorsal and the reticular thalamic nucleus. The activity in the specific nuclei and the mediodorsal nucleus shortly preceded the peak of the spike component. The burst in the reticular thalamic nucleus occurred later than in the specific nuclei. A wave-concurrent firing pattern was observed in the centrolateral nucleus and the paracentral nucleus. Cells in the central medial nucleus and interanteromedial nucleus did not fire in a phase-locked manner. Neurons in the latter nucleus, however, were generally tonically activated during the occurrence of spike-wave discharges. It is suggested that those thalamic nucleic thought to be involved in the production of cortical spindles, and that also fire concurrently with the spike component of the spike-wave discharges, are mediated in the genesis of the latter activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of GABA-ergic agents on spontaneous non-convulsive epilepsy, EEG and behaviour, in the WAG/Rij inbred strain of rats

The effects of GABAergic agents on non-convulsive epilepsy were studied by intracerebroventricular injections of muscimol and bicuculline in WAG/Rij rats. The WAG/Rij rat strain is recognized as an animal model for human absence epilepsy. EEG registrations and behavioural observations showed that muscimol dose-dependently increased the non-convulsive absence epilepsy. Besides this, it induced EEG spikes and body twitches. Bicuculline induced spikes and body twitches as well but decreased the non-convulsive epilepsy. All effects of muscimol can be blocked by bicuculline and vice versa, which suggests that the observed effects are genuine GABAA effects. These results implicate that non-convulsive epilepsy can be caused by a GABAergic hyperfunction.

Effects of diazepam and zolpidem on EEG beta frequencies are behavior-specific in rats.

A pharmacological dissociation of the relation between electroencephalographic (EEG) activity and behavior has been described for the benzodiazepines. While a decrease in high frequency EEG activity is associated with a decrease in arousal in drug-free conditions, sedative benzodiazepines increase beta activity. Non-benzodiazepine GABA(A) receptor modulators can increase beta activity as well. To further study the relationship between rat behavior and EEG under GABA(A) receptor modulation, EEG effects of diazepam (2.5 mg/kg) and zolpidem (2.5 mg/kg) were studied during different behaviors. Both drugs modulate the GABA(A) receptor, albeit that zolpidem shows alpha(1) subunit selectivity while diazepam is non-selective. A detailed analysis of rat open field behavior was made with a distinction of 25 behavioral elements. The EEG was segmented according to each behavioral element and a corresponding power spectrum calculated. Both diazepam and zolpidem increased EEG beta frequencies, characteristic for the benzodiazepines. However, the beta and gamma increase was specific for active behavior and not for inactivity. Interestingly, diazepam and zolpidem seemed to amplify, rather than dissociate, the relation between behavior and the EEG. It is hypothesized that the large increase in beta-3/gamma activity caused by diazepam and zolpidem is a compensatory mechanism that allows for behavioral activation, despite pharmacologically induced sedation.

Thalamic lesions in a genetic rat model of absence epilepsy: dissociation between spike-wave discharges and sleep spindles.

Recent findings have challenged the traditional view that the thalamus is the primary driving source of generalized spike-wave discharges (SWDs) characteristic for absence seizures, and indicate a leading role for the cortex instead. In light of this we investigated the effects of thalamic lesions on SWDs and sleep spindles in the WAG/Rij rat, a genetic model of absence epilepsy. EEG was recorded from neocortex and thalamus in freely moving rats, both before and after unilateral thalamic ibotenic acid lesions. Complete unilateral destruction of the reticular thalamic nucleus (RTN) combined with extensive destruction of the thalamocortical relay (TCR) nuclei, resulted in the bilateral abolishment of SWDs and ipsilateral abolishment of sleep spindles. A suppression of both types of thalamocortical oscillations was found when complete or extensive damage to the RTN was combined with minor to moderate damage to the TCR nuclei. Lesions that left the rostral pole of the RTN and part of the TCR nuclei intact, resulted in an ipsilateral suppression of sleep spindles, but a large increase of bilateral SWDs. These findings demonstrate that the thalamus in general and the RTN in particular are a prerequisite for both the typical bilateral 7-11 Hz SWDs and natural occurring sleep spindles in the WAG/Rij rat, but suggest that different intrathalamic subcircuits are involved in the two types of thalamocortical oscillations. Whereas the whole RTN appears to be critical for the generation of sleep spindles, the rostral pole of the RTN seems to be the most likely part that generates SWDs.

