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EEG Biofeedback in Fibromyalgia SyndromeSadi Kayıran, M.D., Erbil Dursun, M.D., Nigar Dursun,

M.D.Kocaeli University

Physical Medicine & Rehabilitation Department

COST B27 ENOC Joint WGs Meeting Swansea UK, 16-18 September 2006

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Fibromyalgia Syndrome (FMS)

• Fibromyalgia is a disorder of uncertain etiology characterized by widespread musculoskeletal pain, increased tenderness in multiple points, and several symptoms including fatigue, sleep disturbances, morning stiffness, headache, depression, irritable colon disease and female urethral syndrome.

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• FMS patients frequently complain of deficits in memory and attention. Neuropsychological tests have revealed poor working and long term memory, vocabulary deficits and lower information processing speed.

• In FMS perceptual amplification of pain, and neurosensitization are observed which might be related to disinhibitory mechanisms.

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In FMS patients:

• reduced amplitudes1, • prolonged latency and reduced

amplitudes of P300 component of ERP2

1) Özgöçmen S, Yoldaş T, Kamanlı A, Yıldızhan H, Yiğiter R, Ardıçoğlu O. Auditory P300 event related potentials and serotonin reuptake inhibitor treatment in patients with fibromyalgia. Ann Rheum Dis

2003;62:551–5.2) Alanoğlu E, Ulaş UH, Özdağ F, Odabaşı Z, Çakcı A, Vural O.

Auditory event-related brain potentials in fibromyalgia syndrome. Rheumatol Int 2005;25(5):345-9.

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SMR• Increase P300 amplitudes. • SMR is depressed in;

– attention and mood disorders, – anxiety, – panic, – obsessive compulsive disorder, – stress related disorders,– chronic pain,– fatigue.

Egner T, Gruzelier JH. Learned self-regulation of EEG frequency components affects attention and event-

related brain potentials in humans. Neuroreport 2001;12:4155–60.

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• We hypothesized that NFB training aiming to enhance the SMR activity might be a useful therapeutic application in FMS patients.

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Single-Blind Randomized Controlled Study

• Sixteen FMS patients were involved in this study. Twenty sessions of SMR training (daily) was used in 9 FMS patients, and escitalopram (10 mg/day) was used in 7 FMS patients.

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• SMR NFB (Alien Technik 3/32 setup and BrainFeedback-3 EEG biofeedback software).

• The mean amplitude of SMR • The ratio of theta to SMR• The ratio of Delta to SMR • The clinical conditions

were noted.

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• Patients were also followed by specific parameters: – Visual Analog Scale (VAS) (for fatigue

and pain),– Hamilton Depression Inventory Scale

(HDIS), – Hamilton Anxiety Inventory Scale (HAIS), – Beck Depression Inventory Scale (BDIS), – Beck Anxiety Inventory Scale (BAIS),– Fibromyalgia impact questionary (FIQ)– SF-36

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Mean ages of the patients

GROUP  NFB Drug Group

AGE 32,78 ± 6,34 30,57 ± 6,08

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First week: p= 0,622, 2nd week: p=0.049, 4th week:

p=0.001

VAS (PAIN)

0,0

2,0

4,0

6,0

8,0

10,0

12,0

vasp0 vasp2 vasp4

Week

Sc

ore NFB

Control *

*

Baseline 2 4

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First week: p= 0,440, 2nd week: p=0.394, 4th week: p=0.001

VAS (FATIGUE)

0,0

2,0

4,0

6,0

8,0

10,0

12,0

vas f0 vas f2 vas f4

Week

Sc

ore NFB

Control

*

Baseline 2 4

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First week: p= 0,263, 2nd week: p=0.012, 4th week: p=0.001

HDIS

0,0

5,0

10,0

15,0

20,0

25,0

HDIS0 HDIS2 HDIS4

Week

Sc

ore NFB

Control *

*

Baseline 2 4

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First week: p= 0,184, 2nd week: p=0.007, 4th week: p=0.002

HAIS

0,0

5,0

10,0

15,0

20,0

25,0

30,0

HAIS0 HAIS2 HAIS4

Week

Co

ntr

ol

NFB

Control*

*

Baseline 2 4

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First week: p= 0,243 2nd week: p=0.009, 4th week: p=0.002

BDIS

0,0

5,0

10,0

15,0

20,0

25,0

30,0

BDIS0 BDIS2 BDIS4

Week

Sc

ore NFB

Control

Baseline 2 4

**

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First week: p= 0,168, 2nd week: p=0.009, 4th week: p=0.003

BAIS

0,05,0

10,015,020,025,030,035,040,045,050,0

BAIS0 BAIS2 BAIS4

Week

Sco

re NFB

Control

Baseline 2 4

**

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First week: p= 0,958, 2nd week: p=0.023, 4th week: p=0.000

FIQ

0,010,020,030,040,050,060,070,080,090,0

FIQ0 FIQ2 FIQ4

Week

Scor

e NFB

Control

**

Baseline 2 4

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SF 36 Q 7

0,010,020,030,040,050,060,070,080,090,0

sf07 sf27 sf47

WeeK

Sco

re NFB

Control

Baseline 2 4

*

*

SF36 Q 5

0,0

20,0

40,0

60,0

80,0

100,0

sf05 sf25 sf45

Week

Sco

re NFB

Control

Baseline 2 4

**

For Subscale 5: First week: p= 0,425, 2nd week: p=0.009, 4th week: p=0.004

For Subscale 7: First week: p= 0,520, 2nd week: p=0.002, 4th week: p=0.009

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NFB

0,00

1,00

2,00

3,00

4,00

5,00

6,00

7,00

8,00

0

Week

Sco

re

SMR

theta/SMR

delta/SMR

2 4

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Conclusion

• After performing 20 sessions of SMR treatment, most of the symptoms of the patients were vanished or decreased, and certain progressions in VAS, HDS, HAS, BDS, BAS, FIQ and SF-36 were obtained in all of the patients.

• These findings suggested that NFB training aiming to enhance the SMR activity might be a useful therapeutic application in FMS patients.