NEUROFEEDBACK

What is neurofeedback?

Neurofeedback is a brain training process that allows people to self-control their brain functions by measuring their brain waves and then providing a feedback signal to encourage or discourage a certain brain activity.¹ This is done by placing electrodes on a particular part of the patient’s head to obtain their electroencephalographic (EEG) or brain wave activity. When the detected EEG activity is in an optimal range, the patient receives a visual or auditory cue that is perceived as “good” and is considered a reward. When the EEG activity is abnormal, the patient receives feedback that it is “bad” to encourage the patient to change their brain activity.

Consistent sessions are needed to reinforce positive changes in brain function. Typically, patients will notice a difference of about ten sessions; however, 20 sessions are generally required to retrain the brain.

How can neurofeedback help alleviate certain long COVID symptoms?

Neurological symptoms of long COVID can include headache, insomnia, anxiety, depression, dizziness, seizures, and fatigue.² There are several proposed mechanisms for why COVID can cause these symptoms. Damage to neural tissue can be caused by direct and indirect interaction of the SARS-CoV-2 virus with the brain. The SARS-CoV-2 virus is believed to reach the brain through the blood and infect neurons and astrocytes, which make up a large portion of the central nervous system. COVID can also indirectly impact the brain with respiratory symptoms that prevent sufficient oxygen from reaching the brain and a heightened pro-inflammatory response that can damage neural tissue.²

Various studies have also noted EEG abnormalities in COVID patients.³ Retraining the brain to allow a patient to correct these EEG abnormalities is believed to be able to make micro-structural changes of white and gray matter in the brain and improve plasticity with improvement in the trained brain areas.² Neurofeedback has been studied for headaches, insomnia, depression, and fatigue and has been used in multiple sclerosis patients who can experience symptoms similar to those of neurological long COVID symptoms.

What evidence supports the use of neurofeedback for long COVID?

A pilot study looking at the use of neurofeedback therapy on post-COVID fatigue, anxiety, and depression included 10 participants experiencing these symptoms for at least three months. Electrodes were placed on the right and temporal lobes, and the participants underwent five sessions, each 25-45 minutes, completed within two weeks. The study found a significant reduction in anxiety and depression persisting for at least one month but an insignificant effect on fatigue.⁴

A review of 12 studies assessing the effect of EEG-based neurofeedback on depression found significant cognitive, clinical, and neural improvements in patients’ depressive symptoms.⁵ Thus, it appears that neurofeedback therapy can be an effective non-pharmacologic treatment method for new-onset anxiety and depression in post-COVID individuals; however, more studies are needed to assess its efficacy in long COVID.

What should you be aware of with neurofeedback?

Neurofeedback therapy has a relatively low risk of side effects, but side effects can include anxiety, agitation, emotional lability, headaches, and fatigue.⁶ These side effects are often transient. Severe side effects are rare but include seizures, depression, manic attacks, and memory problems.

References:

1)      Marzbani H, Marateb HR, Mansourian M. Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications. Basic Clin Neurosci. 2016 Apr;7(2):143-58. doi: 10.15412/J.BCN.03070208

2)      Orendáčová M, Kvašňák E. Possible Mechanisms Underlying Neurological Post-COVID Symptoms and Neurofeedback as a Potential Therapy. Front Hum Neurosci. 2022 Mar 31;16:837972. doi: 10.3389/fnhum.2022.837972

3)      Kopańska M, Banaś-Ząbczyk A, Łagowska A, Kuduk B, Szczygielski J. Changes in EEG Recordings in COVID-19 Patients as a Basis for More Accurate QEEG Diagnostics and EEG Neurofeedback Therapy: A Systematic Review. J Clin Med. 2021 Mar 22;10(6):1300. doi: 10.3390/jcm10061300

4)      Orendáčová M, Kvašňák E, Vránová J. Effect of neurofeedback therapy on neurological post-COVID-19 complications (A pilot study). PLoS One. 2022 Jul 27;17(7):e0271350. doi: 10.1371/journal.pone.0271350

5)      Patil AU, Lin C, Lee SH, Huang HW, Wu SC, Madathil D, Huang CM. Review of EEG-based neurofeedback as a therapeutic intervention to treat depression. Psychiatry Res Neuroimaging. 2023 Mar;329:111591. doi: 10.1016/j.pscychresns.2023.111591

6)      Rogel A, Guez J, Getter N, Keha E, Cohen T, Amor T, Todder D. Transient Adverse Side Effects During Neurofeedback Training: A Randomized, Sham-Controlled, Double Blind Study. Appl Psychophysiol Biofeedback. 2015 Sep;40(3):209-18. doi: 10.1007/s10484-015-9289-6