Real-Time Neurofeedback to Modulate β-Band Power in the Subthalamic Nucleus in Parkinson's Disease Patients

Abstract The β-band oscillation in the subthalamic nucleus (STN) is a therapeutic target for Parkinson’s disease. Previous studies demonstrated that L-dopa decreases the β-band (13–30 Hz) oscillations with improvement of motor symptoms. However, it has not been elucidated whether patients with Parkinson’s disease are able to control the β-band oscillation voluntarily. Here, we hypothesized that neurofeedback training to control the β-band power in the STN induces plastic changes in the STN of individuals with Parkinson’s disease. We recorded the signals from STN-deep brain stimulation electrodes during operations to replace implantable pulse generators in eight human patients (three male) with bilateral electrodes. Four patients were induced to decrease the β-band power during the feedback training (down-training condition), whereas the other patients were induced to increase (up-training condition). All patients were blinded to their assigned condition. Adjacent contacts that showed the highest β-band power were selected for the feedback. During the 10-minute training, patients were shown a circle whose diameter was controlled by the β-band power of the selected contacts. Powers in the β-band during 5-minute resting sessions recorded before and after the feedback were compared. In the down-training condition, the β-band power of the selected contacts decreased significantly after feedback in all four patients ( p p Significance statement Many studies have reported a relationship between the β-band power in the subthalamic nucleus (STN) and motor symptoms in Parkinson’s disease. Here, we have developed a novel neurofeedback technique using intracranial electrodes implanted in deep brain structures to modulate STN activity. We provided direct feedback of the β-band power as the size of a black disc to induce a sustainable change in β-band power. As a result, the neurofeedback training induced significant changes in the β-band power. This is the first report to demonstrate that human patients with Parkinson’s disease were able to voluntarily control their β-band power in STN to induce changes in the power.