Chromosomal Mapping of Genetic Loci Controlling Absence Epilepsy Phenotypes in the WAG-Rij Rat

Summary:  Purpose: The WAG/Rij rat is among the most appropriate models for the study of spontaneous childhood absence epilepsy, without complex neurologic disorders that are associated with some mouse models for absence epilepsy. Previous studies have allowed the identification of distinct types of spike–wave discharges (SWDs) characterizing seizures in this strain. The purpose of this study was to investigate the genetic basis of electroencephalographic (EEG) properties of SWDs.

Cognition and Vigilance: Differential Effects of Diazepam and Buspirone on Memory and Psychomotor Performance

Effects of a single dose of the anxiolytic buspirone (15 mg) on memory and psychomotor performance were studied in healthy volunteers and compared to those of the classic benzodiazepine anxiolytic diazepam (15 mg). The study was performed in a double-blind, placebo-controlled way. Three groups of 12 subjects were exposed to an extended test battery before and after intake of drug or placebo. Next to this, an evaluation session took place 1 week later. Immediately after intake, diazepam exerted major effects on memory, impaired psychomotor performance and decreased alertness. In particular, long-term memory had deteriorated, which was interpreted as anterograde amnesia. One week later, more items were recalled from the predrug session compared to the number of items from the postdrug session; this was interpreted as retrograde facilitation. After intake of buspirone, there were no effects of alertness and vigilance, on psychomotor performance and on memory. One week later, a small memory decrement was noticed for verbal material, which was considered as a sign of anterograde amnesia. These results indicate that effects of anxiolytics on memory can be more easily demonstrated 1 week later than immediately after drug intake and, furthermore, that the disruptive effects of diazepam outweight the small effects of buspirone. Finally, it was established that the effects of diazepam on cognition might be mediated by its effects on alertness and vigilance and that cognitive effects are not related to the anxiolytic properties of the drug.

Involvement of NMDA receptors in non-convulsive epilepsy in WAG/Rij rats.

The involvement of the NMDA receptor in spontaneous non-convulsive epilepsy was studied by intracerebroventricular injections of APH and NMDA in WAG/Rij rats. The WAG/Rij rat strain is recognized as an animal model for human absence epilepsy. EEG registrations showed that APH (5 nmol/5 microliters; 25 nmol/5 microliters; 50 nmol/5 microliters) causes a dose-dependent decrease in the number and mean duration of the spike-wave discharges, while NMDA (50 pmol/5 microliters; 500 pmol/5 microliters; 5 nmol/5 microliters) induces a dose-dependent increase in the number. The effects of NMDA (5 nmol/5 microliters) can be blocked completely by APH (50 nmol/5 microliters). These results suggest an involvement of the NMDA receptor in experimental non-convulsive epilepsy, observed in the WAG/Rij model.

The ovarian hormones and absence epilepsy: a long-term EEG study and pharmacological effects in a genetic absence epilepsy model.

In the first experiment, the relationship between the phase of the estrous cycle and the number of spontaneously occurring spike-wave discharges was investigated in WAG/Rij rats, a model for generalized absence epilepsy. The electroencephalogram (EEG) was continuously recorded for 96 h in eight rats chronically equipped with cortical EEG electrodes. A circadian pattern emerged for the number of spike-wave discharges: a nadir during the first hours of the light period, and an acrophase during the first hours of the dark period. This daily maximum was increased at proestrus day compared with the other days of the cycle, when the plasma level of progesterone is enhanced specifically at these hours of this day. This suggests that progesterone enhances spike-wave discharges. There was no difference in the first few hours of the light period in the number of spike-wave discharges between proestrus and the three other days, suggesting that estradiol has no effect on spike-wave discharges. In the second study, the effects of the systemic administration of progesterone and 17 beta-estradiol on spike-wave discharges and spontaneous behavior were investigated. It was shown that progesterone (20 and 30 mg/kg) but not estradiol (0.17-1.5 mg/kg) increased the number and total duration of spike-wave discharges. On the other hand, injection of RU 38486 (10 and 30 mg/kg), an antagonist of intracellular progesterone receptors, had no effect on spike-wave discharges and did not block the stimulatory effect of progesterone. The antagonist of 17 beta-estradiol tamoxifen (1 and 3 mg/kg) did not evoke alterations in the number or duration of spike-wave discharges. Our results indicate that progesterone aggravates spike-wave discharges, but is not mediated through intracellular receptors. Since progesterone is rapidly metabolized in the brain to the positive modulator of GABA(A) receptor allopregnanolone, which increases spike-wave discharges in WAG/Rij rats, it is possible that the epileptiformic effects of progesterone are mediated through this metabolite.