Presented by Trevor Brown, PhD: Precision-medicine is uncovering ways to stratify treatment, for example QEEG recently demonstrated the ability to inform the likelihood of Sertraline vs. rTMS response in MDD (Wu et al, 2020). Within the Neurofeedback field, QEEG assessment can uncover previously unknown sleep-related vigilance regulation difficulties impacting executive function in ADHD cases. The patient’s EEG ‘informs’ which standard neurofeedback protocol will be most effective. Thus, ‘QEEG-informed’ neurofeedback allows personalised intervention, stratifying to the most-likely effective protocol. To date, clinical effectiveness data for QEEG-informed neurofeedback have only been published in a small sample of 21 ADHD patients (Arns et al. 2012). Recent research (Krepel et al, in press – presented as the principal study) replicated this effectiveness in a new sample of 114 patients treated with QEEG-informed neurofeedback, from a large multicentric dataset and investigated potential predictors of neurofeedback response.
Methods (of principal study): A sample of 114 patients were included as a replication sample. Patients were assessed with ADHD-RS, PSQI, QEEG and ERP’s, then assigned to a standard neurofeedback protocol (SMR, TBR, or SCP neurofeedback) in combination with coaching and sleep hygiene advice. The ADHD-RS and PSQI were assessed at baseline, every 10th session, and at outtake. Response was defined as ADHD-RS >25% reduction (R25), >50% reduction (R50), and remission. Predictive analyses were focused on predicting remission status.
Results (of principal study): In the current sample, response rates were 85% (R25), 70% (R50), and remission was 55%; and, clinical effectiveness was not significantly different from the original 2012 sample. Non-remitters exhibited significantly higher baseline hyperactivity ratings. Women who remitted had significantly shorter P300 latencies and boys who remitted had significantly lower individual Alpha Peak Frequencies (iAPF).
Discussion: In the principal study, clinical effectiveness was replicated, suggesting it is possible to assign patients to a protocol based on their individual baseline QEEG to enhance signal-to-noise ratio. Furthermore, remitters had lower baseline hyperactivity scores. Likewise, female remitters had shorter P300 latencies, whereas boys who remitted have a lower iAPF. This latter finding is intriguing, since low iAPF was earlier found to predict non-response to MPH (Arns et al., 2008), thus offering opportunities to use this biomarker to stratify between treatments. The data suggests initial specificity in treatment allocation, yet further studies are needed to replicate the predictors of neurofeedback remission.
A comparison of clinical effectiveness versus RCT efficacy in Neurofeedback will lead to a discussion of proposed APA guidelines for rating future evidence (Arns et al. in Press).