Efficacy of Original Neurofeedback Treatment Method for Brain Fog From COVID-19: A Case Report

Abstract

Brain fog is one of the most well-known sequelae of long COVID. It causes cognitive problems, mostly short-term memory disturbances, attention impairments, and problems with concentration. Although trials for treatment methods for brain fog have been carried out worldwide, effective methods have not yet been reported. Neurofeedback is effective for several common disorders and symptoms, including anxiety, depression, headaches, and pain. Neurofeedback is also reported to improve cognitive functions, such as processing speed and executive functions, including attention, planning, organization, problem-solving, and performance. Furthermore, neurofeedback is effective for "chemofog" and "chemobrain," which occur after chemotherapy and cause cognitive impairments in a similar manner to brain fog. However, there have been no reports of neurofeedback treatments for brain fog. Therefore, we have started to develop an original neurofeedback treatment method for brain fog using a Z-score neurofeedback technique. In this study, we present the first case report of a patient who has successfully recovered from brain fog via neurofeedback. Pain and psychological assessments revealed that the patient's pain improved and that the patient recovered from anxiety. Electroencephalograph data revealed several noble findings. C4 was thought to be the most affected site by brain fog, and this improved after treatment. The percentage increase at alpha wavelengths increased at almost all sites, and beta 1, beta 2, beta 3, and Hi beta decreased at almost all sites. The increased values at theta and alpha wavelengths after the 1st and 2nd sessions and the decreased values at higher beta wavelengths, such as beta 3 and Hi beta, were shown at all sessions.

Keywords: brain fog; covid-19; electroencephalography (eeg); mild to severe cognitive dysfunction; neurofeedback therapy; z-score.

Figure 1. The screen of the program, “Z-score index training.” The upper left shows raw electroencephalograph at F3 (C), F4 (D), P3 (E), and P4 (F). The lower left shows that the threshold of “Z-score index training” is set to between plus 2.0 and minus 2.0 standard deviation and that the Z-score index is set to 95%. The right shows that the animation is running and that the green light is on because the Z-score index is more than 95%. Middle shows each wavelength, six metrics, and 10 power ratios.

Figure 2. Pain and psychological measurements.

SF-MPQ-2: Short-Form McGill Pain Questionnaire-2; PDAS: Pain Disability Assessment Scale; PASS-20: Pain Anxiety Symptom Scale - Japanese translated version; HADS-A: Hospital Anxiety and Depression Scale-Anxiety - Japanese translated version; HADS-D: Hospital Anxiety and Depression Scale-Depression - Japanese translated version; SDS: Self-Rating Depression Scale - Japanese translated version.

Figure 3. The subtraction of total values (microvolt) between two homologous sites at C3-C4, T3-T4, F3-F4, and P3-P4 before the 1st session and before the 15th session.

Figure 4. The percentage increase of each value at each wavelength at C3, C4, T3, T4, F3, F4, P3, and P4.

Figure 5. The percentage increase of total values within all sites at each wavelength.