Autism spectrum disorder is characterized by abnormal function in core social brain regions. Here, we demonstrate the feasibility of real-time functional magnetic resonance imaging volitional neurofeedback. Following up the demonstration of neuromodulation in healthy participants, in this repeated-measure design clinical trial, 15 autism spectrum disorder patients were enrolled in a 5-session training program of real-time functional magnetic resonance imaging neurofeedback targeting facial emotion expressions processing, using the posterior superior temporal sulcus as region-of-interest. Participants were able to modulate brain activity in this region-of-interest, over multiple sessions. Moreover, we identified the relevant clinical and neural effects, as documented by whole-brain neuroimaging results and neuropsychological measures, including emotion recognition of fear, immediately after the intervention and persisting after 6 months. Neuromodulation profiles demonstrated subject-specificity for happy, sad, and neutral facial expressions, an unsurprising variable pattern in autism spectrum disorder. Modulation occurred in negative or positive directions, even for neutral faces, in line with their often-perceived ambiguity in autism spectrum disorder. Striatal regions (associated with success/failure of neuromodulation), saliency (insula/anterior cingulate cortex), and emotional control (medial prefrontal cortex) networks were recruited during neuromodulation. Recruitment of the operant learning network is consistent with participants’ engagement. Compliance, immediate intervention benefits, and their persistence after 6 months pave the way for a future Phase IIb/III, randomized controlled clinical trial, with a larger sample that will allow to conclude on clinical benefits from neurofeedback training in autism spectrum disorder (NCT02440451).

Lay abstract

Neurofeedback is an emerging therapeutic approach in neuropsychiatric disorders. Its potential application in autism spectrum disorder remains to be tested. Here, we demonstrate the feasibility of real-time functional magnetic resonance imaging volitional neurofeedback in targeting social brain regions in autism spectrum disorder. In this clinical trial, autism spectrum disorder patients were enrolled in a program with five training sessions of neurofeedback. Participants were able to control their own brain activity in this social brain region, with positive clinical and neural effects. Larger, controlled, and blinded clinical studies will be required to confirm the benefits.

中文翻译：

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训练社交大脑：一项为期 8 周的实时功能磁共振成像神经反馈自闭症 IIa 期临床试验的临床和神经效应

自闭症谱系障碍的特征是核心社交大脑区域的功能异常。在这里，我们展示了实时功能磁共振成像意志神经反馈的可行性。跟踪健康参与者的神经调节演示，在这项重复测量设计的临床试验中，15 名自闭症谱系障碍患者参加了 5 节课的实时功能磁共振成像神经反馈训练计划，针对面部情绪表情处理，使用后上颞沟作为感兴趣区域。参与者能够在多个会话中调节这个感兴趣区域的大脑活动。此外，我们确定了相关的临床和神经影响，如全脑神经影像学结果和神经心理学测量所记录的那样，包括对恐惧的情绪识别，在干预后立即并在 6 个月后持续。神经调节配置文件证明了快乐、悲伤和中性面部表情的受试者特异性，这是自闭症谱系障碍中一种并不令人惊讶的可变模式。调制发生在消极或积极的方向，即使对于中性面孔，也符合他们在自闭症谱系障碍中经常感知的模糊性。在神经调节过程中招募了纹状体区域（与神经调节的成功/失败相关）、显着性（岛叶/前扣带皮层）和情绪控制（内侧前额叶皮层）网络。操作学习网络的招募与参与者的参与是一致的。依从性、即时干预益处以及它们在 6 个月后的持久性为未来的 IIb/III 期铺平了道路，

摘要

神经反馈是一种新兴的神经精神疾病治疗方法。它在自闭症谱系障碍中的潜在应用仍有待测试。在这里，我们证明了实时功能磁共振成像意志神经反馈在针对自闭症谱系障碍的社交大脑区域中的可行性。在这项临床试验中，自闭症谱系障碍患者参加了一个有五次神经反馈训练课程的项目。参与者能够在这个社交大脑区域控制自己的大脑活动，具有积极的临床和神经效应。需要更大规模的、受控的和盲法的临床研究来证实这些益处。